PPT_Chapter32 B

Chapter 32
Assessment of Hematologic
Function and Treatment
Modalities

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Hematologic System
The blood and the blood forming sites, including the bone
marrow and the reticuloendothelial system (RES) (capable
of phagocytosis)
Blood
Plasma: fluid portion of blood (various proteins, as albumin,
globulin, fibrinogen, and other factors necessary for clotting, as well as
electrolytes, waste products, and nutrients) 55% of blood.
o Blood cells: erythrocytes, leukocytes, thrombocytes
Hematopoiesis (complex process of the formation and
maturation of blood cells)

Bone Marrow
Stem cells
o Myeloid
 Erythrocytes (RBC)
 Leukocytes (WBC)
 Platelets
o Lymphoid
 Lymphocytes
Stroma (all tissue within the marrow that not involved in
hematopoiesis) (serves important supportive roles in this process)
 Under normal conditions, the marrow responds to
increased demand and releases adequate numbers of
cells into the circulation.

Hematopoiesis

Quiz
Through the process of hematopoiesis, stem cells
differentiate into either myeloid or lymphoid stem cells.
Into what do myeloid stem cells further differentiate?
Select all that apply.
A) Leukocytes
B) Natural killer cells
C) Cytokines
D) Platelets
E) Erythrocytes

Question #1
Is the following statement true or false?
Hematopoiesis is the complex process of the formation and
maturation of blood cells

Answer to Question #1
True
Hematopoiesis is the complex process of the formation and
maturation of blood cells

Red Blood Cells: Erythrocytes
Types
o Hemoglobin
o Reticulocytes (slightly immature forms of erythrocytes
such as in bleeding)
Erythropoiesis
Iron stores and metabolism
Vitamin B12 and folic acid
Destruction ( life span 120 days)
Erythropoietin, a hormone
produced primarily by the
kidney. If the kidney detects low
levels of oxygen, as occurs when
fewer red cells are available to
bind oxygen (i.e., anemia), or
with people living
at high altitudes with lower
atmospheric oxygen
concentrations, erythropoietin
levels increase.

White Blood Cells: Leukocytes
Granulocytes (Presence in the cytoplasm of the cell)
o Eosinophils
o Basophils
o Neutrophils (Bacterial infection) lifespan 1-2 Days
 Bands: left shift (Immature cells)
Agranulocytes
o Monocytes (granule-free cytoplasm)
Lymphocytes (in the lymphoid tissues)
 T cells and B cells
The lifespan of WBC ranges from 13 to 20 days

Platelets: Thrombocytes
Thrombopoietin: Hormone that regulate PLT production.
Fibrin
Platelets have a normal lifespan of 7 to 10 days

Plasma and Plasma Proteins
Albumin (from liver for osmotic pressure to maintain fluid
intravascular ).
o Low concentration may lead to decrease in osmotic
pressure and the development of edema.
Globulins
o Alpha
o Beta
o Gamma
Impact on fluid balance
Transport globulins such as
thyroxine, Clotting factors,
transferrin carries iron

Question #2
Which type of cells increase in number when the patient is
exposed to a bacterial infection?
A. Erythrocyte
B. Eosinophil
C. Neutrophil
D. Thrombocyte
E. Monocyte

C. Neutrophil
The neutrophils are the mature, circulating white blood
cells. When a bacterial infection occurs, the neutrophils will
increase in order to phagocytize the bacteria

Reticuloendothelial System
The RES is composed of special tissue macrophages. When
released from the marrow, monocytes spend a short time in
the circulation (about 24 hours) and then enter the body
tissues. Within the tissues, the monocytes continue to
differentiate into macrophages, which can survive for
months or years.
Spleen (is the site of activity for most macrophages)
o The spleen sequesters newly released reticulocytes from
the marrow, removing nuclear fragments and other
materials.
o The spleen is a major source of hematopoiesis in fetal
life.
o The spleen has important immunologic functions as well.

Hemostasis
 Hemostasis is the process of preventing blood loss from intact
vessels and of stopping bleeding from a severed vessel, which
requires adequate numbers of functional platelets.

Assessment of Hematologic Health
Health history (refer to Chart 32-1)
Physical assessment
Diagnostic evaluation
o Hematologic studies (CBC, PT, PTT, INR)
o Bone marrow aspiration and biopsy
quantitative (e.g., increased or
decreased production of cells),
Qualitative (e.g., the cells that are
Produced are defective in their
normal functional capacity), or both.

Bone Marrow Aspiration
https://www.youtube.com/watch?v=EYd7OnCt7ug

Therapeutic Approaches
Splenectomy
Apheresis (blood is taken from the patient and passed
through a centrifuge, where a specific component is separated
from the blood and removed)
Hematopoietic stem cell transplantation (HSCT)
Phlebotomy
Blood component therapy (PRBCs, Platelet, Plasma…)
Special preparations (factors II, VII, IX, and X)

Question #3
Is the following statement true or false?
When having a reaction to a blood transfusion, patients will
present with the same symptoms and assessment changes

False
There are a variety of complications and reactions that
can occur from a blood transfusion. Depending on the
type will determine the presenting symptoms

Blood and Blood Products #1
Donor requirements
All donors are expected to meet the following minimal
requirements:
1. Body weight should be at least 50 kg (110 lb) for a
standard 450-mL donation.
2. People younger than 17 years require parental consent
in some states.
3. The oral temperature should not exceed 37.5°C
(99.6°F).
4. The systolic arterial blood pressure should be 80 to 180
mm Hg, and the diastolic pressure should be 50 to 100
mm Hg.
5. The hemoglobin level should be at least 12.5 g/dL.

Donation types
o Directed (at times, friends, families for that person)
o Standard (semi recumbent position, 15 minutes, tested)
o Autologous (elective surgery 4-6 weeks before surgery)
o Intraoperative blood salvage (suctioned into cell-
saver machine--- washed, filtered then returned)
o Hemodilution (About 1 to 2 units of blood are removed
from the patient through a venous or arterial line and
simultaneously replaced with a colloid or crystalloid
solution. The blood obtained is then reinfused after
surgery.)

Complications of donation.
o Because of the loss of blood volume, hypotension
and syncope may occur when the donor assumes an
erect position.
o A donor who appears pale or complains of faintness
should immediately lie down or sit with the head
lowered below the knees. He or she should be
observed for another 30 minutes.
Blood processing (check for diseases such as hepatitis B,C,
AIDS, Others and check ABO and Rh Antigen)
o The majority of transfusion reactions are due to clerical
error where the patient is transfused an incompatible unit
of blood product (McCullough et al., 2015).
o Immunocompromised, any donor lymphocytes must be
removed from the blood components (Irradiated blood)

Transfusion
Common settings
Pretransfusion assessment
Patient education (very important, benefits and risks
before consent form obtained)

Transfusion Process: PRBC

Transfusion Process: Platelet

Transfusion Complications
Febrile nonhemolytic
reaction (most common
from donor leucocytes)
Acute hemolytic reaction
(Most dangerous & fatal)
(occurs when the donor
blood is incompatible with
that of the recipient)
Allergic reaction (hives)
Circulatory overload
Bacterial contamination
Transfusion-related acute
lung injury
Delayed hemolytic
reaction
Disease acquisition
Long-term transfusion
therapy (Iron overload)

Nursing Management for Reactions
Stop
Assess
Notify primary provider and implement prescribed
treatments. Continue to monitor
Return blood
Obtain any samples needed
Document

Transfusion Alternatives
Refer to Chart 32-6
Growth factors
Erythropoietin
Granulocyte colony-stimulating factor
Granulocyte-macrophage colony-stimulating factor
Thrombopoietin

Quiz
A nurse is caring for a patient who undergoing
preliminary testing for a hematologic disorder. What sign
or symptom most likely suggests a potential hematologic
disorder?
A) Sudden change in level of consciousness (LOC)
B) Recurrent infections
C) Anaphylaxis
D) Severe fatigue

PPT_Chapter32 B

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