PATHO-EXAM 3-

DIC treatment

#1 - Life support (oxygen, give fluids,/IV meds to maintain blood pressure: probable drug-induced coma). #2 - Treat the underlying cause (i.e., give antibiotics if caused by an infection). #3 - Give Heparin (to stop the clotting process). #4 - Platelets transfusion (restores lost platelets) PERTINENT LAB TESTS: Decreased PLATELET COUNT (less than 100,000) and abnormal D-Dimer.

Platelets Value

- 150,000 - 400,000.

Lymphocytes values

- 24% - 40%.

Neutrophils Values

- 47% - 63%.

SHOCK

- A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion. - Always causes HYPOTENSION. Hypotension is most often due to Hypovolemia-->Hypovolemia (low volume) causes POOR PERFUSION-->Poor Perfusion means blood is not getting into body tissues so....OXYGEN is not delivery--> Organs STOP functioning and body DIES.

Orthostatic Hypotension Characteristics

- Blood pressure drops due to HYPOVOLEMIA. - TACHYCARDIA results in the heart's attempt to compensate for low B/P. - Give IV or oral fluids until B/P is normal. - Treat the cause of HYPOVOLEMIA. - Maintain patient safety (Fall precautions).

Vasovagal Hypotension Characteristics

- Blood pressure drops due to stimulation of the VAGUS NERVE. - BRADYCHARDIA results from stimulation of the Parasympathetic system ("the rest and digest" part of the Autonomic Nervous System). - SELF-RESOLVING (No TX needed). - MAINTAIN PATIENT SAFETY - If you patient says they pass out when they see needless - take necessary precautions.

Shock Stages - "Compensatory"

- Mechanisms are activated to maintain perfusion to heart and brain (Epinephrine and Norepinephrine are excreted to activate the "Fight or Flight" part of the Adrenergic Nervous System.

Anemia due to excessive RBC destruction

-"Hemolytic Anemias". RBCs die quicker than the bone marrow can replace them. Causes can be "intrinsic" (Inherited defective RBCs) or "Extrinsic" (Everything else). *Inherited - SICKLE CELL (also due to "faulty production" and Thalassemia. *Stressors - Infections, drugs, snake, or spider venom, etc. *Toxins - Advance liver or kidney disease. *Autoimmune - Antibody mediated. Lupus; Cancer; Rh factor; drugs. *Spleen - Blood moves more slowly thru and enlarged spleen, causing RBCs to become prematurely destroyed before they get through the spleen.

signs and symptoms of IRON deficiency Anemia

-"Lightheaded", dizzy, stomatitis, difficulty swallowing, headache, confusion, memory loss.

primary polycythemia

-(Absolute) - POLYCYTHEMIA VERA is an inherited condition affecting primarily Caucasians with European jewish ancestry. Onset of s/s could occur at any age but usually over 60 years. Mostly men.

secondary polycythemia

-(Relative) - Physiologic response to CHRONIC HYPOXIA that triggers the body to make more RBCs for oxygen transport in an effort to get more oxygen to the cells of the body.

Hemoglobin Values

-12 - 16.5.

Hematocrit values

-37 - 50%

White Blood Count (Total WBC)

-5,000 - 10,000

Orthostatic (postural) hypotension

-Also called "Postural Hypotension" - Is a form of low blood pressure that happens when standing up from sitting or lying down. Orthostaic hypotension can cause Lightheadedness, dizzniness, and syncope. Heart rate is often MORE SENSITIVE than blood pressure changes and will INCREASE to compensate for low blood volume. Normal or compensatory vasoconstrictor response on standing is replaced by marked vasodilation (which leads to blood pooling in the muscle vasculature & Renal beds).

FOLATE (VITAMIN B9)

-Also called Folic Acid, this key element is an integral part of cell growth, especially RBCs. Deficiencies during pregnancy can cause birth defects of baby's brain and spine. Low Folate levels are caused by: 1. Overcooking or eating too few vegetables may cvause a folate deficiency. 2. Other: Pregnancy, medications, alcohol abuse, intestinal diseases.

ANEMIA DUE TO DECREASED RBC PRODUCTION - BM DAMAGE

-Aplastic anemia.

Red blood cell indices

-Are calculations that provide information on the physical characteristic of teh RBCs(MCV,MCH,MCHC, RDW). RBC indices lab test are used to DETERMINE IF A PERSON HAS ANEMIA(low red blood cells) and what type of anemia. *MCV - Mean Corpuscular Volume --> Measurement of the average size of RBCs. *MCH - Mean Corpuscular Hemoglobin --> Calculation of the average amount of oxygen carrying hemoglobin inside a red blood cell. *MCHC - Mean Corpuscular Hemoglobin Concentration --> Calculation of the average percentage of hemoglobin inside a red cell. *RDW - Red Cell Distribution Width --> Calculation of the variation in the size of RBCs.

DIC signs and symptoms

-Are related to either the blood clotting or the Hemorrhage phase (Note: BLEEDING FROM AT LEAST 3 UNRELATED SITES IS PARTICULARLY SUGGESTIVE OF DIC.).

PLatelets Count DECREASED in the following conditions:

-Autoimmune disorders. -MEDICATIONS SUCH AS ASPIRIN, IBUPROFEN, ACETAMINOPHEN (damage liver-->bleeding problem). -"G" HERBS (GARLIC, GINGER, GINKOBA, GINSENG). -Chemotheraphy/radiation. -Cancers that damage the bone marrow (leukemia/Lymphoma). -DIC (DISSEMINATED INTRAVASCULAR COAGULATION).

Pertinent Lab TESTS for bleeding Problems:

-BLEEDING: Bleeding Time Tests: * PT and INR (International Normalized Ratio) are used to test patients on COUMADIN blood thinning medication. *PTT test patients on HEPARIN blood thinning medication. -CLOTTING: Blood Clot Test: *D-DIMER. Done to determine the extent of clotting in the body and is done for DVT (deep vein thrombosis), P.E. (Pulmonary Embolism) and DIC (disseminated Intravascular Coagulopathy).

DIC Hemorrhage Phase

-Bleeding gums -Blood oozing from an existing IV site. -GI bleeds. -Petechiae/purpura/ecchymosis.

White blood cells - associated organs

-Bone Marrow, Thymus, and spleen.

Multiple Myeloma SIGN AND SYMPTOMS

-Calcium high in blood (Hypercalcemia) due to calcium moving from damage bone into the blood. -Renal failure (Myeloma nephrosis) cause by damage to kidneys by PARAPROTEINS (that cause hyperviscosity of body fluids) - a distintictive feature of Myeloma. Tumor markers are: "M-proteins" (found in serum) and "Bence-Jones protein" (found in urine) -Anemia - BM not functioning AND kidney not producing Erythopoietin--> s/s of blood dyscrasias. -Bone pain - (1st symptom) and Pathological fractures (occurs spontaneously w/o an injury).

Sickle Cell Crisis - Aplastic

-Caused by exhaustion of the bone marrow. Erythropoiesis can not keep up with the constant need to replace red blood cells. SICKLE RED BLOOD CELLS HAVE A LIFESPAN OF 10-20 DAYS. This constant stress on bone marrow stem cells can eventually lead to bone marrow failure.

VITAMIN B12

-Cobalamin (Vit B12) is a necessary vitamin required to make RBCs. -Vitamin B12 is used to treat many conditions which include: Memory loss; Alzheimer's disease; boosting mood, energy, concentration and the immune system; and slowing aging.

Red blood cells count DECREASE (Anemia)

-Conditions: *Anemias. *Hemolysis. *Chronic Renal Failure. *Hemorrhage. *Failure of marrow production.

Red blood cell count ELEVATED (Polycythemia)

-Conditions: *Cardiovascular disease. *Stress. *Polycythemia Vera. *Smokers. *High altitud. *Hemoconcentration and Dehydration. *Renal cell carcinoma and other Erythropoietin- producing neoplasms.

DISSEMINATED INTRAVASCULAR COAGULOPATHY

-DIC is a serious disruption in the body's clotting mechanism. Normally, the body forms a blood clot in reaction to an injury. With DIC, the body OVERPRODUCES many small blood clots throughout the body, depleting the body of clotting factors and platelets. These small clots are dangerous and can interfere with the blood supply to organs, causing dysfunction and failure. Then, massive bleeding can occur due to the body's lack of clotting factor and platelets. DIC is life-threatening and needs to be treated prompty.

aplastic anemia

-Destruction of Bone Marrow (BM) stem cells (affects ALL blood components). Damage BM is diagnosed as either aplastic or hypoplastic - meaning that it's empty (Aplastic) or contains very few blood cells (Hypoplastic). Causes "Pancytopenia" = ALL blood cells are depressed. -Aplastic anemia develops because of Bone Marrow damage. The damage may be present at birth or occur after exposure to radiation, chemotherapy, autoimmune disease, toxic chemicals, some drugs, or infection. -Viruses that have been linked to the development of Aplastic anemia include Hepatitis, Epstein-Barr, Cytomegalovirus, Parvovirus B19, and HIV.

SIGN & SYMPTOMS of THROMBOCYTOPENIA

-Epistaxis. -Purpura. -GI Bleeds. -Menorrhagia. -Bleeding gums. -Petechiae.

KIDNEY CONNECTION

-Erythropoietin (made in kidneys) signals bone marrow to make more RBCs, so if kidneys are damaged, Erythropoietin is not excreted, and RBCs are not made.

Leukemia s/s

-Fatigue, low fever, night sweats, weight loss, (none of these s/s are specific for leukemia). *Lymphadenopathy - Swelling lymph nodes. May swell without any other s/s or swell in random patterns. *Anemia, infection, Bleeding problems - (due to bone marrow damage that affects all blood cells). *Pallor - Malignant Leukocytes crowding the bone marrow and leading to decrease erythrocyte and thrombocyte production(causing a pale skin color).

Hypotension Treatment

-Fluid bolus, blood transfusion or fluid volume expanders as needed. Treat underlying cause.

Anemia due to blood loss

-Gastrointestinal (GI) conditions - upper or lower GI bleeds. -NSAID overuse (Risk factor: PAtients with chronic pain). -Excessive menstruation or childbirth complications.

Causes of Thrombosis - Abnormal Blood Flow

-HIGH BLOOD PRESSURE blood flow --> Clots develop in ARTERIES due to increased turbulence caused by high blood pressure - especially in the coronary arteries that get the blood coming right out of the heart at highest pressure. This turbulent flow of blood causes damage to vessel walls or blood cells. The resulting inflammation then triggers the clotting cascade. -LOW BLOOD PRESSURE blood flow--> clots develop in veins due to lower blood pressure and slower flow of blood in veins as compare to arteries - slow blood clots.

Causes of thrombocytopenia

-Idiopathic Thrombocytopenia Purpura ITP: Autoimmune disorder that causes an IgG antibody to bind with platelets, destrying their function. Results in low platelet count and s/s of bleeding. (Definition of IDIOPATHIC: arising spontaneously or from an obscure or unknown cause). -Thrombotic Thrombocytopenia Purpurta TTP: Thought to be caused by widespread endothelia damage that triggers thrombosis and platelet destruction. S/s are: Fever, Hemolitic anemia, renal failure, neurologic decline. -Drug Induced Thrombocytopenia: A hypersensitivity reaction causes platelet destruction. Heparin can induce a Type III Hypersensitivity reaction that can quickly be resolved after eliminating drug.

Treatment of THROMBOCYTOPENIA

-Immunosuppression Treatments (treatment for TTP). -Plasmapheresis (treatment for TTP). -ELIMINATE THE CAUSATIVE DRUG. -PLATELET INFUSION.

Causes of Thrombosis - Altered blood constituents

-Increased viscosity of blood (dehydration can increase the risk of clot formation). -THROMBOCYTOSIS--> increased/abnormal production of platelets (may be a marker for cancer since 40% of people with unexplained high platelet count have cancer).

Causes of Thrombosis - Injured vessels walls

-Interior of blood vessels can be damaged by the development of atherosclerotic plaque (can lead to the development of strokes or heart attack); DEEP VEIN THROMBI in legs break off to create pulmonary EMBOLI.

plasmapheresis

-Is a blood purification procedure used to treat several autoimmune diseases. Blood is removed from the body and spun in a centrifuge to filter out the plasma. The red blood cells are returned to the body, and the plasma may be treated and reintroduced, or replaced, depending on the condition which the plasmapheresis is designed to treat.

Platelets associated organ

-LIVER - Platelet production is regulated by THROMBOPOIETIN, a gormone produced in the liver.

white blood cells (leukocytes)

-Leukocytes (WBCs) are found throughout the body, including the blood and lymphatic system. WBCs can be divided into Granulocytes and Agranulocytes.

Hypotension Sign & Symptoms

-Lightheadedness, dizzines, fainting (syncope), pallor, diaphoresis, visual disturbances. Severe hypotension will cause Heart Attack and Death.

Clinical manifestations common to ALL anemias

-Low Hemoglobin and Hematocrit levels in addition to reduced RBCs. -PLasma Expansion--> "watery" blood, i.e., less viscous blood. This causes more turbulent blood flow, and "pale" look of blood.

HYPOTENSION

-Low blood pressure BELLOW 90 SYSTOLIC.

Hemoglobin

-Measures the AMOUNT of the Oxygen-carrying protein in the blood. Measured in grams.

Hematocrit

-Measures the PERCENTAGE of a person's blood that consist of red blood cells. -A low Hematocrit means patient is losing blood(either internally or externally). *Critical low - <15% --> Heart Failure. *Critical High - >60% --> Blood clotting problems. -Hematocrit can be affected by the person's fluid status: High HCT is caused by DEHYDRATION; Low HCT is caused by FLUID OVERLOAD.

Reticulocyte count

-Measures the absolute count or percentage of IMMATURE red blood cells in blood(If elevated, it means that mature RBC's are depleted, and the body is now relying on immature RBCs.

Aplastic anemia - Treatment

-Medications, blood transfussions, and stem-cells transplants.

Leukocytosis - White blood cells is ELEVATED in the following conditions

-Neutrophils - ACUTE bacterial infections. -Lymphocytes - Viral infection and/or CHRONIC Bacterial infection. -Eosinophils - Allergies or parasitic infections.

Anemias

-Not enough RBCs. -There are more than 400 types of anemias, which are divided into three groups: 1)Anemia caused by a blood loss. 2)Anemia caused by decreased or faulty red blood cell production. 3)Anemia caused by destruction of red blood cells.

Anemia due to Decreased or Faulty RBC Production

-Nutritional Deficiencies: (iron, Vitamin B12, and Folate are necessary components of RBC production). -Bone Marrow & Stem cell problem: Leukemia and lymphoma are examples. Also, APLASTIC ANEMIA, osteomyelitis, etc. -Sickle Cell Anemia

Sickle cell crisis - Vaso-Oclusive

-Occurs when the SICKLE RED BLOOD cells trigger the formation of blood clots within the circulation. Tissue damage is minor and can resolve within a week. DEHYDRATION and INFECTION are an initiating cause. More serious results can include - Stroke, Pulmonary infarction, Myocardial infarction, Gangrene.

Polycythemia treatment

-Periodic phlebotomy i.e., "blood letting" to siphon off some excess blood! Also, O2, CPAP, aspirin to prevent blood clotting, radioactive phosphate also used.

Platelets (thrombocytes)

-Platelets, also called thrombocytes, are CELL FRAGMENTS(NOT CELLS) that are vital for normal blood clotting. A person who doesn't have enough platelets may be at an increased risk of excessive bleeding and bruising. The CBC measures the number and size of platelets present.

Disseminated Intravascular Coagulopathy TRIGGERS

-Sepsis and septic shock. -Obstetric complications. -Trauma (especially burns & head injury). -Blood transfusions. -Some cancers. -Hematologic disease.

ANEMIA DUE TO FAULTY RBC PRODUCTION - SICKLE CELL ANEMIA

-Sickle cell anemia (an autosomal recessive defect of hemoglobin) is the most common inherited blood disorder in the United States. Individuals with the single defective gene have SICKLE CELL "TRAIT" (SCT) while those with 2 defective genes have SICKLE CELL "DISEASE" (SCD). -SC anemia is predominant in those African descent (1 in 13 black or African American babies is born with sickle cell trait; every 1 in 365 Black or African American births have SCD) and those of mediterranean ancestry. SCD is diagnosed at birth with newborn screens or through amniocentesis.

Platelets Count INCREASED in the following conditions:

-Some cancers. -Inflammatory conditions. -Birth control pills. -Recovery phase of trauma/surgery.

Leukopenia - White Blood Cell count is DECREASED in the following conditions

-Steroids (or medicines containing them, i.e., prednisone). -Chemotherapy. -Bone marrow failure(aplastic anemia or cancer such as Leukemia). -Use of antiseizure medication such as Tegretol.

Sickle Cell Anemia - Treatment

-There are several drug therapies and bone marrow transplants available (with complications of rejection i.e. septicemia or host vs Graft disease).

ANEMIA DUE TO DECREASED OR FAULTY RBC PRODUCTION - Nutritional Deficiency Anemias

-There are three Vitamins/minerals that are required to produce RBC's and therefore will cause an anemia if not available to the body in suficient amounts. They are FOLATE, VIT B12, AND IRON.

THROMBOCYTOPENIA

-Thrombocytopenia (Platelet count < 140,000) Is REDUCED number of thrombocytes leading to impaired clotting ability.

Sickle Cell Crisis - Sequestration

-When the sickle red blood cells are removed from the general circulation by the spleen. The severity depends on the amount of blood removed and held and the spleen and liver thereby reducing the amount of circulating red blood cells. CAN PRODUCE HYPOVOLEMIC SHOCK.

Low Vitamin B12 levels are caused by

1. Dietary: Eating little or not meat may cause a lack of B12. 2. Lack of intrinsic factor(IF): Intrinsic factor (a protein excreted by the stomach) is needed for Vitamin B12 absorption(B-12 is destroyed in gastric juices if not bound to intrinsic factor). If stomach/upper intestines is damage or removed, intrinsic factor is not secreted, so there is not absorption of VIT B12. Conditions causing lack of IF are Crohn's disease, Gastric by pass, cancer(requires lifelong B12 replacement injections.

S/S of anemia are a result of HYPOXIA(low oxygen levels in blood)

1. Fatigue (decreased energy production) 2. Tachypnea (Increased respiratory rate) 3. Tachycardia (increased heart rate to circulate red blood cells more freely). 4. Pallor (Pale skin & mucous membranes caused by low hemoglobin or RBCs).

Aplastic anemia - S/S may be develop slowly or sudenly

1. Fatigue and rapid heart rate (due to low RBCs). 2.Frequent infections (due to low WBCs). 3.Bleeding tendencies (due to low platelets) as evidenced by bleeding gums/nose bleeds/petechiae, easy bruising, heavy menstrual cycles, G.I. bleeding, etc.

SICKLE CELL CRISIS TREATMENT - Nursing consideration for treating all type of Sickle cell CRISIS

1. Give OXYGEN (to relieve Hypoxia). 2. IV FLUIDS (to treat dehydration and prevent sickle cells sticking together). 3. PAIN MEDS (patient will develop painful clotting throughout the body and go into SHOCK).

S/S OF BLEDDING

1. HEMORRHAGE: Blood leaving the blood vessels (internal or external bleeding). 2. MENORRHAGIA: Heavier than normal menstrual bleeding. 3. EPISTAXIS: Bleeding from the nose. 4. PETECHIAE: Pinpoint Hemorrhages of small capillaries in the skin, conjunctiva of the eyes, or mucous membranes. 5. PURPURA: Red or purple discoloration on the skin that does not blanch on applying pressure. 6. ECHYMOSIS: Blood leaks into tissues under the skin causing bruising. 7. HEMATOMA: Collection of blood, usually clotted, in organs, body spaces, or under the skin.

Hypotension causes:

1. Low fluid volume (Hypovolemia). 2. Prolongued immobilization. 3. Medications (name some). 4. Neurological Disease/Damage.

Granulocytes (All end in "phil")

1. Neutrophils - In High in ACUTE bacterial infection. 2.Eosinophils - In high Allergic attacks. 3.Basophils - High during stress/Allergy.

causes of polycythemia

1. SLEEP APNEA - Due to either Obstructive Sleep Apnea (airway "colapses" during--> blockage of air and snoring) or Central Sleep Apnea (the brain does not signal the lungs to breathe). Both types result in oxygen deprivation. 2. COPD - Chronic Obstructive Pulmonary Disease (asthma and emphysema) that hamper gas exchange in the lungs. 3. HEART FAILURE - Reduces tissue profusion, which create hypoxic tissue even if the blood volume and concentrations are normal. The low oxygenation will trigger an increase in production of RBCs. 4. PULMONARY DISEASE - Gas exchange between lungs and vasculature may be impaired. The decrease in O2 exchange will produce hypoxia and trigger and increase in production of RBCs. 5. HIGH ALTITUDE - Body compensates for lower O2 levels at higher altitudes by making more RBCs to carry oxygen. Takes 6-8 weeks to build up enough erythrocytes. 6. EPO (erythropoietin) SHOTS - Example: "blood doping" by athletes for performance enhancement or who abuse anabolic steroids.

LOW Platelet count occurs because:

1. The body's bone marrow doesn't make enough platelets. 2. THe bone marrow makes enough platelets, but the body destroys them or uses them up. 3. The spleen holds on to too many platelets.

WBC LAB TESTS

1. White Blood Cells (WBC) count - Is a count of the TOTAL number of White Blood Cells in a sample of blood. 2. White Blood Cell Differential - May or may not be included as part of the panel of test. It identifies and counts the number of the various types of white blood cells present. The five types include NEUTROPHILS, LYMPHOCYTES, MONOCYTES, EOSINOPHILS and BASOPHILS. THe percentages of each type of WBC can give a clue about what the body is fighting.

Agranulocytes (all end in "cytes")

1.Lymphocytes - High in Chronic bacterial or viral infection. *T-Cells (Killer, helper, suppressor, Memory, etc.) *B-Cells (antibodies). 2.Monocytes - Non-specific phagocytes that can become macrophages when needed to fight infection tissue.

Red Cell Count (RBC)

3.6 - 5.4

complete blood count (CBC)

A CBC lab test is a panel of test that evaluates the RED blood cells, WHITE blood cells, and PLATELETS.

Polycythemia

A disorder characterized by an abnormal increase in the number of red blood cells in the blood. The opposite of anemia can cause hyperviscosity or thrombosis.

Vasovagal hypotension

A reflex of the Vagus nerve (Parasympathetic Nervous System - "Rest and Digest") that causes the heart to slow down (bradycardia) which in turn affects the nerves to the blood vessels in the legs permitting those vessels to dilate. As a result the heart puts out less blood, the blood pressure drops, and what blood is circulating tends to go into the legs rather than to the head. The brain is deprived of oxygen which causes fainting.

Treatment of thrombosis

A. ANTI-COAGULANT DRUGS - reduced the blood cell's ability to clot. These drugs prevent future clots but have no effect on existing clots. Examples are: a. HEPARIN (injected - fast actin) too high of levels causes bleeding problems. b. COUMADIN (Oral med - long-acting) too high of levels cause bleeding tendencies. c. ASPIRIN (Oral - small dose everyday prophylaxis to prevent clotting) Causes GI bleeding. B. THROMBOLYTIC DRUGS - So-called "clot busters", these drugs break up or dissolve existing blood clots, which are the main cause of both heart attacks and stroke but do not prevent future clots. (Examples: TPA, Streptokinase). C. ACETAMINOPHEN (TYLENOL) - VERY DAMAGING TO THE LIVER - overdoses (accidental or intentional) are lethal because the liver dies quickly. Without a functioning liver, clotting factors are not available to combine with platelets and blood can not clot.

DIC is a coagulation disorder that results in

BLOOD CLOTTING and HEMORRHAGING.

LYMPHOMAS

Blood cancer that affects the LYMPHATIC SYSTEM - causes an overproduction of malfunctioning lymphocytes. This overload compromises the immune system. Lymphoma can develop in many parts of the body, including lymph nodes, bone marrow, blood, spleen, and other organs. There are two types: HODGKIN'S LYMPHOMA and NON-HODGKIN'S LYMPHOMA.

s/s of polycythemia

Caused by reduced blood flow of viscous blood and clotting - PLETHORA: ruddy complexion; Fatigue; Dizziness; Headache. Thick blood increases workload on the heart--> High B/P--> decrease perfusion to the brain due to sluggish blood flow of thick blood.

DIC clotting phase

DVT- (Deep Vein Thrombosis) Renal failure- (clots in kidneys) Difficulty breathing- (clots in lungs) Neurologic changes- (clots in brain) Numbness- (clots in spinal cord) Liver dysfunction- (clots in liver)

Multiple myeloma Prognosis

Early diagnosis and treatment = 3-5 years of survival. Late diagnosis and treatment = 50% of patients die within 3 months and 90% within 2 years.

Hematologic System

Encompasses the production of blood and the transport of blood throughout the body. All blood components originate in the bone marrow. Bone marrow stem cells differentiate into one of the following blood cells: -Red blood cells (Erythrocytes). -White blood cells (Leukocytes) -Platelets (Thrombocytes).

Iron

Iron deficiency is the most common and widespread nutritional disorder in the world. Bone marrow needs iron to make Hemoglobin. Iron deficiencies are caused by lack of iron in the diet or by blood loss. Examples: 1-Metabolic demands of pregnancy and breastfeeding. 2-Blood loss through excessive menstruation, childbirth, or blood. 3-Digestive conditions (Chrohn's) OR removal of stomach/small intestines. 4-Medications, excess caffeine.

Red blood cell (RBC) count

Is a count of the actual number of RBC's in a person's sample of blood.

Cancers affecting WBCs

Leukemias, Lymphomas, and Multiple Myelomas are all cancers of the blood-forming organs. They arise due to errors in the genetic information of an immature blood cell. Because of these errors, the cell's development is arrested so that it does not mature further, but is instead replicated over and over again, resulting in a proliferation of abnormal blood cells. Nearly every stage of the hematopoietic process can give rise to a distinct type of cancer.

MULTIPLE MYELOMAS

MM is cancer that start in a type of B-CELL LYMPHOCYTE called PLASMA CELLS in the bone marrow. These are Protein-making cells which normally make all the different kinds of proteins that comprise the antibodies (immunoglobulins) of the immune system.

LEUKEMIA

Malignant growth of Leukocytes--> OVER PRODUCTION OF NONFUNCTIONING WHITE BLOOD CELLS in the bone marrow that grows faster than the functioning cells. Eventually, the Leukemia cells crowd out all the functioning blood cells in the bone marrow which leads to the various s/s of Leukemia(anemia, infections, and bleeding problems). Leukemia is classified by its SPEED OF PROGRESSION and the TYPE OF CELLS involved.

Iron replacement

Mineral supplements/ Iron injections; Foods - soybeans, lentils and beans, red meat, chicken, fish, fortified foods.

FLUID CHALLENGE - "Rule of Thumb"

Replace ONE LITER of fluid (in 500 mL increments at a time) for each 10 point DROP IN SYSTOLIC PRESSURE or 10 point RISE IN HEART RATE.

How to do Orthostatic vital signs reading:

Take blood pressure and heart rate LYING DOWN FIRST, take the 2nd B/P & HR reading after patient SISTS. Take the 3rd reading after the patient STANDS. (stand by patient for safety)

Leukemia classification - FIRST TYPE

The first type of classification is by HOW FAST THE LEUKEMIA PROGRESSES: 1.ACUTE LEUKEMIA. IN acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment. 2.CHRONIC LEUKEMIA. There are many types of Chronic leukemias. Some produced too many cells and some causes too few cells to be produced. Chronic Leukemia involves more mature cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.

Leukemia Classification - SECOND TYPE

The second type of classification is by TYPE OF WHITE BLOOD CELL AFFECTED. 1. LYMPHOCYTIC LEUKEMIA. This type of leukemia affects the lymphoid cells (Lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system. 2. MYELOGENOUS LEUKEMIA. This type of leukemia affects the Myeloid cells. Myeloid cells give rise to the red blood cells, white blood cells and platelet-producing cells.

RED BLOOD CELLS (ERYTHROCYTES)

The single purpose of the Hemoglobin in Erythrocytes is to bind O2 MOLECULES IN THE LUNG AND DELIVERY THEM TO THE BODY. When there are not enough red blood cells, tissue develops hypoxia. Hypoxia produces several universal signs and symptoms.

SICKLE CELL CRISIS

Three types of Sickle Cell Crisis: Vaso-occlusive (thrombotic Crisis) - most common type. Splenic Sequestration & Aplastic Crisis.

thrombosis

blood clot