13 hema

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13 hema

  1. 1. DI ST URBANCES I N OX Y GE NAT I ON CARRYI NG ME C H A N I S M A N DT RANS P ORT AT I ON F ACI L I T I ES Jefferson C. Ramos, RMT RN
  2. 2. BLOOD Circulatory fluid of the the Cardiovasclar system that is circulating constantly through a closed circuit of tubes.
  3. 3. PARTS OF THE BLOOD  Liquid Portion  Plasma - a pale, straw colored fluid that remains if coagulation is prevented  Serum - fluid part that remains after separation of the clot
  4. 4. PARTS OF THE BLOOD Solid Portion  Red Blood Cells/Erythrocytes  White Blood Cells/Leukocytes  Platelets/Thrombocytes
  5. 5. CHARACTERISTICS OF BLOOD Volume  Specific Gravity  5 - 6 liters or 7 - 8% of the  Between 1.055 - 1.065 body weight  Reaction Color  Venous blood - dark red  Range of 7.35 - 7.45 (avg.  Arterial blood - bright of 7.4) scarlet red Viscosity  Thick and sticky (5x that of water)
  6. 6. FUNCTIONS OF BLOOD Metabolic Functions  Respiration  Regulation of body temperature  Nutrition  Transportation of hormones  Excretion  Maintenance of normal  Regulation of water acid-base balance in the balance body
  7. 7. FUNCTIONS OF BLOOD Defensive Functions  Production of immune globulins  Functions as phagocytes
  8. 8. ERYTHROCYTES Biconcave discs resembling a soft ball compressed between 2 fingers Gases can easily diffuse across it due to its very thin membrane Contains HEMOGLOBIN  From matured erythrocytes; with Iron  Makes up 95% of blood mass  Enables the RBCs to perform its principal function
  9. 9. RBC DESTRUCTION 120 days Removed by the reticuloendothelial cells in the liver and spleen Hemoglobin is recycled  Bilirubin  New hgb molecules in the bone marrow  Sterco- and urobilinogen
  10. 10. KINDS OF WBCS Granulocytes • Agranulocytes  Neutrophils • Lymphocytes  Eosinophils • Monocytes  Basophils
  11. 11. NEUTROPHILS Most abundant type of phagocyte, 50 - 60% Responsible for neutralizing bacterial infections They engulf pathogens coated with antibodies Does not return to the blood
  12. 12. EOSINOPHILS  1 - 3%  They play a crucial part in killing parasites  Neutralize histamine
  13. 13. BASOPHILS0 - 1% of the differential count Appears in inflammatory reactions esp. those that cause allergic reations Containsheparin & histamine
  14. 14. LYPMHOCYTES  About 25 - 33% of the differential  Usually abnormal results in diseases caused by viruses  Has three kinds:  Natural Killer Cells  T Cells  B Cells
  15. 15. MONOCYTES About 3 - 7% Functions to replenish resident macrophages and dendrictic cells under noramal states Also responds to inflammation signals
  16. 16. THROMBOCYTES 100,000 - 450,000 in value Derivedfrom the fragmentation of precursor megakaryocytes Plays a key role in hemostasis
  17. 17. ASSESSMENT AND DIAGNOSTIC FINDNIGSHematologic Studies  Complete blood count  Peripheral blood smear  Hemoglobin  Hematocrit  RBC indices
  18. 18. ASSESSMENT AND DIAGNOSTIC FINDNIGS Bone marrow aspiration and biopsy  Bone marrow aspiration  Bone marrow biopsy
  19. 19. MANAGEMENT OF HEMATOLOGICDISORDERS
  20. 20. ANEMIAA condition in which Hemoglobin (Hgb) concentration is lower than normal  Hgb = 75 – 175 μg/dL or 13.5-17.5 g/dL (M) = 65 to 165 μg/dL or 11.5-15.5 g/dL (F)
  21. 21. ANEMIA: CAUSES Acute or chronic blood loss Inadequate dietary intake of vitamins and minerals Increased demands of vitamins and minerals for RBC production Decreased RBC production by bone marrow Increased RBC destruction
  22. 22. Hemolytic ANEMIA Hypo- proliferativeBleeding
  23. 23. ANEMIA: SIGNS AND SYMPTOMS Pallor  Syncope Easy  Brittlehair fatigability  Paresthesia Weakness  Cold Weight loss sensitivity Headache  Anorexia Tachycardia  Amenorrhea
  24. 24. IRON DEFICIENCY ANEMIA Laboratory findings  Assessment 1. CBC- Low levels of 1. Pallor Hct, Hgb and RBC count 2. Weakness & fatigue 2. Low serum iron, low 3. Smooth & sore ferritin tongue 3. Bone marrow aspiration- MOST 4. Koilonychia definitive 5. Vinson Plummer syndrome
  25. 25. MEGALOBLASTIC ANEMIAS:VIT. B12 DEFICIENCY Inadequate dietary intake Pernicious Anemia  Due to the absence of intrinsic factor secreted by the parietal cells  Intrinsic factor binds with Vit. B12 to promote absorption
  26. 26. MEGALOBLASTIC ANEMIAS: VIT. B12 DEFICIENCYCausative factors1.Strict vegetarian diet2.Gastrointestinal malabsorption3.Crohns disease4.Gastrectomy
  27. 27. MEGALOBLASTIC ANEMIAS:MANIFIESTATIONS 1. Weakness 2. Fatigue 3. Listless 4. Neurologic manifestations (only in Vit. B12 deficiency) 5. Jaundice – due to poor erythropoiesis 6. Red beefy tongue 7. Mild diarrhea 8. Extreme pallor 9. Paresthesias in the extremities
  28. 28. MEGALOBLASTIC ANEMIAS: LAB DATA1. Peripheral blood smear- shows giant RBCs, WBCs with giant hypersegmented nuclei2. Very high MCV3. Schilling’s test – determines the cause of Vit B12 deficiency4. Intrinsic factor antibody test
  29. 29. MEGALOBLASTIC ANEMIAS1. Vitamin supplementation  Folic acid 1 mg daily2. Diet supplementation  Vegetarians should have vitamin intake or fortified soy milk3. Lifetime monthly injection of IM Vit. B12 – 1000µg (if intrinsic factor is absent)
  30. 30. MEGALOBLASTIC ANEMIAS1. Monitor patient (neurologic assessment)2. Provide assistance in ambulation3. Oral care for sore tongue4. Explain the need for lifetime IM injection of Vit. B12
  31. 31. POLYCYTHEMIA Refers to an INCREASE volume of RBCs The hematocrit (Hct) is ELEVATED to more than 55% Classified as Primary or Secondary
  32. 32. POLYCYTHEMIA: PRIMARYPOLYCYTHEMIA VERA Colleen C. Flores, RNA proliferative disorder in which the myeloid stem cells become uncontrolledCausative factor: unknown
  33. 33. POLYCYTHEMIA: PRIMARYUncontrollablestem cell growth Increased blood viscosity Hypercellular bone marrow Increase in number Increased RBC, of blood cells WBC, platelets Hematopoiesis in spleen Splenomegaly Fibrotic bone marrow
  34. 34. POLYCYTHEMIA: PRIMARY1. Ruddy skin 1. Angina2. Splenomegaly 2. Claudication3. Headache 3. Dyspnea4. Tinnitus5. Fatigue 4. Thrombo-6. Paresthesia phlebitis7. Blurred vision 5. Pruritus 6. Erythromelalgia
  35. 35. POLYCYTHEMIA: PRIMARYLaboratory findings 1. CBC- shows elevated RBC mass 2. Elevated WBC and platelets 3. Elevated hematocrit 4. Normal oxygen saturation
  36. 36. POLYCYTHEMIA: PRIMARYComplications 1. Increased risk for thrombophlebitis, CVA and MI 2. Bleeding due to dysfunctional platelets
  37. 37. POLYCYTHEMIA: PRIMARY 1. To reduce the high blood cell mass (goal) Colleen C. Flores, RN  PHLEBOTOMY 2. Allopurinol (Zyloprim) – if uric acid is increased 3. Dipyridamole (Persantine) 4. Chemotherapy to suppress bone marrow (hydroxyurea)
  38. 38. POLYCYTHEMIA: PRIMARY Patient education: Client instructions on:1. Avoiding Iron supplements2. Bathing with cool water (cocoa-butter based lotion and bath products)3. Minimize bleeding  Avoid Aspirin (if with bleeding history)  Minimize alcohol intake
  39. 39. POLYCYTHEMIA: SECONDARY  Caused by:  Excessive production of erythropoietin (hypoxic stimulus)  Hemoglobinopathies  Neoplasms (renal cell carcinoma)  Treat primary problem
  40. 40. BLEEDING DISORDERS Platelets
  41. 41. THROMBOCYTOPENIALow platelet level due to: 1. Decreased platelet production by bone marrow 2. Increased platelet destruction (ITP) 3. Increased platelet consumption (DIC)Manifestation: bleeding and petichiae (<20,000mm3)
  42. 42. IDIOPATHIC THROMBOCYTOPENICPURPURA (ITP)
  43. 43. ITP  Goal: safe platelet count (>30,000mm3)  Immunosuppressants - block the binding receptors on macrophages so that the platelets are not destroyed 1. Prednisone 2. Cyclophosphamide (Cytoxan) 3. Azathioprine (Imuran) 4. Dexamethasone (Decadron)  IVIG  Spleenectomy  Chemotherapy – Vincristine (Oncovin) Colleen C. Flores, RN
  44. 44. ITP  Determine bleeding risks  Client education regarding  Medication and treatment  Lifestyle  Refrain from vigorous sexual intercourse (< 10,000/mm3)  Avoid client constipation
  45. 45. HEMOPHILIA Inherited (x-linked) bleeding disorder Deficient or defective factor VIII (A) Deficient or defective factor IX (B) Hemorrhage after minimal trauma (joints)
  46. 46. HEMOPHILIA: INHERITANCE
  47. 47. VON WILLEBRAND’S DISEASE Inherited(autosomal dominant) bleeding disorder; deficiency of the vWF Common manifestations  Nosebleeds  Heavy menses Lab data = normal platelet count but prolonged PTT
  48. 48. VON WILLEBRAND’S DISEASE: MANAGEMENT Cryoprecipitate or FFP Desmopressin (DDAVP) – can be used to prevent bleeding with dental/surgical procedures or manage mild post-op bleeding
  49. 49. DISSEMINATED INTRAVASCULARCOAGULATION (DIC)A potentially life-threatening sign of an underlying conditionTriggered by sepsis, trauma, cancer, abruptio placenta, transfusion reactions (hemolysis)
  50. 50. DIC: MANIFESTATIONS  Minimal occult internal bleeding to profuse hemorrhage  Lab data:  Fibrin degradation products – high  PTT - high  Platelet count - low  PT - high  Serum fibrinogen - low
  51. 51. DIC: MANAGEMENTTreatunderlying disorderCorrect secondary effects of tissue ischemiaCryoprecipitate or FFPHeparin infusion* – to interrupt thrombosis

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