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• Disorders of the Hematopoietic System • A rare disorder, combo of

○ Julie Mann, NP thrombocytopenia, hemolytic anemia,

○ N145 renal failure, fever, and neuro
• Case #1 abnormalities. May result from platelet-
○ Mr. Jones has been on Heparin therapy as a aggregating substances (molecular
result of his recent atrial fibrillation substances that naturally occur).
○ For your info: Test - Platelet count,
episode. He develops purple discolorations
of the skin. anticipate an order to stop heparin and get
○ What might be causing this? a bag o' platelets. May give lovenox. Avoid
needlesticks, leaving BP cuff on. Initiate
• Bleeding into skin tissue, not clotting
falls precautions, avoid injury.
well, therefore thrombocytopenia
• Case Study 2
• Thrombocytopenia
○ Mr. Larson has a history of peptic ulcers
○ A decrease in the number of platelets
○ The greater the decrease the bigger the and hemorrhoids. He is a new vegetarian (9
months) and he complains of fatigue and
risk of bleeding
dyspnea. He also states he has periods
○ Three causes:
where he feels his heart racing.
• decreased production • Fatigue and dyspnea, r/t decreased O2
• increased sequestration of platelets in from lack of iron.
the spleen. • Higher risk r/t bleeding - peptic ulcers,
• decreased platelet survival hemorrhoids.
• Other types of thrombocytopenia ○ Give Iron pills (don't give with calcium),
○ Drug-induced thrombocytopenia teach how to eat with iron,
• Produce and antigen-antibody response • Anemia
(quinine, quinidine, some sulfa drugs) ○ abnormally low circulating RBC or
○ Heparin-induced thrombocytopenia hemoglobin, or both
(common in hospital) ○ results in diminished oxygen-carrying
• Immune reaction, antibody-platelet capacity
complexes are made, activation of ○ Related to:
other platelets, thrombosis. • excessive bleeding
○ Immune thrombocyticytopenic purpura
• destruction of RBC’s
• Autoimmune platelet antibody
• deficient production of RBC’s
formation and excess destruction of
platelets. • Types of Anemia’s
○ thrombotic thrombocytopenic purpura ○ Blood Loss Anemia
• Acute (not tolerated as well) or Chronic • Chemo can alter RBC, WBC (don't want
○ Hemolytic Anemias: premature destruction infex)
of RBC's. • Considerations: Neutropenic diet (no
• Transfusion reactions fresh fruits/vegies, must be cooked
• Mechanical injury well, pasteurized), no flowers, stimulate
• Sickle Cell Disease WBC, universal precautions for nurses,
visitors, doctors, gowns.
• Types of Anemias
○ Iron-Deficiency Anemia: • Neutropenia
○ decrease in the absolute number of
• Dietary deficiency, loss of iron in
leukocytes in the blood
bleeding, or increased demands. Iron is ○ usually a decrease in the number of
component in heme, low levels
decrease hemoglobin synthesis, impair
○ Causes:
O2 delivery.
○ Megaloblastic Anemias: • decreased neutrophil production
• Vitamin B-12 Anemia • accelerated utilization or destruction
 B12 is essential for RBC • shift from the blood to the tissue
maturation; deficiency leads to compartments
large, immature RBC's with a short • Acquired Neutropenia
life span. ○ Autoimmune Neutropenia
• Folic Acid-Deficiency Anemia • Antibodies against the neutrophils or
 Folic acid is essential for RBC the bone marrow. Can be primary
maturation; deficiency leads to (childhood) or secondary (related to
large, immature RBC's with a short other autoimmune process, RA, lupis).
life span. ○ Infection-Related Neutropenia
○ Aplastic Anemia • Affect either auto-antibody production
• A disorder of the stem cells in the bone or infects bone marrow and
marrow. Bone marrow can't replace the splenomegaly. Common in AIDS.
RBC's. ○ Drug-Related Neutropenia
• Case 3 • Mostly seen with chemotherapy-
○ Ms. Sally is receiving radiation and induced neutropenia.
chemotherapy for her Stage IV breast CA. • Clinical Course
○ She has a CBC, why are these lab results ○ Mild to Moderate
important? • Mild Skin Lesions
• Stomatitis (mouth sores)
•Pharyngitis (inflammation of pharynx) • intermediate or fast growing: also have
• Diarrhea constitutional symptoms of fever, night
○ Severe sweats, or weight loss.
• malaise • Hodgkin Lymphoma
• fever ○ Reed-Sternberg cells multiplying in affected

• chills lymph node

○ Usually arises in a single node or chain
• weakness
○ cause is unknown, generally poor
• fatigue
○ painless enlargement of a node or group of
Cancers nodes
• Lymphoma ○ Usually occur above waist, often picked up
○ malignancies that arise from the peripheral on Xray
lymph tissues ○ other symptoms (fatigue, anemia) indicate
○ Both forms involve: disease spread
• uncontrolled lymph node and tissue • HIV
growth ○ A retrovirus that destroys the body’s
• bone marrow involvement immune cells, takes over and destroys the
• constitutional symptoms (fever, CD4 T-cells (Thelper cells)
fatigue, weight loss) ○ Transmission: sexual contact, blood-to-
• Non-Hodgkin Lymphoma blood contact, pregnancy perinatally.
○ cause is unknown ○ HIV infected person is infectious even when
○ Either a T cell or B cell neoplasm no symptoms are present. (window period)
• Within each it is either fast growing • Phases of HIV Infections
(notice lymph node enlargement, fever, ○ Primary Infection Phase:
night sweats) or slow growing • An acute mono like illness. (fever,
(insidious, not noticed) fatigue, malaise, myalgias, sore throat,
○ usually originates in the lymph nodes but night sweats, GI problems,
can originate in the lymph tissue lymphadenopathy, maculopapular rash,
○ clinical manifestations depend on the type HA).
of lymphoma • Increased viral replication decreased
• slow growing: painless CD4 T-cell count. Appears 1-4 weeks
lymphadenopathy after exposure; lasts 7-10 days. Then
CD4 count drops to lower level and • HIV associated neurocognitive
maintains for years. disorders
• Try to catch at this point for more  Impaired attention and
chances to address illness. concentration, slow mental speed
○ Chronic Asymptomatic or latent phase: and agility, slow motor speed,
• CD4 count drops gradually. Some apathetic behavior.
people have lymphadenopathy. This • Toxoplasmosis (not as common now,
phase lasts for about 10 years. once was)
○ AIDS phase:  Parasitic infection (opportunistic),
• CD4 count very low or the development affects the CNS. (fever, HA,
of an AIDS-defining illness. Without confusion, lethargy, visual
treatment this phase will lead to death disturbances, and seizures)
in 2-3 years. High risk for opportunistic • Progressive Multifocal
infections. Leukoencephalopathy
 Demyelinating disease of the white
• Clinical Course
○ Opportunistic Infections: matter of the brain. Caused by a
virus. (progressive limb weakness,
• May be fungal, bacterial, parasitic,
subtle changes in mental status,
viral, etc.
hemiparesis, ataxia, diplopia, and
○ Respiratory Manifestations
• P. jiroveci pneumonia (aka
• Clinical Manifestations
Pneumocystic carinii pneumonia)
○ Cancers and Malignancies
 Inhaled pathogen from soil,
opportunistic (normally not an • Kaposi Sarcoma
issue with healthy individuals)  Malignancy of the endothelial lining
• Mycobacterium tuberculosis of the small blood vessels. Lesions
 This is the leading cause of death in the skin, lungs, and GI tract
in HIV patients worldwide. • Non-Hodgkin Lymphoma
 Becoming resistant to treatment. • Noninvasive cervical and anal
• Clinical Course carcinoma: HPV
○ Gastrointestinal Manifestations ○ Wasting Syndrome
• Esophageal candidiasis, CMV infection, • Involuntary weight loss >10%, diarrhea
herpes simplex virus. Also diarrhea and >2x's a day, chronic weakness, fatigue.
○ Nervous System Manifestations