3/11/2009
Disorders of the Hematopoietic System Chapter 37
Blood Disorders Blood Dyscrasias: abnormalities in the numbers and types of red blood cells Coagulopathies: bleeding disorders that involve platelets or clotting factors
Anemia Deficiency of erythrocytes or hemoglobin Reduction in amount of O2 carried to cells Causes
Blood loss Inadequate or abnormal erythrocyte production Destruction of normally formed RBCs
1
3/11/2009
Anemia Lab Interpretation
MCV: size
Microcytic Normocytic Macrocytic
Hemoglobin
Hematocrit
Carries O2 Volume of RBCs
MCHC: color
Hypochromic Normochromic Hyperchromic
Hypovolemic Anemia
Occurs when there is a loss in blood volume
Acute Chronic
Assessment Findings
Severe: EXTREME pallor, tachycardia, hypotension, ↓urine output, altered LOC Chronic: pallor, fatigue, chills, postural hypotension, tachycardia, tachypnea CBC: ↓Hgb, ↓Hct
Hypovolemic Anemia
Medical Management
IV fluids Blood transfusions Treatment of underlying conditions
Nursing Management
2
3/11/2009
Hypovolemic Anemia
Medical Management
Blood transfusions Restore blood volume
Nursing Management
Vital signs Control acute bleeding Limit activity that increases O2 consumption
Iron Deficiency Anemia
Insufficient iron for hemoglobin production Blood loss Inadequate dietary intake Malabsorption Hemolysis
Iron Deficiency Anemia
Assessment Findings Reduced energy, fatigue Feel cold all the time Dyspnea with minor exertion Rapid heart rate
Diagnostic Findings
CBC, serum iron, blood smear
3
3/11/2009
Iron Deficiency Anemia
Medical Management
Iron: Oral, IM Iron rich foods in diet: meat, egg yolks, shellfish, whole grains, nuts, legumes
Nursing Management
Patient Teaching Dilute oral iron, drink through straw Orange juice to promote absorption Change in stool color Avoid antacid, coffee, tea, milk for 2 hr between iron use
Z-Track Technique
Sickle Cell Anemia Hereditary disease Primarily in African Americans; can occur in Meditarranean & Middle Eastern countries Sickle Cell Disease
Inherit 2 defective genes (one from each parent); all Hgb is abnormal
Sickle Cell Trait
Inherit 1 defective gene
4
3/11/2009
Sickle Cell Anemia Sickle Cell Crisis Vascular occlusions occur rapidly under hypoxic conditions SX: Severe pain in ischemic tissue, necrotic tissue, fever, swelling in joints Complications: Stroke, pulmonary infarct, shock, renal failure
http://library.thinkquest.org/06aug/0044 0/images/sicary.jpgklecellincapill http://learn.genetics.utah.edu/units/disorders/whataregd/sicklecell/images/sicklecell.jpg
Sickle Cell Anemia Assessment Findings Jaundice Gallstones Predisposition to infection Chronic leg ulcers Priapism Acute chest syndrome
Diagnostic Findings Sickledex Test ↓ Hgb
http://student.bmj.com/issues/03/12/education/images/view_20.jpg
5
3/11/2009
Sickle Cell Anemia
Medical Management
Supportive treatment Regular blood transfusions Bone marrow transplantation Antibiotic therapy
Sickle Cell Crisis
Management
Narcotic analgesia O2, bed rest IV fluids Desferal
Sickle Cell Anemia Nursing Management Health history Physical assessment Patient teaching
Adequate hydration Avoid vigorous exercise Avoid vasoconstriction, stop smoking Pneumonia vaccine Seek immediate medical attention for signs of infection
6
3/11/2009
Hemolytic Anemia Erythrocytes are destroyed prematurily Spleen becomes obstructed and damaged resulting in an increased risk of infection Persistent anemia causes:
Tachycardia Dyspnea Cardiomegaly & dysrhythmias
http://www.wadsworth.org/chemheme/heme/microscope/pix/schistocyte_nw.jpg
http://www.medvet.umontreal.ca/clinpath/banq-im/Images/acanschzf.jpg
Hemolytic Anemia
Assessment Findings
Jaundice Enlarged spleen Shock
Diagnostic Findings
Microscopic examination Positive Coombs test
7
3/11/2009
Hemolytic Anemia
Medical Management
Remove the cause Corticosteroids Blood transfusion Splenectomy
Nursing Management
Health history Supportive care
Thalassemias Genetic disorder that results in abnormal Hgb synthesis Hereditary Alpha-thalassemias
asymptomatic
Beta-thalassemias
Mild: asymptomatic Severe: Cooley’s anemia
Thalassemias Diagnosis Hgb electrophoresis Medical Management
Frequent blood transfusions Cooley’s: iron chelating therapy
Nursing Management
Bedrest Protect from infection http://www.scinfo.org/chelate/img023.gif
8
3/11/2009
Pernicious Anemia Lack of intrinsic factor necessary for absorption of vitamin B12 Assessment
Glossitis (inflammation of tongue) Stomatitis Digestive disturbances Neuromuscular changes
Diagnostic findings
Schilling test
http://content.answers.com/main/content/img/elsevier/dental/f0031-01.jpg
Pernicious Anemia
Medical Management
Nursing Management
Vitamin B12 injections for life If glossitis and stomatitis are present: soft, bland diet Small frequent meals Oral care
Folic Acid Deficiency Anemia
Characterized by immature erythrocytes
Four common causes 1. Poor nutrition 2. Malabsorption syndromes 3. Drugs that impede absorption & use of folic acid 4. Alcohol abuse & anorexia
9
3/11/2009
Folic Acid Deficiency Anemia
Assessment Findings
Similar to pernicious anemia
Smooth, beefy-red tongue
Absence of neurologic problems
Medical Management
Nursing Management
Folic acid supplement Dietary choices high in folic acid Good oral hygiene Rest periods if fatigued easily http://www.doctorspiller.com/images/OralAnatomy/AtrophicGlossitis.jpg
Polycythemia Vera Greater than normal number of erythrocytes, leukocytes & platelets Assessment Findings
Reddish-purple face and lips
Fatigue, dizziness, exertional dyspnea, Pruritis Excessive bleeding Hemorrhoids Splenomegaly Swollen joints
Polycythemia Vera
Medical Management
Phlebotomy Anticoagulants Radiation therapy Antineoplastic drugs
Nursing Management
Patient education Observe client for complications
10
3/11/2009
Leukemia Any malignant blood disorder in which rapid reproduction of leukocytes (usually immature) is unregulated Cause is unknown Predisposing factors
Genetics Exposure to chemicals/radiation
Viruses
Leukemia
Hallmark Assessment Findings
Infection Severe anemia with fatigue Easy bruising
Diagnostic Findings
↓ leukocytes, erythrocytes, platelets
Leukemia
Medical Management
Antineoplastic drugs Transfusions Bone marrow & stem cell transplants
Nursing Management
Risk for infection Risk for hemorrhage Disturbed body image, anxiety, fear
11
3/11/2009
Multiple Myeloma
Malignancy involving plasma cells (Blymphocytes) in the bone marrow.
Poor prognosis Survival of 1-5 years
http://lh6.ggpht.com/_p163cKQmQ3k/RqCs5euktOI/AAAAAAAAAo8/Tem3O_R9NXw/Multiple+Myeloma+punch+out+lesions.jpg
Multiple Myeloma
Assessment Findings
Skeletal pain Pathologic fractures Infection Anemia
Diagnostic Findings
X-ray: honeycomb bone lesions ↑ serum calcium, low blood counts Bence Jones protein
Multiple Myeloma
Medical Management
Chemotherapy Radiation Bone marrow & stem cell transplant Analgesics Antibiotics
Nursing Management
Pain Hydration Signs of infection Safety to prevent injury/fracture
12
3/11/2009
Agranulocytosis
Most common cause: toxicity from drugs
Antibiotics, anti-thyroid agents, psychotropic agents, anti-convulsants
Chemotherapy agents
Assessment Findings
Infection, fever, chills General malaise, fatigue Opportunistic infections: mouth, throat, nose, rectum, and vagina
Agranulocytosis
Medical Management
Removal of the cause Neupogen
Nursing Management
Medication history Protective isolation if leukocyte count is low Good hand washing Restriction of visitors and staff
Aplastic Anemia Insufficient number of erythrocytes, leukocytes, and platelets Consequence of inadequate stem cell production in the bone marrow Exact cause is unknown
Congenital: autoimmune
Acquired: exposure to toxic chemicals, radiation, and drug therapy
13
3/11/2009
Aplastic Anemia
Assessment Findings
Weakness, fatigue, Unusual bleeding, petechiae, ecchymosis Enlarged spleen Opportunistic infections
Diagnostic Findings
CBC: insufficient blood cells Bone marrow aspiration
Aplastic Anemia
Medical Management
Withdrawal of the causative agent Transfusions Bone marrow & stem cell transplants Antibiotics
Nursing Management
Assess for anemia, infection, bleeding Soft foods and oral hygiene to avoid bleeding from gums
Coagulopathies A term used to describe a condition in which a component that is necessary to control bleeding is either missing or inadequate Examples:
Thrombocytopenia Hemophilia
14
3/11/2009
Thrombocytopenia
Platelet manufacture by bone marrow is decreased Aplastic anemia
Platelet destruction by spleen is increased
Hematologic malignant disorders
Pregnancy
Infection
Drug induced
Severe burns
Chronic alcoholism
HIV
Chemotherapy or radiation
Splenomegaly
Thrombocytopenia
Assessment Findings
Purpura
Bleeding
http://podiatry.files.wordpress.com/2007/03/backtcp.jpg
Thrombocytopenia
Medical/Surgical Management
Eliminate cause when possible Platelet transfusions Splenectomy
Nursing Management
Minimize risk for bleeding
15
3/11/2009
Hemophilia A disorder involving clotting factors Hereditary: sex-linked recessive characteristic Three types
Hemophilia A (von Willebrand’s) Hemophilia B (Christmas disease) Hemophilia C (Rosenthal’s disease)
Hemophilia Clinical manifestations:
Slow, persistent bleeding from minor trauma and small cuts
Bleeding into joints
Delayed bleeding after minor injury
Uncontrollable hemorrhage after dental extraction
Epistaxis
GI bleeding
Hematuria
http://www.accessmedicine.com/loadBinary.aspx?name=licha&filename=licha_XI.050.jpg
16
3/11/2009
Hemophilia
Medical Management
Transfusions Thrombin application Direct pressure/cold compress/ice to bleeding site
Nursing Management
Health history, last bleeding episode Patient teaching
17
