1 / 35

Hematology

Hematology. By Joyce Smith RN BSN. Introduction. Red Blood Cell Disorders White Blood Cell Disorders Coagulation Disorders Clotting Factor Disorders. RBC Destruction: Sickle Cell Disease. Hereditary, chronic form of anemia Abnormal sickle or crescent-shaped erythrocytes are present

Jims
Télécharger la présentation

Hematology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hematology By Joyce Smith RN BSN

  2. Introduction • Red Blood Cell Disorders • White Blood Cell Disorders • Coagulation Disorders • Clotting Factor Disorders

  3. RBC Destruction: Sickle Cell Disease • Hereditary, chronic form of anemia • Abnormal sickle or crescent-shaped erythrocytes are present • D/t abnormal Hemoglobin S (Hb S) in the RBCs • High presence of disease in Mediterranean & African population & African American population in US

  4. Sickle Cell Disease • Sickle Cell Crisis • Exact cause of sickling crisis unknown • 2 factors 1. Hypoxia caused by  O2 tension in blood 2.  blood viscosity/ plasma volume,  hydrogen ion concentration, &  plasma osmolality, caused by concentration of cells & dehydration

  5. Sickle Cell Crisis • Sickle cell interferes with O2 transport • Obstruction of capillary blood flow • Causes fever & severe pain in joints & abdomen • Crisis is precipitated by  O2

  6. Diagnostic Tests • Stained blood smear • Sickle cell observed • Sickle cell preparation of blood • Sickling noted after deoxygenation • Sickle solubility test • Turbid solution indicates presence of Hb S

  7. Diagnostic Tests • Hemoglobin electrophoresis • Presence of Hb S & Hb A indicates sickle cell trait < 40% Hb S • Presence of Hb S only indicates sickle cell anemia 85-95% • Erythrocyte life span • Decreased 10 to 20 days

  8. Hemolytic anemia Pallor Jaundice Fatigue Irritability Extensive Sickling Vaso-occlusive or thrombotic crisis Aplastic Crisis Sequestration Crisis Hyperhemolytic Crisis Clinical Manifestations

  9. Health History • Previous crisis • Precipitating events • Severity • Usual treatment • Review of activities last 24 hours • Food & fluid intake • Exposure to temperature extremes • Type of clothing worn • Meds taken, ingestion of alcohol & recreational drugs • Exercise, trauma, stress

  10. Health History • Activity toleration • Fatigue • Activity intolerance • ADLs • Sleep & rest pattern • Climbing stairs • SOB • Measure on Likert scale 0-10

  11. Assess • Skin • Jaundice or Pallor, ulcerations • Skeletal structures • Joint swelling, disproportionably long arms & legs, skeletal fragility • GI function • Enlarged liver & spleen

  12. Assess • Comfort • Bone, abdominal pain • Cardiac Function • Systolic murmurs, tachycardia, dysrthythmias, cardiac enlargement, hyportension,  pulse pressure • Respiratory Function • Dyspnea, acute respiratory distress

  13. Assess • Sensory Function • Altered LOC, abnormal pupillary response, abnormal reflexes • Renal Function • Decreased UO, edema • Sexuality • Delayed sexual maturity

  14. General Management • Supportive Care • Rest • O2 therapy • IV fluids & e’lytes • Analgesics • Sedatives • Blood transfusion • Genetic counseling

  15. Drug Therapy • Experimental use of antisickling agents • Hydroxyurea • Erythropoientin • Nitric Oxide • Flurocor • Oral administration • Folic acid &/or Fe • Bone Marrow Transplant • Gene Replacement Therapy

  16. Immunohemolytic Anemiaor Autoimmune Hemolytic Anemia •  RBC hemolysis due to attack by own immune system • Attacks antigen on RBC cell membrane • Against universal component of Rh system • Immune system is not able to recognize self as normally would • Cause may be infections, drug reactions, and certain cancers • Hemolytic anemia of newborn can occur with a Rh neg mother and Rh positive baby • Blood transfusions can also cause a problem

  17. Immunohemolytic Anemiaor Autoimmune Hemolytic Anemia • Signs and symptoms • Pallor • Fatigue • Tachycardia • Shortness of breath • Hypotension

  18. Treatment • Glucocorticoids for mild to moderate immune suppression • Cytoxin, Imuran • Plasma exchange therapy • Splenectomy • Transfusion limited or no benefit

  19. PERNICIOUS ANEMIA or Vitamin B 12 Deficiency

  20. Vitamin B12 Deficiency • Rare chronic progressive condition • Abnormal formation & function of RBCs • Inadequate intake or inability to absorb Vitamin B12 • Fatal if not treated

  21. A & P • Can be results of atrophied parietal cells in the stomach • Absence of intrinsic factor (IF), preventing absorption of B12 • IF secreted by parietal cells gastric mucosa • B12 absorbed in distal ileum • Digested B12 attached to IF in stomach, able to pass into blood stream in ileum

  22. A & P • If not attached to IF, B12 passed through the body through the stool • Insidious onset, several months for symptoms to manifest

  23. Symptoms • Affect 3 major body systems • Hematopoietic system • Fatigue • Dizziness • Ringing in ears • Pale or yellowish skin • ^ HR, enlarged heart with murmur • Chest pain

  24. Symptoms • GI system • Sore, beefy red tongue • Loss of appetite, Weight loss • Diarrhea & abd cramping

  25. Symptoms • Nervous system • Numbness, tingling, & burning in arms, legs & feet • Muscle weakness • Difficulty & loss of balance while walking • Changes in reflexes • Irritability, confusion & depression

  26. Diagnostic Tests • CBC abnormally large RBCs, may be abnormal shaped, retic ct. low • WBC may be decreased • Gastric analysis: NG inserted & gastric contents aspirated, acholohydria • Gastorscopy with biopsy: assess parietal cell atrophy R/O CA

  27. Diagnostic Tests • Schilling test: Patient given Injection to saturate liver • Radioactive B12 orally • 24 hour urine collection • Impaired absorption radioactive B12 will not be excreted in urine

  28. Treatment • Prognosis good if treatment started • Up to 18 month for improvement • Dietary replacement if absorption normal • Red meat, liver, fish, poultry, shellfish, milk, dairy products, eggs, some fortified foods

  29. Treatment • If absorption abnormal Cynocobalamine IM 200ug/d X 2 weeks, Biweekly for 2 weeks, & monthly for life • Stop smoking, maintain ideal weight, teaching for med. Action, side effects, daily skin care, mouth & foot care, assess for breakdown, alt. Rest & activity, promote safe environment, avoid heat pad etc.

  30. Folic Acid Deficiency • Vitamin B complex • Seen in alcoholism, malabsorption syndromes, & pregnancy • Most prevalent in infants, adolescents, pregnant & lactating females, alcoholics & elderly • Increase incidence of drugs use during pregnancy

  31. Food Sources • Found in asparagus spears, beef liver, broccoli, collards, mushrooms, oatmeal, peanut butter, red beans, wheat germ

  32. Clinical Manifestations • Develop slowly over a period of months • Symptoms related to tissue hypoxia • Glossitis • Jaundice • Spleenomegaly

  33. Treatment • Administer folic acid every day until deficiency is corrected • High dises to patients with malabsorption problems • Folvite ; adults 250 to 1,000 mcg/d until hematological responses increases • Maintainance 400 mcg/day X 2

More Related