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Assessment and management of
patients with hematologic
disorders
Mrs. Samia Almusalhi
Types of anemia
• Hypoproliferative anemia
• Hemolytic anemia
Hypoproliferative anemia
• Clinical manifestation:
1. iron deficincy anemia and
2. megaloblastic anemia
iron deficiency anemia
• Lack of iron intake result in lack of hemoglobin synthesis.
• Clinical manifestation: sore tongue, brittle and ridged
nails, and angular cheilosis could because of multiple
pregnancies, GI bleeding Pica. In addition, head ache,
weakness and fatigue
angular cheilosis
• Assessment and diagnostic finding:
bone marrow aspiration the iron will be
less of absent. Iron store (ferritin) leads to
erythrocytes production by bone marrow,
MCV low size of erythrocytes, low RBCs
and low Hb level occult blood test.
iron deficiency anemia
• Prognosis: improved after iron correction.
• Medical management: iron supplement for 6-12
months.
• Nursing management: preventive education,
high iron diet as: liver, beans, green leafy
vegetables, with V.C to enhance absorption.
Avoid milk with iron supplement as it affect
absorption. Take with food if GI absent, and
stool softness if constipation, use straw, oral
hygiene and mouth rinsing in case of taking
syrup iron supplement.
megaloblastic anemia
• Two types: folic acid deficiency and vitamin B12
deficiency
• Clinical manifestation: weakness and fatigue.
• Assessment and diagnostic finding: vitamin
B12 called pernicious anemia has sore red
tongue, and mild diarrhea, pale, confusion,
numbness of feet and lower leg, might lead to
death secondary to heart failure.
• The test can help them determine whether
the stomach is producing “intrinsic factor.”
Intrinsic factor is a type of protein required
for vitamin B-12 absorption. Without it, the
body will be unable to absorb vitamin B-
12, resulting in pernicious anemia.
vitamin B12 deficiency
• A special protein, called intrinsic factor (IF)
is found in stomach helps absorption of
v.B12.
• V. B12 is found in meat, poultry, seafood,
beans and peas, eggs, processed soy
products, nuts and seeds.
• This special protein IF plays a major role
in absorbing Vitamin B12. In other words,
this prevents the occurrence of Pernicious
Anemia. This protein is released by cells
in the stomach. So when the stomach
does not make enough IF, the intestine
fails to absorb vitamin B12.
Assessment and management of patients with hematologic disorders
vitamin B12 deficiency
• Diagnostic test: Schilling test. Taking
radioactive V.B12 orally and giving usual type of
IV fluid then all urine to be collect. If urine test of
VB12 is positive it means it is absorbed and if
not there is mal-absorption in the GI system. Or
intrinsic factor antibody (antibody attacks V.B12
and prevent it from absorption.
• Medical management: 1mg folic acid tabs daily,
or by diet,
vitamin B12 deficiency
• Nursing management: physical
examination of skin for pale appearance,
jaundice in sclera, assess patient gait
(neurologic dysfunction in severe case),
provide assistive device for walking, if
sensation lost avoid excessive heat or
cold. Bland or soft food of sore is
present,,,,,,,,,
Types of hemolytic anemia
disorders
• Sickle cell anemia
• Thalassemia
• Glucose 6 phosphate dehydrogenase
deficiency (G6PD)
Hemolytic anemia: Sickle cell
anemia
Hemolytic anemia: Sickle cell
anemia
• Clinical manifestation: RBCs has
10-12 days life span, hb 7-10g/dl,
jaundice in sclera, tachycardia,
enlarged heart and spleen,
• Assessment and diagnostic finding:
hemoglobin electrophoresis is used for
diagnose, sickle cell crises, hypoxia and
necrosis, how HB, sometimes absence
retics and overload of bone marrow,
Hemolytic anemia: Sickle cell
aneamia
• Prognosis: crisis (VOC), aneamia or
death sometimes in first year of life
because of infection,
• Medical management: peripheral blood
stem cell transplant. Pharmacological
therapy e.g: Hydoroxurea (Hydrea)
increase fetal hemoglobin which decrease
sickled cell. Arginine is anti-sickling and
enhance vasodilatation.
Hemolytic anemia: Sickle cell
anemia
• Pain management (opioids, NSAIDs,
PCA)
• hydration e.g Oral and IV
prevent exposure to sun for long time
• O2
• Prevent infection
• Avoid High altitudes
Surgical management: spleenectomy
Peripheral blood smear
Variations in Red Blood Cell
Morphology : Size, Shape, Color
Variations in Red Blood Cell
Morphology : Size, Shape, Color
Variations in Red Blood Cell
Morphology : Size, Shape, Color
Assessment and management of patients with hematologic disorders
Assessment and management of patients with hematologic disorders
Assessment and management of patients with hematologic disorders
Thalassemia
What is thalassemia?
 Genetic blood disorder resulting in a mutation or
deletion of the genes.
 Normal hemoglobin is composed of 2 alpha and 2
beta globins
 2 types of thalassemia:
alpha and beta.
Hemolytic anemia: Thalassemia
• Decrease in hb level, small red blood
cells, anemia and destructions of red
blood cell (hemolysis).
• Abnormal globulin chain in hemoglobin.
• It is alpha and beta
• Thalassemia major is characterized by
severe anemia, hemolysis, and ineffective
erythropoiesis. It need blood transfusion
for proper child growth and development.
Thalassemia
• which are characterized by reduced or
absent synthesis of one or more globin
chain type.
• The imbalance of globin chain synthesis,
which result leads to ineffective
erythropoiesis and a shortened red cell
lifespan.
Hemolytic anemia: Thalassemia
• Organ dysfunction result from iron
overload so chelation therapy is needed.
• Chelation therapy is a medical procedure
that involves the administration of
chelating agents to remove heavy metals
from the body.
Hemolytic anemia: G6PD
• Deficiency in the gene within red blood cell
which protect its stability.
• It happens when RBCs is stressed by
medication (they should carry identification card
with them) or curtain substance (Naftalin,
Henna, beans,,,,,,,,,,,)
• Clinical manifestation: asymptomatic then
pallor, jaundice, hemoglubinuria, increase retics
increase,,,,,,,,,,,,
Hemolytic anemia: G6PD
• Assessment and diagnostic finding:
screening test of G6PD
• Medical management: stop causing
medication, transfusion in severe cases,
• Nursing management: educate patient
and give him/her list of medication to be
avoided, genetic counseling may be
needed.
Thank you

Discuss the clinical manifestation, assessment
and diagnostic finding, medical and nursing
management of patient with lymphomas and
myeloma.
• TABLE
Identify different bleeding disorders, clinical
manifestation, assessment and diagnostic
findings, medical and nursing management.
1. Thrompocytopenia
2. hemophilia
Thrompocytopenia
• Is low platelet level from decreased production,
increased destruction and increase consumption
of platelets. table 33-4
• Clinical manifestation: bleeding, petechiae,
nasal bleeding or after surgery, Aspirin ,,,,,,,,
• Assessment and diagnostic finding: bone
marrow aspiration, peripheral smear test,,,,,,
Thrompocytopenia
• Medical management: platelets
transfusion, splenectomy,
• Nursing management: chart 33-8 pg 938
to prevent complication and control
bleeding.
Assessment and management of patients with hematologic disorders
Normal clotting process
Hemophilia
• Two types: hemophilia A ( deficiency
factor VIII and B (deficiency factor IX)
• Clinical manifestation: hemorrhage after
minimal trauma to knees, elbow, wrists,
pain, hematoma,
• Medical management: before fresh
frozen plasma now factor VIII and factor IX
replacement, some medication is found
useful in these case to raise the factor.
Hemophilia
• Nursing management: prevent unnecessary
trauma, safety at home and workplace, avoid
medication interfere with platelet aggregation
e.g: aspirin, NSAIDs, herbs and alcohol. Dental
hygiene to prevent bleeding from dental
extraction, no injections, carrying Identification
card everywhere, use cold compress for pain,
genetic testing and premarital counseling for
males to prevent its occurrence for future
generation,,,,,,,,,,,,,,
Thank You


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Assessment and management of patients with hematologic disorders

  • 1. Assessment and management of patients with hematologic disorders Mrs. Samia Almusalhi
  • 2. Types of anemia • Hypoproliferative anemia • Hemolytic anemia
  • 3. Hypoproliferative anemia • Clinical manifestation: 1. iron deficincy anemia and 2. megaloblastic anemia
  • 4. iron deficiency anemia • Lack of iron intake result in lack of hemoglobin synthesis. • Clinical manifestation: sore tongue, brittle and ridged nails, and angular cheilosis could because of multiple pregnancies, GI bleeding Pica. In addition, head ache, weakness and fatigue angular cheilosis
  • 5. • Assessment and diagnostic finding: bone marrow aspiration the iron will be less of absent. Iron store (ferritin) leads to erythrocytes production by bone marrow, MCV low size of erythrocytes, low RBCs and low Hb level occult blood test.
  • 6. iron deficiency anemia • Prognosis: improved after iron correction. • Medical management: iron supplement for 6-12 months. • Nursing management: preventive education, high iron diet as: liver, beans, green leafy vegetables, with V.C to enhance absorption. Avoid milk with iron supplement as it affect absorption. Take with food if GI absent, and stool softness if constipation, use straw, oral hygiene and mouth rinsing in case of taking syrup iron supplement.
  • 7. megaloblastic anemia • Two types: folic acid deficiency and vitamin B12 deficiency • Clinical manifestation: weakness and fatigue. • Assessment and diagnostic finding: vitamin B12 called pernicious anemia has sore red tongue, and mild diarrhea, pale, confusion, numbness of feet and lower leg, might lead to death secondary to heart failure.
  • 8. • The test can help them determine whether the stomach is producing “intrinsic factor.” Intrinsic factor is a type of protein required for vitamin B-12 absorption. Without it, the body will be unable to absorb vitamin B- 12, resulting in pernicious anemia.
  • 9. vitamin B12 deficiency • A special protein, called intrinsic factor (IF) is found in stomach helps absorption of v.B12. • V. B12 is found in meat, poultry, seafood, beans and peas, eggs, processed soy products, nuts and seeds.
  • 10. • This special protein IF plays a major role in absorbing Vitamin B12. In other words, this prevents the occurrence of Pernicious Anemia. This protein is released by cells in the stomach. So when the stomach does not make enough IF, the intestine fails to absorb vitamin B12.
  • 12. vitamin B12 deficiency • Diagnostic test: Schilling test. Taking radioactive V.B12 orally and giving usual type of IV fluid then all urine to be collect. If urine test of VB12 is positive it means it is absorbed and if not there is mal-absorption in the GI system. Or intrinsic factor antibody (antibody attacks V.B12 and prevent it from absorption. • Medical management: 1mg folic acid tabs daily, or by diet,
  • 13. vitamin B12 deficiency • Nursing management: physical examination of skin for pale appearance, jaundice in sclera, assess patient gait (neurologic dysfunction in severe case), provide assistive device for walking, if sensation lost avoid excessive heat or cold. Bland or soft food of sore is present,,,,,,,,,
  • 14. Types of hemolytic anemia disorders • Sickle cell anemia • Thalassemia • Glucose 6 phosphate dehydrogenase deficiency (G6PD)
  • 16. Hemolytic anemia: Sickle cell anemia • Clinical manifestation: RBCs has 10-12 days life span, hb 7-10g/dl, jaundice in sclera, tachycardia, enlarged heart and spleen, • Assessment and diagnostic finding: hemoglobin electrophoresis is used for diagnose, sickle cell crises, hypoxia and necrosis, how HB, sometimes absence retics and overload of bone marrow,
  • 17. Hemolytic anemia: Sickle cell aneamia • Prognosis: crisis (VOC), aneamia or death sometimes in first year of life because of infection, • Medical management: peripheral blood stem cell transplant. Pharmacological therapy e.g: Hydoroxurea (Hydrea) increase fetal hemoglobin which decrease sickled cell. Arginine is anti-sickling and enhance vasodilatation.
  • 18. Hemolytic anemia: Sickle cell anemia • Pain management (opioids, NSAIDs, PCA) • hydration e.g Oral and IV prevent exposure to sun for long time • O2 • Prevent infection • Avoid High altitudes Surgical management: spleenectomy
  • 20. Variations in Red Blood Cell Morphology : Size, Shape, Color
  • 21. Variations in Red Blood Cell Morphology : Size, Shape, Color
  • 22. Variations in Red Blood Cell Morphology : Size, Shape, Color
  • 27. What is thalassemia?  Genetic blood disorder resulting in a mutation or deletion of the genes.  Normal hemoglobin is composed of 2 alpha and 2 beta globins  2 types of thalassemia: alpha and beta.
  • 28. Hemolytic anemia: Thalassemia • Decrease in hb level, small red blood cells, anemia and destructions of red blood cell (hemolysis). • Abnormal globulin chain in hemoglobin. • It is alpha and beta • Thalassemia major is characterized by severe anemia, hemolysis, and ineffective erythropoiesis. It need blood transfusion for proper child growth and development.
  • 29. Thalassemia • which are characterized by reduced or absent synthesis of one or more globin chain type. • The imbalance of globin chain synthesis, which result leads to ineffective erythropoiesis and a shortened red cell lifespan.
  • 30. Hemolytic anemia: Thalassemia • Organ dysfunction result from iron overload so chelation therapy is needed. • Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body.
  • 31. Hemolytic anemia: G6PD • Deficiency in the gene within red blood cell which protect its stability. • It happens when RBCs is stressed by medication (they should carry identification card with them) or curtain substance (Naftalin, Henna, beans,,,,,,,,,,,) • Clinical manifestation: asymptomatic then pallor, jaundice, hemoglubinuria, increase retics increase,,,,,,,,,,,,
  • 32. Hemolytic anemia: G6PD • Assessment and diagnostic finding: screening test of G6PD • Medical management: stop causing medication, transfusion in severe cases, • Nursing management: educate patient and give him/her list of medication to be avoided, genetic counseling may be needed.
  • 34. Discuss the clinical manifestation, assessment and diagnostic finding, medical and nursing management of patient with lymphomas and myeloma. • TABLE
  • 35. Identify different bleeding disorders, clinical manifestation, assessment and diagnostic findings, medical and nursing management. 1. Thrompocytopenia 2. hemophilia
  • 36. Thrompocytopenia • Is low platelet level from decreased production, increased destruction and increase consumption of platelets. table 33-4 • Clinical manifestation: bleeding, petechiae, nasal bleeding or after surgery, Aspirin ,,,,,,,, • Assessment and diagnostic finding: bone marrow aspiration, peripheral smear test,,,,,,
  • 37. Thrompocytopenia • Medical management: platelets transfusion, splenectomy, • Nursing management: chart 33-8 pg 938 to prevent complication and control bleeding.
  • 40. Hemophilia • Two types: hemophilia A ( deficiency factor VIII and B (deficiency factor IX) • Clinical manifestation: hemorrhage after minimal trauma to knees, elbow, wrists, pain, hematoma, • Medical management: before fresh frozen plasma now factor VIII and factor IX replacement, some medication is found useful in these case to raise the factor.
  • 41. Hemophilia • Nursing management: prevent unnecessary trauma, safety at home and workplace, avoid medication interfere with platelet aggregation e.g: aspirin, NSAIDs, herbs and alcohol. Dental hygiene to prevent bleeding from dental extraction, no injections, carrying Identification card everywhere, use cold compress for pain, genetic testing and premarital counseling for males to prevent its occurrence for future generation,,,,,,,,,,,,,,

Editor's Notes

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