paramedic

1. Hematology

2. Hematology
• The study of blood and blood forming organs

3. A&P: Blood Functions
Transports O2 from lungs to tissues
Transports CO2 away from tissues to
the lungs
Carries nutrients
Transports hormones
Carries antibodies and defensive cells
Carries waste products of metabolism

4. A&P: Blood Forming
Organs
 Bone Marrow
 Liver
 Spleen

7. Blood Volume
• 6% of total body weight
• Body can compensate for .5 liters blood loss
• Fluid shift can easily alter amount of blood
• Number of red blood cells remain constant
• Red blood cells confined to vascular space

8. Assessment

10. Blood Components
• Plasma
• Red blood cells
• White blood cells
• Platelets

11. Plasma
• 90-92 % water
• 6-7% proteins
• Large proteins (Albumin) won’t cross
membranes
• Osmotic Pull (Oncotic pressure)- water
retention

12. Erythropoietin
• Hormone responsible for red blood cell
production

13. Red Blood Cells
• Erythrocyte- red blood cell
• No nucleus when mature

14. Hemoglobin
• Oxygen-bearing molecule in RBC
• Made up of iron-rich pigment- heme and
protein- globin
• Each hemoglobin has 4 subunits of globin
• Each globin can carry one Oxygen molecule

15. Oxygen Transport
• Normal pO2 is 95 mmHg
• Bohr effect- Uptake of O2 in lungs:
• Alkalosis makes hemoglobin bind to oxygen
more tightly
• Acidosis makes hemoglobin release oxygen

16. Oxygen Disassociation Curve

17. Oxygen Disassociation Curve

18. Oxygen Disassociation Curve

21. Erythropoeisis
• Production of red blood cells

22. Hemolysis
• Destruction of red blood cells

23. Hemostasis:
• The process of stopping bleeding by:
Vasoconstriction
Platelet plugging
Coagulation

25. Hematologic Disorders
Hemolytic disorders: Disease processes
that cause the breakdown of red blood
cells
Hemostatic disorders: Bleeding and
clotting abnormalities

26. Coagulopathy
Any process that interferes with the
clotting cascade.

28. White Blood Cell Production
• Leukopoiesis (differentiation of WBC)
• Immature WBC:
– Myeloblasts (from granulocytes)
– Monoblasts
– Lymphoblasts

29. White Blood Cells
• Granulocytes (Neutrophils, Basophils, and
Eosinophils)
• Monocytes
• Lymphocytes

31. Granulocytes
• Basophils- primary function in allergic
reaction… contain histamine….
• Eosinophils-Fight parasitic infection… can
counteract allergic reactions (major basic
protein)
• Neutrophils- count can rise rapidly… fight
infection

32. Monocytes
• May circulate as monocytes or mature into
“Macrophages”
• Garbage collectors

33. Lymphocytes
• Primary cells involved in immune response
• T- Cells (thymus)- CELL MEDIATED IMMUNITY
• B- Cells (bone marrow)- HUMORAL IMMUNITY

34. Autoimmune Disease
• Condition in which the body makes antibodies
against own tissues

41. Sarcoidosis

42. Inflammatory Response
• Nonspecific defense mechanism that wards
off damage from microorganisms or trauma

43. White Blood Cells
• Leukocytes
• Many (marginalized) loiter on walls of blood
vessels.
• Demargination- recirculation of WBC in
response to stress, corticosteroids, seizures,
epinephrine, and exercise

44. Phagocytosis
• When white blood cells engulf and destroy an
invader

45. Platelets
• Thrombocytes
• 150,000 – 450,000 per microliter of blood
• Live 7 – 10 days
• Removed by the spleen
• Thrombocytosis – too many
• Thrombocytopenia – not enough

46. Hemostasis
• Vascular Spasms
• Platelet Plug
• Stable Fibrin Blood Clots

48. Blood Clot Destruction
• Plasminogen- released from fibrin clot
• Turned into plasmin…
• Fibrinolyis- plasmin dismantles blood clot
• Takes hour to days

52. Glycoprotein IIb/IIIa Inhibitors
• Glycoprotein IIb/IIIa inhibitors
– used for ACS with angioplasy
– with our without stent placement
– Abciximad (RoPro)
– Eptifibatide (Integrilin)
– Tirofiban (Aggrastate)

53. Blood Types
• A
• B
• AB
• O

54. Rh Factor

55. Blood Compatibility

56. Erythroblastosis Fetalis
• hemolytic disease of the newborn

58. • AB- universal recipient
• 0- universal donors
• Type A- A-antigens, anti-B antibodies

59. Types of Transfusions
• Whole blood
• Packed red blood cells
• Platelets
• Fresh frozen plasma
• Clotting factors

60. Transfusion Reactions
• Facial flushing, hyperventilation, tachycardia,
sense of dread
• Hives, chest pain, wheezing, fever, chills,
cyanosis

61. Patient Assessment
• Petechiae (tiny red dots in skin)
• Purpura (large purplish blothces)-
• Jaundice- high bilirubin
• Epistaxis
• Enlarged spleen
• Bleeding from gums
• Arthralgia-pain and swelling in joints
• Bleeding around IV site

66. Diseases of RBC
• Polycythemia- too many
• Anemia- inadequate number of RBC or
inadequate hemoglobin

67. Anemia
• Symptom, not a disease
• Hematocrit < 37 % in women < 40% in men
• Pica- craving of unusual substances as ice or
clay

68. Anemia
A hemoglobin level lower than normal
Iron deficiency anemia
GI Bleeds
Menstrual bleeding
Blood loss

69. Sickle Cell Crisis
Vasoocclusive crisis
Acute Chest Syndrome
Splenic sequestration crisis
Acute splenic sequestration syndrome

71. Sickle Cell Crisis: Assessment
SOB
Hypotension
Chest, abdominal, or arthritic pain
Jaundice and yellowing in the eye

72. Sickle Cell Disease
• Inherited disorder of RBC production
• Mom Xx Dad Xx
• Babies XX Xx Xx xx
• Xx – carriers of sickle cell trait
• xx have disease

74. Polycythemia
• Hematocrit too high
• > 50%
• Rare disorder
• 50 y/o +
• May cause platelet dysfunction

75. WBC Diseases
• Leukopenia – too few (treatment is
supportive)- prevent infection
• Leukocytosis – too many
– Look for neutrophils with segmented nuclei
(bands)

77. Leukemia
• ALL, AML, CLL, CML, Hairy cell leukemia
• High risk of infection

80. Lymphoma
• Cancers of the lymphatic system
– Hodgkin’s lymphoma (better survival rate)
– Nonhodgkin’s lymphoma

81. Platelet Diseases
• Thrombocytosis - Increase in number of
platelets
• Thrombocytopenia- abnormal decrease in
number of platelets

82. Hemophelia
• Disease in which one of the proteins
necessary for blood clotting is missing or
defective
• Hemophelia A- Deficiency in factor VIII (most
common)
• Hemophelia B (Christmas Disease)- Deficiency
if factor IX rarer and more severe

83. Hemophelia
• Sex- Linked
• Normal Dad + Carrier Mom
• XY + Xx
• Children XX Xx (carrier) XY
xY (hemophelia)

84. Von Willebrand’s Disease
• Factor VIII
– Factor VIII:vWF

85. • https://www.youtube.com/watch?v=cy3a__O
Oa2M

88. Multiple Myeloma
• Cancerous disorder of plasma cells
• Pain in ribs or back
• Pathological fractures

89. Disseminated intravascular
coagulation
Results from
Trauma and extended hypotension
Free thrombin and fibrin increase and
platelet aggregation increases
Uncontrolled hemorrhaging due to
reduction in clotting factors

90. DIC
• Disseminated Intravascular Coagulation
• Caused by systemic activation of the
coagulation cascade
• Widespread thrombosis
• Bleeding due to decreased fibrinogen level,
consumption of coagulation factors,
thrombocytopenia

92. DIC Causes
• Sepsis
• Hypotension
• Obstetric complications
• severe tissue injury
• Cancer
• Major hemolytic transfusion reactions

93. DIC Treatment
• FFP
• Platelets

94. Lab Values

95. Blood Tests
• Hematocrit
– 37-49 %
– 36-46 %
• Hemoglobin
– 13.0- 18.0 g/dL
– 12 – 16 g/dL

96. Blood Tests
• WBC- 4500 – 11000 / mm3
• RBC
– 4.5-5.3 million/mm3
– 4.1-5.1 million/mm3

97. WBC Differential
• Bands 0-5%
• PMN or segs (mature neutrophils) 45-70%
• Eosinophils 0-8% (allergies have high #s)
• Basophils 0-3% (leukemia has high #s)
• Lymphocytes 16-46% (leukemia has high)
• Monocytes 4-11% (TB)
• Left Shift

98. Clotting
• D-Dimer
• PT- (11.2-13.2 sec)
– Prothrombin Time (coumadin)
• PTT (22.1-34.2 sec)
– Partial Thromboplastin Time (heparin)
• INR (1 for normal patients, 1.5-2.5 on
coumadin)
– International Normalized Ratio