How to manage it

1. Hematology
Hematology
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2. Hematology
Hematology
 Cellular Components
Cellular Components
 Components of Blood
Components of Blood
 Red Blood Cells
Red Blood Cells
 White Blood Cells
White Blood Cells
 Inflammatory process
Inflammatory process
 Coagulation
Coagulation
 Hemorrhage
Hemorrhage
 Blood Typing
Blood Typing
 Clotting disorders
Clotting disorders
 Transfusion Medicine
Transfusion Medicine
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3. Hematology
Hematology
Spleen
Kidneys
Liver
Bone
Marrow
Blood
Hematopoietic
System
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4. Cellular Components
Cellular Components
Pluripotent Stem Cell
Myeloid Multipotent
Stem Cells
Common Lymphoid
Stem Cells
Unipotent
Progenitors
Basophils
Eosinophils
Neutrophils
Monocytes
Lymphocytes
Erythrocytes
Thrombocytes
Erythropoietin
WBC’s
RBC’s
Platelets
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5. Components of Blood
Components of Blood
 Plasma
Plasma
 Transport mechanism
Transport mechanism
 90-92% water.
90-92% water.
 6-7% proteins
6-7% proteins
 2-3%
2-3%
 Fats
Fats
 Carbohydrates (glucose)
Carbohydrates (glucose)
 Electrolytes
Electrolytes
 Gases (O
Gases (O2
2, CO
, CO2
2)
)
 Chemical messengers
Chemical messengers
Plasma Components
Other
3%
Protein
7%
Water
90%
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6. Components of Blood
Components of Blood
 Red Blood Cells
Red Blood Cells
 Erythrocyte
Erythrocyte
 Hemoglobin – O
Hemoglobin – O2
2 bearing
bearing
molecule
molecule
 Comprised of 4
Comprised of 4
subunits:
subunits:
 Globin (binds to 1
Globin (binds to 1
O
O2
2 molecule)
molecule)
 Heme (iron)
Heme (iron)
 100% saturation = 4
100% saturation = 4
globin subunits carrying
globin subunits carrying
O
O2
2
 Each gram of
Each gram of
hemoglobin = 1.34
hemoglobin = 1.34
ml O
ml O2
2
Cellsalive.com
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7. Components of Blood
Components of Blood
 Red blood cell
production
 Erythropoiesis
 Erythropoietin
 Hemolysis
 Sequestration
 Laboratory analysis of red
blood cells
 Red blood cell count
 Hematocrit
 Hemoglobin
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8. Components of Blood
Components of Blood
 Platelets (Thrombocytes)
Platelets (Thrombocytes)
 Megakaryocytes
Megakaryocytes
 Thrombopoietin
Thrombopoietin
 Thrombocytopenia
Thrombocytopenia
 Thrombocytosis
Thrombocytosis
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9. Hemorrhage
Hemorrhage
Class I
Class I Class II
Class II Class III
Class III Class IV
Class IV
Blood Loss (ml)
Blood Loss (ml) Up to 750
Up to 750 750-1500
750-1500 1500-2000
1500-2000 >2000
>2000
Blood Loss (%
Blood Loss (%
volume)
volume)
Up to 15%
Up to 15% 15%-30%
15%-30% 30%-40%
30%-40% >40%
>40%
Pulse
Pulse <100
<100 >100
>100 >120
>120 >140
>140
BP
BP Normal
Normal Normal
Normal Decreased
Decreased Decreased
Decreased
Pulse Pressure
Pulse Pressure Normal or
Normal or
increased
increased
Decreased
Decreased Decreased
Decreased Decreased
Decreased
Resp. Rate
Resp. Rate 14-20
14-20 20-30
20-30 30-40
30-40 >35
>35
Urine Output (ml/hr)
Urine Output (ml/hr) >30
>30 20-30
20-30 5-15
5-15 Negligible
Negligible
Mental Status
Mental Status Slightly
Slightly
anxious
anxious
Mildly
Mildly
anxious
anxious
Anxious,
Anxious,
confused
confused
Confused,
Confused,
lethargic
lethargic
Fluid Replacement
Fluid Replacement
(3:1) rule
(3:1) rule
Crystalloid
Crystalloid Crystalloid
Crystalloid Crystalloid and
Crystalloid and
blood
blood
Crystalloid and
Crystalloid and
blood
blood
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10. Blood Products and Blood Typing
Blood Products and Blood Typing
 Blood Types
Blood Types
 Antigens
Antigens
 A, B, AB, O
A, B, AB, O
 Rh factor
Rh factor
 Rh+ = ~85%
Rh+ = ~85%
 Rh- = ~15%
Rh- = ~15%
Blood transfusion
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11. Blood Products and Blood Typing
Blood Products and Blood Typing
Blood Typing - ABO
Blood Typing - ABO
Blood type
Blood type Antigen present
Antigen present
on erythrocyte
on erythrocyte
Antibody
Antibody
present in
present in
serum
serum
O
O
AB
AB
B
B
A
A
None
None
A and B
A and B
B
B
A
A
Anti-A, Anti-B
Anti-A, Anti-B
None
None
Anti-A
Anti-A
Anti-B
Anti-B
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12. Blood Products and Blood Typing
Blood Products and Blood Typing
Compatibility Among ABO Blood Groups
Compatibility Among ABO Blood Groups
Reaction with serum of Recipient
Reaction with serum of Recipient
Donor Cells
Donor Cells AB
AB B
B A
A O
O
AB
AB
B
B
A
A
O
O
-
-
-
-
-
-
-
-
+
+
-
-
+
+
-
-
+
+
+
+
-
-
-
-
+
+
+
+
+
+
-
-
-= no reaction
+ = reaction
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13. Blood Products and Blood Typing
Blood Products and Blood Typing
Brady; Paramedic Care Principles and Practice
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14. Diseases of Erythrocytes
Diseases of Erythrocytes
 Anemias
Anemias
 Anemia is a sign, not a separate disease process.
Anemia is a sign, not a separate disease process.
 Signs and symptoms may not be present until the body is
Signs and symptoms may not be present until the body is
stressed.
stressed.
 Differentiate chronic anemia from acute episode.
Differentiate chronic anemia from acute episode.
 Treat signs and symptoms.
Treat signs and symptoms.
 Maximize oxygenation and limit blood loss.
Maximize oxygenation and limit blood loss.
 Establish IV therapy if indicated.
Establish IV therapy if indicated.
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15. Diseases of Erythrocytes
Diseases of Erythrocytes
Brady; Paramedic Care Principles and Practice
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16. Diseases of Erythrocytes
Diseases of Erythrocytes
 Sickle Cell Disease
Sickle Cell Disease
 Normal red cells maintain their
Normal red cells maintain their
shape as they pass through the
shape as they pass through the
capillaries and release oxygen
capillaries and release oxygen
to the peripheral tissues (upper
to the peripheral tissues (upper
panel). Hemoglobin polymers
panel). Hemoglobin polymers
form in the sickle rell cells with
form in the sickle rell cells with
oxygen release, causing them
oxygen release, causing them
to deform. The deformed cells
to deform. The deformed cells
block the flow of cells and
block the flow of cells and
interrupt the delivery of
interrupt the delivery of
oxygen to the tissues (lower
oxygen to the tissues (lower
panel).
panel).
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17. Diseases of Erythrocytes
Diseases of Erythrocytes
 Sickle Cell Disease (cont.)
Sickle Cell Disease (cont.)
 Sickle cell crises
Sickle cell crises
 Vaso-occlusive
Vaso-occlusive
 Musculoskeletal/abdominal pain
Musculoskeletal/abdominal pain
 Priapism
Priapism
 Renal/cerebral infarctions
Renal/cerebral infarctions
 Hematological
Hematological
 Lowered hemoglobin
Lowered hemoglobin
 Splenic sequestration
Splenic sequestration
 Infectious
Infectious
 Management
Management
 Follow general treatment guidelines prn.
Follow general treatment guidelines prn.
 Consider analgesics.
Consider analgesics.
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18. Diseases of Erythrocytes
Diseases of Erythrocytes
 Polycythemia
Polycythemia
 Overproduction of erythrocytes.
Overproduction of erythrocytes.
 Occurs in patients > 50 years old or with secondary
Occurs in patients > 50 years old or with secondary
dehydration.
dehydration.
 Most deaths due to thrombosis
Most deaths due to thrombosis
 Results in bleeding abnormalities:
Results in bleeding abnormalities:
 Epistaxis, spontaneous bruising, GI bleeding.
Epistaxis, spontaneous bruising, GI bleeding.
 Management:
Management:
 Follow general treatment guidelines.
Follow general treatment guidelines.
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19. Diseases of Leukocytes
Diseases of Leukocytes
 Leukopenia/Neutropenia
Leukopenia/Neutropenia
 Too few white blood cells or neutrophils.
Too few white blood cells or neutrophils.
 Follow general treatment guidelines and provide
Follow general treatment guidelines and provide
supportive care.
supportive care.
 Leukocytosis
Leukocytosis
 An increase in the number of circulating white
An increase in the number of circulating white
blood cells, often due to infection.
blood cells, often due to infection.
 Leukemoid reaction
Leukemoid reaction
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20. Diseases of Leukocytes
Diseases of Leukocytes
 Leukemia
Leukemia
 Cancer of hematopoietic cells
Cancer of hematopoietic cells
 Initial presentation
Initial presentation
 Acutely ill, fatigued, febrile and weak, anemic.
Acutely ill, fatigued, febrile and weak, anemic.
 Thrombocytopenia
Thrombocytopenia
 Often have a secondary infection.
Often have a secondary infection.
 Management
Management
 Follow general treatment guidelines.
Follow general treatment guidelines.
 Utilize isolation techniques to limit risk of infection.
Utilize isolation techniques to limit risk of infection.
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21. Diseases of Leukocytes
Diseases of Leukocytes
 Lymphomas
Lymphomas
 Cancers of the lymphatic system
Cancers of the lymphatic system
 Hodgkin's
Hodgkin's
 Non-Hodgkins
Non-Hodgkins
 Presentation
Presentation
 Swelling of the lymph nodes
Swelling of the lymph nodes
 Fever, night sweats, anorexia, weight loss, fatigue, and pruritis
Fever, night sweats, anorexia, weight loss, fatigue, and pruritis
 Management
Management
 Follow general treatment guidelines.
Follow general treatment guidelines.
 Utilize isolation techniques to limit risk of infection.
Utilize isolation techniques to limit risk of infection.
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22. Clotting Disorders
Clotting Disorders
 Thrombocytosis and Thrombocytopenia
Thrombocytosis and Thrombocytopenia
 Thrombocytosis
Thrombocytosis
 An abnormal increase in the number of platelets
An abnormal increase in the number of platelets
 Thrombocytopenia
Thrombocytopenia
 An abnormal decrease in the number of platelets
An abnormal decrease in the number of platelets
 Sequestration
Sequestration
 Destruction (ITP)
Destruction (ITP)
 Decreased production
Decreased production
 Management
Management
 Provide supportive care and follow general treatment
Provide supportive care and follow general treatment
guidelines.
guidelines.
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23. Clotting Disorders
Clotting Disorders
 Hemophilia
Hemophilia
 Deficiency or absence of a blood clotting factor
Deficiency or absence of a blood clotting factor
 Deficiency of factor VIII causes hemophilia A.
Deficiency of factor VIII causes hemophilia A.
 Deficiency of factor IX causes hemophilia B.
Deficiency of factor IX causes hemophilia B.
 Deficiency is a sex-linked, inherited disorder.
Deficiency is a sex-linked, inherited disorder.
 Defective gene is carried on the X chromosome.
Defective gene is carried on the X chromosome.
 Signs & Symptoms
Signs & Symptoms
 Numerous bruises, deep muscle bleeding, and joint
Numerous bruises, deep muscle bleeding, and joint
bleeding.
bleeding.
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24. Clotting Disorders
Clotting Disorders
 Hemophilia (cont.)
Hemophilia (cont.)
 Management
Management
 Treat the patient similarly to others.
Treat the patient similarly to others.
 Administer supplemental oxygen.
Administer supplemental oxygen.
 Establish IV access.
Establish IV access.
 Be alert for recurrent or prolonged bleeding, and prevent additional
Be alert for recurrent or prolonged bleeding, and prevent additional
trauma.
trauma.
 Von Willebrand’s Disease
Von Willebrand’s Disease
 Deficient component of factor VIII
Deficient component of factor VIII
 Generally results in excessive bleeding.
Generally results in excessive bleeding.
 Generally is not serious; provide supportive care.
Generally is not serious; provide supportive care.
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25. Clotting Disorders
Clotting Disorders
 Disseminated Intravascular Coagulation
Disseminated Intravascular Coagulation
 System activation of coagulation cascade.
System activation of coagulation cascade.
 Results from sepsis, hypotension, OB complications,
Results from sepsis, hypotension, OB complications,
severe tissue or brain injury, cancer, and major
severe tissue or brain injury, cancer, and major
hemolytic reactions.
hemolytic reactions.
 Multiple Myeloma
Multiple Myeloma
 Cancerous disorder of plasma cells.
Cancerous disorder of plasma cells.
 Pathologic fractures are common.
Pathologic fractures are common.
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