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Credits to Mr. Jefferson Ramos :)

Credits to Mr. Jefferson Ramos :)

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    13   hema 13 hema Presentation Transcript

    • 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
    • BLOOD Circulatory fluid of the the Cardiovasclar system that is circulating constantly through a closed circuit of tubes.
    • 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
    • PARTS OF THE BLOOD Solid Portion  Red Blood Cells/Erythrocytes  White Blood Cells/Leukocytes  Platelets/Thrombocytes
    • 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)
    • 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
    • FUNCTIONS OF BLOOD Defensive Functions  Production of immune globulins  Functions as phagocytes
    • 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
    • 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
    • KINDS OF WBCS Granulocytes • Agranulocytes  Neutrophils • Lymphocytes  Eosinophils • Monocytes  Basophils
    • 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
    • EOSINOPHILS  1 - 3%  They play a crucial part in killing parasites  Neutralize histamine
    • BASOPHILS0 - 1% of the differential count Appears in inflammatory reactions esp. those that cause allergic reations Containsheparin & histamine
    • 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
    • MONOCYTES About 3 - 7% Functions to replenish resident macrophages and dendrictic cells under noramal states Also responds to inflammation signals
    • THROMBOCYTES 100,000 - 450,000 in value Derivedfrom the fragmentation of precursor megakaryocytes Plays a key role in hemostasis
    • ASSESSMENT AND DIAGNOSTIC FINDNIGSHematologic Studies  Complete blood count  Peripheral blood smear  Hemoglobin  Hematocrit  RBC indices
    • ASSESSMENT AND DIAGNOSTIC FINDNIGS Bone marrow aspiration and biopsy  Bone marrow aspiration  Bone marrow biopsy
    • MANAGEMENT OF HEMATOLOGICDISORDERS
    • 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)
    • 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
    • Hemolytic ANEMIA Hypo- proliferativeBleeding
    • ANEMIA: SIGNS AND SYMPTOMS Pallor  Syncope Easy  Brittlehair fatigability  Paresthesia Weakness  Cold Weight loss sensitivity Headache  Anorexia Tachycardia  Amenorrhea
    • 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
    • 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
    • MEGALOBLASTIC ANEMIAS: VIT. B12 DEFICIENCYCausative factors1.Strict vegetarian diet2.Gastrointestinal malabsorption3.Crohns disease4.Gastrectomy
    • 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
    • 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
    • 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)
    • 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
    • POLYCYTHEMIA Refers to an INCREASE volume of RBCs The hematocrit (Hct) is ELEVATED to more than 55% Classified as Primary or Secondary
    • POLYCYTHEMIA: PRIMARYPOLYCYTHEMIA VERA Colleen C. Flores, RNA proliferative disorder in which the myeloid stem cells become uncontrolledCausative factor: unknown
    • 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
    • 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
    • POLYCYTHEMIA: PRIMARYLaboratory findings 1. CBC- shows elevated RBC mass 2. Elevated WBC and platelets 3. Elevated hematocrit 4. Normal oxygen saturation
    • POLYCYTHEMIA: PRIMARYComplications 1. Increased risk for thrombophlebitis, CVA and MI 2. Bleeding due to dysfunctional platelets
    • 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)
    • 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
    • POLYCYTHEMIA: SECONDARY  Caused by:  Excessive production of erythropoietin (hypoxic stimulus)  Hemoglobinopathies  Neoplasms (renal cell carcinoma)  Treat primary problem
    • BLEEDING DISORDERS Platelets
    • 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)
    • IDIOPATHIC THROMBOCYTOPENICPURPURA (ITP)
    • 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
    • ITP  Determine bleeding risks  Client education regarding  Medication and treatment  Lifestyle  Refrain from vigorous sexual intercourse (< 10,000/mm3)  Avoid client constipation
    • HEMOPHILIA Inherited (x-linked) bleeding disorder Deficient or defective factor VIII (A) Deficient or defective factor IX (B) Hemorrhage after minimal trauma (joints)
    • HEMOPHILIA: INHERITANCE
    • 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
    • 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
    • DISSEMINATED INTRAVASCULARCOAGULATION (DIC)A potentially life-threatening sign of an underlying conditionTriggered by sepsis, trauma, cancer, abruptio placenta, transfusion reactions (hemolysis)
    • 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
    • DIC: MANAGEMENTTreatunderlying disorderCorrect secondary effects of tissue ischemiaCryoprecipitate or FFPHeparin infusion* – to interrupt thrombosis