Nursing Care of Clients with Hematologic Problems Part 1 of 2


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Nursing Care of Clients with Hematologic Problems Part 1 of 2 : Anatomy and Physiology Review, Erythrocytes (RBCs)

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Nursing Care of Clients with Hematologic Problems Part 1 of 2

  1. 1. Maria Carmela L. DomocmatInstructorNorthern Luzon Adventist College
  2. 2. Consists of blood and the bone marrow blood - the major body fluid tissue bone marrow - manufactures new blood cells (hematopoiesis)
  3. 3. transports vital substances maintains stability of interstitial fluid distributes heat 14-2
  4. 4. changes in fluid concentration changes in electrolyte concentration amount of adipose tissueabout 8% of body weight or about 5 liters
  5. 5. Let us watchHuman Physiology How Does the Body Make Blood.aviContents of Blood.avi
  6. 6. WaterIonsGlucoseProteins
  7. 7. Water 3 L in average adult; constitutes 90% of plasmaIons: Sodium, potassium, calcium, phosphorous, and other elctrolytesGlucose Prime oxidative metabolite of body cells
  8. 8. Proteins: act as buffers Albumin Largest component of plasma protein Principally responsible for plasma colloid osmotic pressure (COP) Reversibly combines with and transports certain lipids, bilirubin, thyroxin, and certain drugs, such as barbiturates
  9. 9. Proteins Alpha and beta globulins Help establish COP Transport certain vitamins, iron, copper, and cortisol Hemostasis (prothrombin and fibrinogen are in this blood fraction) Gamma globulins Antibodies
  10. 10. • straw colored• liquid portion of blood• 55% of blood
  11. 11. Albumins Alpha and Beta Globulins • most numerous plasma proteins • originate in liver • originate in liver • transport lipids and fat-soluble • help maintain osmotic pressure of vitamins blood Gamma GlobulinsFibrinogen • originate in lymphatic • originate in liver tissues • plays key role in blood • constitute the antibodies coagulation of immunity 14-22
  12. 12. Gases Nutrients • oxygen • amino acids • carbon dioxide • simple sugars • nitrogen • nucleotides • lipids • lipoproteins 14-23
  13. 13. Chylomicrons VLDLs • high • relatively high concentration of concentration of triglycerides triglycerides • transport dietary • produced in the liver fats to muscles and • transport triglycerides adipose cells from liver to adipose cells LDLs • relatively high HDLs concentration • relatively high of cholesterol concentration of proteins • formed from • relatively low VLDLs concentration of lipids • deliver • transport remnants of cholesterol to chylomicrons to liver various cells 14-24
  14. 14. molecules containing nitrogen but are not proteins urea – product of protein catabolism; about 50% of NPNsubstances uric acid – product of nucleic acid catabolism amino acids – product of protein catabolism creatine – stores phosphates creatinine – product of creatine metabolism BUN – blood urea nitrogen; indicate health of kidney 14-25
  15. 15. • sodium• potassium• calcium• magnesium• chloride• bicarbonate• phosphate• sulfate• sodium and potassium most abundant 14-26
  16. 16. Red blood cells orerythrocytesPlatelets orthrombocytesWhite blood cellsor leukocytes
  17. 17. Mostly in bone marrow from stem cellsRate regulated by cytokines & growth factors
  18. 18. 14-5
  19. 19. DescriptionNormal Values FunctionErythropoiesis Hemolysis
  20. 20. odeformable7.5 µm in diameterin 1 cm – you can put ›1,500 RBCs side bysideAverage life span: 120 daysunique shape biconcave disk shape thin center, thick edges – ideal for gas exchange deformable
  21. 21. 1 RBC has 200-300 million Hb1 Hb has 4 globin chains (1 pair of ά chainand 1 pair of β chain)1 globin is bound to 1 heme (red pigment)1 heme has 1 iron atomIron binds O2
  22. 22. Transport O2 and CO2 to and from bodytissuesContains hemoglobinparticipate in acid-base balance
  23. 23. The process begins in the embryonic yolk sacmaturing fetus - liver, spleen and lymphnodes end of pregnancy and after birth- restrictedto bone marrowAs time progresses, the contribution fromlong bones decreasesAdult life - only the marrow of membranousbones is involved vertebrae, ribs and pelvis,.
  24. 24. Red Blood Cell ProductionRequirements in production of healthy RBCs Precursor cells (reticulocytes) Adequate supplies of iron, Vitamin B12, folic acid or folate, protein, pyridoxine, and traces of copper
  25. 25. 1. Pluripotent stem cells or hemocytoblast2. Proerythroblast3. Erythroblast4. Normoblast5. Reticulocyte6. Erythrocyte – mature RBC
  26. 26. hemocytoblast reticulocyte 3-7 days (in bone marrow)reticulocyte erythrocyte 24-48 hrs (in blood)erythrocyte lifespan 100-120 days
  27. 27. STIMULUS: Decreased oxygen level in blood(hypoxia) due to: Less RBCs from bleeding Less RBCs from excess RBC destruction Low oxygen levels (high altitude, illness) Increased oxygen demand (exercise)Causes kidneys and liver to release oferythropoietin Kidneys produce 90%; liver 10%
  28. 28. Erythropoietin: the hormone that stimulatesRBC productionTakes several days to effectRed bone marrow increases production ofRBC Reach maximum production after 5 days from stimulation
  29. 29. Increased number of RBC in the circulationresult to increased oxygen-carrying capacityof the bloodDetected by the liver and kidneysNegative feedback to the kidney and liver :Inhibition of the erythropoietin productionNote: if with kidney failure – hypoxia has little orno effect on RBC production
  30. 30. RBC lacks mitochondria –no source of energyRelies on glucose ad glycolytic pathway forits metabolic needsEnzyme-mediated anaerobic metabolism ofglucose Generate the ATP needed for normal membrane function and ion transportDepletion of glucose or functional deficiencyof one of glycolytic enzymes leads topremature death of RBC (G6PD deficiency) 14-7
  31. 31. RBC destructionRate of RBC destruction: 2.5 million/sec or1% of RBCs per dayRBC destruction = RBC productionRBC circulate for about 120 daysmacrophages ingest and destroy worn outand defective RBCs in spleen, liver, bonemarrow and lymph nodeshemoglobin is broken down into heme andglobin
  32. 32. Let’s watch Crenation: theHemoysis and formation ofcrenation of RBC abnormal notching around the edge of an erythrocyte; the notched appearance of an erythrocyte due to its shrinkage after suspension in a hypertonic solution.
  33. 33. Let’s watch Hb breakdown
  34. 34. Heme in the spleen - heme is converted to unconjugated bilirubin heme attaches to plasma protein for transport in the blood removed from the blood by the liver and conjugated withglucuronide becomes conjugated bilirubin conjugated bilirubin and biliverdin are secreted in bile andexcreted in feces and urine Globin: neutralized or recycled into amino acids
  35. 35. heme releases iron iron attaches to biliverdin for transport return to bone marrow to be reused or stored in the spleen and liver for future use
  36. 36. 33% of cell massthe O2-carrying substance that gives blood itsred color 1 liter of water has 3ml of dissolved O2 hemoglobin can transport 70 times this amount 20ml of O2= 100ml of blood
  37. 37. large molecules with globin and hemesheme group – iron-containing pigment part ofhemoglobin to which oxygen bindsglobin - complex protein with 4 polypeptides(2 alpha and 2 beta polypeptide chain)each polypeptide has one heme group; eachheme carries one O2
  38. 38. oxyhemoglobin - when oxygen is bound toirondeoxyhemoglobin - no oxygen bound to ironcarbaminohemoglobin - when carbon dioxideis bound (to polypeptide chain) to iron
  39. 39. essential for hemoglobin to carry oxygenFound in several compartments 80% is in heme of blood ‹20% stored in bone marrow, liver, spleen, other organs Small amount in myoglobin in muscles, cytochromes, iron-containing enzymesdaily Fe loss: 0.9 mg men/l.7 mg women
  40. 40. Dietary iron helps maintain body stores Absorbed in small intestines (especially duodenum) (10-15% is absorbed) Most iron enter the circulation Some are sequestered in intestinal epithelial cells and is lost in feces as these cells slough offFe in blood bound to transferrin Iron – transferrin complex Those iron that enter the circulation combines with betaglobulin transferrin in order to be transported to the plasma
  41. 41. Iron – transferrin complex is then transportedto plasma where: (1) Bone marrow uses iron to make Hb (2) Excess iron is stored in the liver as ferritin
  42. 42. When RBC age or destroyed in spleen hemereleases iron into circulationReturned to: (1) to bone marrow to be reused for heme synthesis or (2) to spleen and liver for storageIf there is iron overload – there will beincreased iron excretion
  43. 43. Serum ferritin levels blood measurement which provide an index of body iron stores If decreased –indicate a need for iron supplements
  44. 44. Antigens - substances that trigger formationof antibodies that interact specifically withthat antigen Determine a person’s blood group or blood type
  45. 45. Type A RBCs contain A antigen antibodies to B in plasma Compatible with type A or OType B RBCs contain B antigen antibodies to A in plasma Compatible with type B or O
  46. 46. Type AB RBCs contain A and B antigens no antibodies in plasma Compatible with type A, B, AB or OType O RBCs do not contain A or B antigens antibodies to both A and B in plasma Compatible with type O
  47. 47. Rh-positive blood with Rh antigenRh-negative blood without Rh antigen no antibodies to Rh+ unless exposed to Rh+ antigen) hemolytic disease of newborn Rh- mom and Rh+ fetus (treatment) Rhogam
  48. 48. plasma contain antibodies(immunoglobulins) that interact with theseantigens—causing cells to agglutinate(clump together)But plasma cannot contain antibodies to itsown cell antigen—or it would destroy itselfThus- type A blood –does not have anti-Aantibodies; but have anti-B antibodies
  49. 49. AnemiasPolycythemias
  50. 50. Normal RBCsRBCs of person withhemolytic anemia
  51. 51. Patients peripheral blood smear illustrating marked hypochromicmicrocytic red cells, numerous target cells, polychromasia,poikilocytosis, and anisocytosis with numerous small teardrop forms,ovalocytes, and schistocytes (red cell fragments).
  52. 52. • sickle cell anemia• iron deficiency anemia • abnormal shape of RBCs • hemoglobin deficient • defective gene • lack of iron • thalassemia• pernicious anemia • hemoglobin deficient • excess of immature RBCs • RBCs short-lived • inability to absorb B12 • defective gene • hemolytic anemia • aplastic anemia • RBCs destroyed • bone marrow damaged • toxic chemicals • toxic chemicals • radiation
  53. 53. Table 16-3: Causes of Anemia
  54. 54. chelitisRiboflavin deficiency mostly manifests itselfat the edge of the mucosa.
  55. 55. Spoon-shaped Nails
  56. 56. Beefy red tongue
  57. 57. poikilocytosis anisocytosis
  58. 58. Excellent sources of iron: beans, carrots,cauliflower, celery, egg yolk, graham bread,kidney, lettuce, liver, oatmeal, soybeans,spinach, whole wheat Good sources of iron: beef, beets, cabbage,cucumbers, dates, duck, goose, lamb,molasses, mushrooms, oranges, peanuts,peas, peppers, potatoes, prunes, radishes,raisins, pineapples, tomatoes
  59. 59. Thalassemia major is aninherited form of hemolyticanemia, characterized by redblood cell (hemoglobin)production abnormalities.This is the most severe formof anemia, and the oxygendepletion in the bodybecomes apparent within thefirst 6 months of life. If leftuntreated, death usuallyresults within a few years.Note the small, pale(hypochromic), abnormally-shaped red blood cellsassociated with thalassemiamajor. The darker cells likelyrepresent normal RBCs froma blood transfusion.
  60. 60. Thalassemia minor is aninherited form ofhemolytic anemia that isless severe thanthalassemia major. Thisblood smear from anindividual withthalassemia shows small(microcytic), pale(hypochromic), variously-shaped (poikilocytosis) redblood cells. These smallred blood cells (RBCs) areable to carry less oxygenthan normal RBCs.
  61. 61. Frontal bossingProminence of facial bonesForward protrusion of upper teeth anddepression of nasal bridge
  62. 62. Chelation therapy is the administrationof chelating agents to remove heavymetals from the bodyDeferoxamine acts by binding free iron in thebloodstream and enhancing its elimination inthe urine. By removing excess iron, the agentreduces the damage done to various organsand tissues, such as the liver. A recent studyalso shows that it speeds healing of nervedamage (and minimizes the extent of recentnerve trauma).
  63. 63. Let’s watch