► HEMATOLOGY

– the scientific study of the structure and functions of blood in health and in disease.

► BLOOD

– is the circulatory fluid of the CV system which is circulating constantly through a closed circuit of tubes.

► FUNCTIONS: ► supply

oxygen from the lungs and absorbed nutrients from the GIT to the cells ► remove waste products from tissues to the kidneys, skin and lungs for excretion ► transport hormones from their origin in the endocrine glands to other parts of the body ► protect the body form dangerous microorganism ► promote Hemostasis ( to stop bleeding) ► regulate body temperature by heat transfer – vasoconstriction and

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CHARACTERISTICS: Color
 Arterial Blood  Venous Blood

Viscosity – 3-4 times more viscous than water ► pH – 7.35-7.45 ► Specific gravity - 1.048 to 1.066 ( 1.055 – 1.065) ► Volume – 5 liters or approx. 7-8% of the body weight of an average-sized adult ► Composition ► Liquid phase: PLASMA (55%) ► - A light yellow substance which is one of the major fluids of the body. Major function is to maintain the blood volume within the vascular compartment.

prothrombin) ► Electrolytes (.Ca 2+.. CIˉ).g. hormones . vitamins.. ► Miscellaneous (less than 1%): sugars. Na+. fats. fibrinogen. HCO3ˉ.► 92% Water ► 7% Proteins ( albumingammaglobulins.

Erythrocytes/ RBC ► Solid phase: formed elements (45%) Are biconcave discs (AKA discocytes) which are less than 7. responsible for 72% of CO2 transport LIFESPAN ► ► ► .5 micrometers in diameter. Carries about 200-300 million molecules of hemoglobin (hemeglobin-iron) that attach oxygen within each RBC. responsible for 97% of O2 transport Contains carbonic anhydrase that joins CO2 to water that eventually dissociates.

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and traces of copper . CHON. Precursor cells 2. pyridoxine. Proper microenvironment 3. Folic acid. Adequate supplies of Iron.Erythropoiesis Requirements in the prdxn: 1. B12.

Hematopoietic stem cells Poietin Stimulation Differentiation Immature erythrocytes Leave the bone marrow via veins and enter general circulation or nucleated reticulocyte Travel the spleen Undergo conditioning and evolve to mature erythrocytes Released to general circulation .

.Leukocytes/ WBC ► Whitish in color because they lack hemoglobin. ► Classified according to microscopic appearancepresence or visibility of granules.

Granulocytes  Neutrophils First line of defense. Induces IgE mediated allergic reactions . Releases histamine and heparin and chemotactic factor for eosinophils. Usually activated during parasitic invasion (Schistosomes / blood flukes). they are mediators in inflammatory process. Lifespan= hours to 3 days Modulates or reduce IgE mediated allergic reactions Basophils not phagocytic in nature. elevated during asthma attacks. most common type of leukocyte but a short lifespan of only 10-12 hours making them ineffective in destroying infectious agents Helpful in localizing the infection and in immobilizing the pathogens until other WBCs arrive Eosinophils Weak phagocytic action.

cells – differentiated in the Thymus and lives long cell-mediated response b.poorly understood in killing tumor cells and virally infected cells. it is just a hypoactive phagocytic cell.cells – differentiated in the bone marrow. T. Monocytes .upon release in the bone marrow and travel to the different tissues.cells / natural killers / null lymphocytes. antibody-mediated immune response (Humoral) c. NK.Agranulocytes 1. 2. become a Macrophage when it attaches to the endothelium of organs and performs its full phagocytic function. B. . Lymphocytes a.

Thrombocytes/ Platelets -functions: (1) occlude small openings of blood vessels. (2) provision of chemical components in the molecular cascade leading to coagulation .

it is accomplished in the liver. ribs. it is confined in the red bone marrow ( but some WBCs are still produced in the lymphatic tissues). clavicle. sternum. Cell differentiation gives rise to . and vertebrae. lymph nodes and red bone marrow. sometimes occurring in the proximal ends of long bones (humerus and femur) all formed elements come from one stem cell or the HEMOCYTOBLAST. hematopoiesis becomes localized within the flatbones of the sternum.HEMATOPOIESIS      process of blood cell production. spleen. thymus. After birth. ilium. vertebrae. all blood cells are essentially produced in marrow sites of the flatbones of the skull. during childhood. and pelvis After puberty. at birth. ribs.

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immune response is diminished in both very young and very old . Sex .because some laboratory results are sex-specific . bleeding expressed among males . more prevalence of agranulocytosis .hemophilia.anemia prevalence increases with age . Risk Factor Analysis • Non-Modifiable Assessment of the Hematologic System a.women have lower hemoglobin and hematocrit levels.because some laboratory results are age.folic acid deficiency in growth spurt (infants and adolescents) .specific b.1. Age .

c.Blacks have lower hemoglobin levels than whites (more prevalent sickle cell anemia) . Race .

Family history . bleeding disorders (hemophilia and Von Willebrand’s Dse). autoimmune dse (aplastic anemia. pernicious anemia) e. cancer. delayed healing. infections.because some hematologic disorders are inherited -Anemia. Jaundice.d. Congenital lack of the intrinsic factor . thrombocytopenia. Congenital Blood Disorder (Sickle Cell anemia).

g benzene.Drugs (chloramphenicol.) . sulfonamide. nitrites.Chemical Oxidants (e.• Modifiable a. arsenic. hair dyes . streptomycin. Exposure to certain chemical and drugs . etc.Anti-neoplastic drugs/ chemotherapy . lead. anticonvulsant.Radiation overexposure .

onset  abrupt or gradual?  since childhood or recent allergen triggered response? Seasonal? How long do the allergic manifestations last? Relieved or persist once the allergen is removed? . History – Chief complaint • Disorders of the hematologic system often affects all organs and tissues • Determine: .2.

voice changes.quality and quantity= how severe? Massive bleeding? How long does it last? How long do the bleeding episodes last and how severe they are? Does blood ooze from a site or does sudden massive bleeding occur? How often do bleeding episodes occur and how long do they last? What does the client do to stop them? Is there any break in skin integrity? Swelling? Edema? Fever? Pain? Tenderness? Pruritus? Redness? Or drainage? Note allergic manifestations such as rhinitis. hoarseness. postnasal drip. nasal stuffiness. wheezing. sneezing. dyspnea. malaise. sore throat. tearing . fatigue. persistent cough.

severity and location= rest can alleviate fatigue? Bleeding of joints?  Can rest alleviate fatigue? (s/sx of anemia)  Ask how activities and activity tolerance changed over time  Does the client bruise easily?  Has bleeding in the joints?  Number and saturation of sanitary pads  anaphylactic reactions? Or simple allergic response? .

vaccine and insect venom) aggravating and relieving factors  salicylates containing OTC may aggravate bleeding  what relieves allergic manifestations .precipitating factors  Anticoagulant? – bleeding  Bone Marrow suppression – anemia. and thrombocytopenia  Antineoplastic drugs? Antibiotics? Radiation?  Infectious agents? Corticosteroids or immunosuppressive drugs?  Allergic triggers (inhalants such as pollens and dust. injectable agents such as drugs. ingested agents such as foods and drugs. leukemia. contact agents such as dyes and cosmetics.

Major illnesses and hospitalization • Previous hematologic problems • Surgical procedures that may affect the hematologic system • Liver problems • Any bleeding disorders .3. Past Medical History a.

aspirin. Medications. Allergies. Family History . antineoplastic drugs c. chloramphenicol.How long was the bleeding problem? Do any members of the family have a history of bleeding? Is bleeding linked with any specific event or procedure? Does it occur with menses or following minor trauma? Any frequency of nose bleeding? Does he bruise easily? Any petechiae? How severe are any of the bleeding episodes? What is the durations? Any history of hepatic/ splenic or renal disease? Recently taken medications? b.Hx of allergies and BT and/reactions d.

Habits. alcohol abuse .exposure to chemicals and radiation b. Psychosocial Hx and Lifestyle a.4. Occupation.nutritional. substance abuse.

dry skin. brittle. - Review of Systems/ Physical Examination SKIN pallor ruddy skin jaundice .1. spoon shaped with longitudinal ridges .

pruritus .petechiae purpura and ecchymoses rashes. urticaria.

2.blindness (retinal hemorrhage related to thrombocytopenia and bleeding do) .visual disturbances (anemia and polycythemia) .bleeding in auditory canal (bleeding do) 4.vertigo.scleral jaundice (hemolytic anemia) 3. NOSE . tinnitus (severe anemia) .epistaxis (thrombocytopenia and bleeding disorders) . EARS . EYES .

smooth. anemia) .► ► ► 5. glossy. bright red tongue and sore tongue (pernicious and Fe def. MOUTH . .gingival bleeding (thrombocytopenia and bleeding disorders) .

hepatomegaly. splenomegaly (hemolytic anemia) .dysphagia (mucous membrane atrophy due to iron def. GIT . angina (anemia) 8. CARDIOVASCULAR SYSTEM . murmurs. orthopnea (anemia) 7. anemia) .abdominal pain( bleeding) . melena (thrombocytopenia and bleeding disorders) .hematemesis.dyspnea.6.tachycardia. palpitation. LUNGS .

MUSCULOSKELETAL . paresthesis. NERVOUS SYSTEM -headache. confusion (anemia.hematuria (bleeding disorders) -amenorrhea and menorrhagia (iron def.9. and bleeding do) 10. loss of balance (pernicious .backpain (hemolysis) . polycythemia) -brain hemorrhage (thrombocytopenia and bleeding disorders) -peripheral neuropathy.joint pain (hemophilia) -sternal tenderness and bone pain (sickle cell crisis) 11. GUT .

oozing of blood from cuts and venipuncture sites. vagina. anorectal. hematuria and back and flank pain Hemophilia – lifelong bleeding tendencies such as excessive bleeding and circumcision or dental extraction. genitourinary. headache or vertigo Bleeding d/o –petechiae. respiratory). and rectum. diarrhea . gingival. jaundice. conjunctival hematemesis. purpura and ecchymosis. severe anemia manifests with chronic severe fatigue. weakness and lightheadedness. spontaneous bleeding from the nose. exertional dyspnea.► ► ► ► Anemia – characterized by paloor. poor wound healing. repeated episodes of spontaneous bleeding into joints and lifethreatening bleeding Immunodeficiencies – hx of recurrent infxns esp of mucous membranes (oral cavity.

MCV (mean corpuscular volume) b. to diagnose anemia and ploycythemia b.measure RBC size and hemoglobin content a. WBC Differential count. used also to diagnose anemia and ploycythemia and abnormal hydration states d. to measure the oxygen-carrying capacity of the blood c. Hematocrit – expressed in %. measures the volume of RBCs in proportion to plasma. to diagnose thrombocytopenia and subsequent bleeding tendencies f. RBC count. Hemoglobin. to detect infection or inflammation g. MCH (mean corpuscular hemoglobin) c. RBC indices. MCHC (mean corpuscular hemoglobin concentrarion) e.# of Platelet/ mm3. Complete Blood Count a. used to classify leukemias .DIAGNOSTIC PROCEDURES: 1. WBC count.of WBCs/ mm3 of blood. Platelet count.# of RBCs/ mm3 of blood.# of grams of hgb/ 100ml of blood.determines proportion of each WBC in a sample of 100 WBCs.

to determine the variations/ abnormality in RBCs. Picture 4 Peripheral Blood Smear. WBCs and Platelets: normal size and shape (normocytes) and normal color (normochromic) Normocytic-normochromic .► 2.

5.used to determine the responsiveness of the bone marrow to the depletion of circulating RBCs (probably due to hemolytic anemia or hemorrhage) . test umbilical cord for Erythroblastosis fetalis and diagnose acquired hemolytic anemia 4. RETICULOCYTE COUNT .3. DIRECT ANTIGLOBULIN EST (Coomb’s Test) – used in cross matching blood when transfusion reaction occurs. INDIRECT ANTIGLOBULIN TESTidentifies antibodies to RBC antigens in the serum of clients who have greater than normal chance of developing transfusion reactions.

WBCs and platelet precursors and to examine various maturational abnormalities.Bone Marrow Aspiration BONE MARROW ASPIRATION and BIOPSY.used to determine size and shape of RBCs. .

apply ice on the contralateral side relieve pain Postprocedure .inform client of pain or of what to expect .place patient in lateral site of aspiration .check site frequently for bleeding .clean pt’s skin with antiseptic sol’n . with uppermost numb tissues to .administer local anesthesia to skin and subcutaneous .apply pressure until bleeding stops . obtain consent .give sedatives as ordered Procedure position.explain the purpose.NURSING RESP: Preprocedure .

X (Stuart-Power factor). prothrombin and fibrinogen. used to determine dosages of oral anti-coagulant.7. c. prothrombin and fibrinogen. Bleeding Time – measures the ability to stop bleeding after small puncture wound b. COAGULATION SCREENING TESTS a. monitors heparin therapy. Prothrombin Time (Pro-time) – determines activity and interaction of the Prothrombin group: factors V (preacclerin). Partial Thromboplastin Time (PTT) – used to identify deficiencies of coagulation factors. . VII (proconvertin).

CBC Normal Values RBC: Women – 4.000/mm3 .2-5.7-6.0% Agranulocytes Lymphocytes: 20-40% Monocytes: 2-8% Platelets: 150.5-18 g/dl Hct : Women – 37-47% Men – 42-52% WBC: 4000-9000/mm3 Granulocytes Neutrophils: 55-70% Eosinophils: 1-4% Basophils: 0.000-450.5-1.4 million/mm3 Men – 4.1 million/mm3 Hgb: Women – 12-16 g/dl Men – 13.

Prothrombin Time (PT): 12-14 sec. .75-8 min Partial Thromboplastin Time (PTT): 2035 sec.Peripheral Blood Smear: Normocytic. Normochromic Coomb’s Test: Direct – Negative Indirect – Negative Reticulocytes: 25-75 x 10 9/L Bleeding Time: 2.

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