ANATOMY AND PHYSIOLOGY: HEMATOLOGY THE CHILD WITH ALTERATION IN OXYGENATION:

TRANSPORT
 The Hematologic System is made up of the Blood, the
Spleen, Bone Marrow, and the Liver DISORDERS AFFECTING RBC
 The principal component of the hematologic system is the
blood. IRON DEFICIENCY ANEMIA
 Blood is made up of three main components: red blood  is a common type of anemia- a condition in which blood
cells, white blood cells, and plasma. lacks adequate healthy red blood cells.
 Red blood cells, erythrocytes, are the most common blood  Red blood cells carry oxygen to the body's tissues.
cells. They appear as discs with an indent in the surface,  As the name implies, iron deficiency anemia is due to
and they lack a nucleus. insufficient iron.
 White Blood Cells, or leukocytes, are one of the  Without enough iron, your body can't produce enough of a
body's defenses. substance in red blood cells that enables them to carry
 There are two types: granulocytes and agranulocytes. oxygen (hemoglobin).
 As a result, iron deficiency anemia may leave you tired
There are seven types of leukocytes. and short of breath.
 Neutrophils  Initially, iron deficiency anemia can be so mild that it goes
 Eosinophils unnoticed. But as the body becomes more deficient in iron
 Basophils and anemia worsens, the signs and symptoms intensify.
 Extreme fatigue
 Neutrophils fight bacteria and fungi.  Pale skin
 Eosinophils fight larger parasites and  modulate the  Weakness
inflammatory response with allergies.  Shortness of breath
 Basophils release histamine to induce an  Chest pain
inflammatory response.  Frequent infections
 Headache
There are three types of lymphocytes:  Dizziness or lightheadedness
 B Cells, T Cells, and Natural Killer Cells.  Cold hands and
 B Cells release antibodies and assist T Cell activation.  feet Inflammation
 T Cells can be regulatory, which cause the body to return  soreness of your tongue
to normal after an inflammatory response, they can  Brittle nails
activate and regulate B and T Cells, or they can attack  Fast heartbeat
virus infected or cancer cells.  Unusual cravings for non-nutritive substances,
such as ice, dirt or starch
 Natural killer cells attack virus infected and tumor cells as
 Poor appetite, especially in infants and children
well.
with iron deficiency anemia
 uncomfortable tingling or crawling feeling in your
 Monocytes move to tissues and then differentiate into
legs (restless legs syndrome)
macrophages.
 Macrophages are phagocytic cells, and they eat cellular
 Iron deficiency anemia occurs when your body doesn't
waste, debris, and pathogens.
have enough iron to produce hemoglobin.
 They also stimulate lymphocytes. 
 Blood loss- such as from a peptic ulcer, a hiatal hernia, a
colon polyp or colorectal cancer
 Plasma is a fluid made up of 90% of water, in which blood
 Gastrointestinal bleeding can result from regular use
is suspended.
of some over-the-counter pain relievers, especially
 Plasma allows blood cells to travel through vessels, in the aspirin.
water it contains.
 A lack of iron in your diet.
 Plasma is also made up of minerals, nutrients, and
 An inability to absorb iron- Iron from food is absorbed into
electrolytes.
your bloodstream in your small intestine. (celiac disease)
 Platelets are cells which are critical to blood clotting.
 Pregnancy. Without iron supplementation

 The spleen is an important organ: it acts as a reservoir for RISK FACTORS

blood, and it filters out erythrocytes that can no longer  Women.
carry out their function.  Infants and children.
 And it can still be removed, and the only side effects  Vegetarians.
would be an slight increase in white blood cells, and  Frequent blood donors.
platelets, and increased susceptibility to some diseases.
 With respect to the Hematologic System, the Liver  Because women lose blood during menstruation,
detoxifies the blood.  women in general are at greater risk of iron deficiency
anemia.
 Infants, especially those who were low birth weight or
born prematurely, who don't get enough iron from
 breast milk or formula may be at risk of iron
deficiency.
 People who don't eat meat may have a greater risk of
iron deficiency anemia if they don't eat other iron-rich
foods.
 People who routinely donate blood may have an
increased risk of iron deficiency anemia since blood
donation can deplete iron stores.
TESTS AND DIAGNOSTICS
 Red blood cell size and color.
 Hematocrit.
 With iron deficiency anemia, red blood cells are
smaller and paler in color than normal.
 This is the percentage of your blood volume made up
by red blood cells. Normal levels are generally
between 34.9 and 44.5 percent for adult women and
38.8 to 50 percent for adult men.
 Hemoglobin. Lower than normal hemoglobin levels
indicate anemia. The normal hemoglobin range is
generally defined as 13.5 to 17.5 grams (g) of hemoglobin
per deciliter (dL) of blood for men and 12.0 to 15.5 g/dL for
women.
 Ferritin.
 This protein helps store iron in your body, and a low
level of ferritin usually indicates a low level of stored
iron.
TREATMENTS
 Iron supplementation
 Take iron tablets on an empty stomach.
 Don't take iron with antacids.
 Take iron tablets with vitamin C.
 Vitamin C improves the absorption of iron. Your doctor
might recommend taking your iron tablets with a glass
of orange juice or with a vitamin C supplement.
 Treating underlying causes of iron deficiency
NURSING CARE
 Choose iron-rich foods
 Choose foods containing vitamin C to enhance iron
absorption
 Preventing iron deficiency anemia in infants
 Feed your baby breast milk or iron-fortified formula for
the first year.
 Between the ages of 4 and 6 months, start feeding
your baby iron-fortified cereals or pureed meats at
least twice a day to boost iron intake.
 After one year, be sure children don't drink more than
24 ounces of milk a day.
PERNICIOUS ANEMIA
 is an autoimmune disorder in which the body fails to make
enough healthy red blood cells (RBCs).
 Vitamin B-12, or cobalamin, is found in certain foods and
medications.
 IF is a protein made by the stomach’s mucosal (mucus-
secreting) cells, called parietal cells.
 When vitamin B-12 enters the body, it binds with IF. The
two are then absorbed in the last part of the small
intestine.
 The body requires vitamin B-12 and a type of protein
called intrinsic factor (IF) to make red blood cells.
CAUSES
 PA is a type of macrocytic anemia and is sometimes
called megaloblastic anemia.
 long-term use of certain medications and antibiotics
(methotrexate, azathioprine, etc.)
 chronic obstructive pulmonary disease (COPD)
 folate deficiency caused by poor intake or malabsorption
 Because of the large size of the red blood cells
produced. Anemia is a medical condition in which the
blood is low in normal red blood cells.
SIGNS AND SYMPTOMS
 The progression of PA is very slow, making it difficult for
patients to recognize symptoms because they have grown
accustomed to feeling “unwell.”
Commonly overlooked symptoms include:
 weakness
 headaches
 chest pain
 weight loss
In rare cases of PA, patients may display neurological
symptoms including:
 unsteady gait
 spasticity peripheral neuropathy
 progressive lesions of the spinal cord
 memory loss
 (stiffness and tightness in the muscles)
 (damage to the nerves in your arms and legs)
TESTS AND DIAGNOSTICS
 complete blood count (CBC) test
 vitamin B-12 deficiency test
 IF deficiency test
 proof of stomach destruction
 Hemoglobin
 hematocrit -
 hemoglobin - protein bound to oxygen to carry it
throughout the blood
 Hematocrit- used to measure how much space red
blood cells use within the blood
TREATMENT/MANAGEMENT
The treatment for PA is a two-part process:
 first, treat any existing vitamin B-12 deficiency and check
for iron-deficiency
 second, lifelong surveillance for long-term consequences  Alcohol interferes with folic acid absorption. It also
Treatment begins with: increases folate excretion through the urine.
 vitamin B-12 injections that are slowly decreased over
time
 blood test for iron deficiency followed by regular blood SIGNS AND SYMPTOMS
tests Symptoms of folic acid deficiency are often subtle. They
 CBC tests to measure serum cobalamin and ferritin levels include:
 blood tests to monitor replacement treatments  fatigue
 grey hair
 mouth sores
Symptoms of long-term damage include:  tongue swelling
 upset stomach  growth problems
 difficulty swallowing Symptoms of anemia caused by folic acid deficiency include:
 weight loss  persistent fatigue
 iron deficiency  lethargy
 pale skin
 tender tongue
FOLIC ACID DEFICIENCY
 irritability
 Folic acid, or folate
 diarrhea
 Folic acid deficiency can cause anemia.
 Folic acid is particularly important in women of TESTS AND DIAGNOSTICS
childbearing age.
 Folic acid deficiency is diagnosed with a blood test.
 A deficiency during pregnancy can lead to birth defects.
 Pregnant women will often have folate levels tested during
Most people get enough folic acid from food.
a prenatal checkup.
 Folic acid, or folate, is a type of B vitamin. It helps to:
TREATMENT AND MANAGEMENT
- repair DNA
 Treatment involves increasing dietary intake of folate.
- make DNA
 You can also take a folic acid supplement.
- produce red blood cells (RBCs)
 Folic acid is frequently combined with other B vitamins in
supplements.
CAUSES
 These may be called vitamin B complexes.
 Diet
 Alcohol intake should be decreased, and completely
 A diet low in fresh fruits, vegetables, and fortified
eliminated for pregnant women.
cereals is the main cause of folic acid deficiency.
 To prevent folic acid deficiency, eat a proper nutritious
 In addition, overcooking your food can sometimes
diet. Foods that contain high amounts of folate include:
destroy the vitamins.
 leafy green vegetables, such as broccoli and spinach
 Folic acid levels in your body can become low in just
 citrus
a few weeks, if you don’t eat enough folate-rich foods.
 fruit such as bananas and melons
 Disease
 tomato juice
 Diseases that affect absorption in the gastrointestinal
 eggs
tract can cause folic acid deficiencies. Such diseases
 beans and legumes
include:
 mushrooms
 Crohn’s disease
 The recommended folate dose is 400 micrograms per day.
 celiac disease
 Women who may become pregnant should take a folate
 Medication Side Effects
supplement. Folate is critical for normal fetal growth.
 Certain medications can cause folic acid deficiency.
These include:
 phenytoin (Dilantin)
SICKLE CELL ANEMIA
 trimethoprim-sulfamethoxazole
 sulfasalazine  inherited form of anemia — a condition in which there
aren't enough healthy red blood cells to carry adequate
 Celiac disease- serious autoimmune condition oxygen throughout your body.
disease that occurs in genetically predisposed people  the red blood cells become rigid and sticky and are
where in the ingestion of gluten leads to damage in shaped like sickles or crescent moons.
the small intestine.  These irregularly shaped cells can get stuck in small blood
 Gluten- substance present in cereals grains (protein) vessels, which can slow or block blood flow and oxygen to
especially wheat, responsible for the elastic texture of parts of the body.
the dough
 A mixture of 2 proteins can cause disease.  Normally, your red blood cells are flexible and round,
moving easily through your blood vessels.
 Excessive Alcohol Intake
 There's no cure for most people with sickle cell anemia.
 However, treatments can relieve pain and help prevent
further problems associated with sickle cell anemia.
SIGNS AND SYMPTOMS
 Anemia. Sickle cells are fragile. They break apart easily
and die, leaving you without a good supply of red blood
cells.
 Red blood cells usually live for about 120 days before
they die and need to be replaced.
 But sickle cells die after an average of less than 20
days.
 This results in a lasting shortage of red blood cells
(anemia).
 Episodes of pain. Periodic episodes of pain, called crises,
are a major symptom of sickle cell anemia.
 Hand-foot syndrome. Swollen hands and feet may be the
first signs of sickle cell anemia in babies.
 Frequent infections. Sickle cells can damage your spleen,
an organ that fights infection.
 Delayed growth. Red blood cells provide your body with
the oxygen and nutrients you need for growth. A shortage
of healthy red blood cells can slow growth in infants and
children and delay puberty in teenagers.
 Vision problems. Some people with sickle cell anemia
experience vision problems.
CAUSES
 caused by a mutation in the gene that tells your body to
make hemoglobin — the red, iron-rich compound that
gives blood its red color.
 With each pregnancy, two people with sickle cell traits
have:
 A 25 percent chance of having an unaffected child
with normal hemoglobin
 A 50 percent chance of having a child who also is a
carrier
 A 25 percent chance of having a child with sickle cell
anemia
RISK FACTORS
 The risk of inheriting sickle cell anemia comes down to
genetics.
 For a baby to be born with sickle cell anemia, both parents
must carry a sickle cell gene.
 The gene is more common in families that come from
Africa, India, Mediterranean countries, Saudi Arabia, the
Caribbean islands, and South and Central America.
 In the United States, it most commonly affects blacks.
TESTS AND DIAGNOSTICS
 New born screening
 A blood test can check for hemoglobin S — the defective
form of hemoglobin that underlies sickle cell anemia.
 In adults, a blood sample is drawn from a vein in the arm.
 In young children and babies, the blood sample is usually
collected from a finger or heel.
 The sample is then sent to a laboratory, where it's
screened for hemoglobin S.
Additional tests
 To confirm any diagnosis, a sample of blood is
examined under a microscope to check for large
numbers of sickle cells — a marker of the disease.
Tests to detect sickle cell genes before birth
 Sickle cell disease can be diagnosed in an unborn baby
by sampling some of the fluid surrounding the baby in the
mother's womb (amniotic fluid) to look for the sickle cell
gene.
TREATMENTS
 Bone marrow transplant offers the only potential cure for
sickle cell anemia. But finding a donor is difficult and the
procedure has serious risks associated with it, including
death.
 Treatments may include medications to reduce pain and
prevent complications, blood transfusions and
supplemental oxygen, as well as a bone marrow
transplant.
MEDICATIONS
 Antibiotics. Children with sickle cell anemia may begin
taking the antibiotic penicillin when they're about 2 months
of age and continue taking it until they're at least 5 years
old.
 Pain-relieving medications.
 Hydroxyurea (Droxia, Hydrea). When taken daily,
hydroxyurea reduces the frequency of painful crises and
may reduce the need for blood transfusions.
 Hydroxyurea seems to work by stimulating production of
fetal hemoglobin — a type of hemoglobin found in
newborns that helps prevent the formation of sickle cells.
 Assessing stroke risk
 Using a special ultrasound machine (transcranial),
doctors can learn which children have a higher risk of
stroke.
 Vaccinations to prevent infections
 Blood transfusions
 Supplemental oxygen
 Stem cell transplant
 also called a bone marrow transplant, involves
replacing bone marrow affected by sickle cell anemia
with healthy bone marrow from a donor.
NURSING CARE
 Take folic acid supplements daily, and choose a healthy
diet.
 Drink plenty of water.
 Avoid temperature extremes.
 Exercise regularly, but don't overdo it.
 Use over-the-counter medications with caution. Some
medications, such as the decongestant pseudoephedrine,
can constrict your blood vessels and make it harder for the
sickle cells to move through freely.
 Fly on airplanes with pressurized cabins. Unpressurized
aircraft cabins may not provide enough oxygen. Low
oxygen levels can trigger a sickle crisis.
 Plan ahead when traveling to high-altitude areas. There is
less oxygen at higher altitudes, so you may require
supplemental oxygen to avoid triggering a sickle cell crisis.
APLASTIC ANEMIA
 condition that occurs when your body stops producing
enough new blood cells.
 Aplastic anemia leaves you feeling fatigued and with a
higher risk of infections and uncontrolled bleeding.
 aplastic anemia can develop at any age.
 Aplastic anemia may occur suddenly, or it can occur
slowly and get worse over a long period of time.
 Treatment for aplastic anemia may include medications,
blood transfusions or a stem cell transplant.
SIGNS AND SYMPTOMS
 Fatigue
 Shortness of breath with exertion
 Rapid or irregular heart rate
 Pale skin
 Frequent or prolonged infections
 Unexplained or easy bruising
 Nosebleeds and bleeding gums
 Prolonged bleeding from cuts
 Skin rash
 Dizziness
 Headache
 Aplastic anemia can progress slowly over weeks or
months, or it may come on suddenly.
 The illness may be brief, or it may become chronic.
 Aplastic anemia can be very severe and even fatal.
CAUSES
 Aplastic anemia develops when damage occurs to your
bone marrow, slowing or shutting down the production of
new blood cells.
 Bone marrow is a red, spongy material inside your bones
that produces stem cells, which give rise to other cells.
 Stem cells in the bone marrow produce blood cells red
cells, white cells and platelets.
 In aplastic anemia, the bone marrow is described in
medical terms as aplastic or hypoplastic meaning that it's
empty (aplastic) or contains very few blood cells
(hypoplastic).
Factors that can temporarily or permanently injure bone
marrow and affect blood cell production include:
 Radiation and chemotherapy treatments.
 Exposure to toxic chemicals.
 Use of certain drugs- such as those used to treat
rheumatoid arthritis and some antibiotics, can cause
aplastic anemia.
 Autoimmune disorders.
 A viral infection.
 Pregnancy.
 Unknown factors.
RISK FACTORS
 Treatment with high-dose radiation or chemotherapy for
cancer
 Exposure to toxic chemicals
 The use of some prescription drugs — such as
chloramphenicol, which is used to treat bacterial
infections, and gold compounds used to treat rheumatoid
arthritis
 Certain blood diseases, autoimmune disorders and
serious infections
 Pregnancy, rarely
TESTS AND DIAGNOSTICS
 Blood tests. Normally, red blood cell, white blood cell and
platelet levels stay within a certain range.
 Bone marrow biopsy. To confirm a diagnosis, you'll need
to undergo a bone marrow biopsy.
TREATMENT AND DRUGS
 Blood transfusions- Red blood cell and platelets.
 Stem cell transplant
 Immunosuppressants- cyclosporine (Gengraf, Neoral,
Sandimmune) and anti-thymocyte globulin
(Thymoglobulin)
 Bone marrow stimulants- sargramostim (Leukine),
filgrastim (Neupogen) and pegfilgrastim (Neulasta), and
epoetin alfa (Epogen, Procrit) — may help stimulate the
bone marrow to produce new blood cells.
 Antibiotics, antivirals
NURSING CARE
 Resting when you need to. Anemia can cause fatigue and
shortness of breath with even mild exertion. Take a break
and rest when you need to.
 Avoiding contact sports. Because of the risk of bleeding
associated with a low platelet count, avoid activities that
may result in a cut or fall.
 Protecting yourself from germs. You can reduce your risk
of infections with frequent hand-washing and by avoiding
sick people. If you develop a fever or other indicators of an
infection, see your doctor for treatment.
THALASSEMIA
 is an inherited blood disorder characterized by less
hemoglobin and fewer red blood cells in your body than
normal.
Major types of thalassemia
 Alpha-Thalassemia
 Beta-Thalassemia
 If you have mild thalassemia, you may not need treatment.
But, if you have a more severe form of thalassemia, you
may need regular blood transfusions.
ALPHA-THALASSEMIA
 when the body has a problem producing alpha globin
 occurs when the gene that controls the making of alpha
globins is absent or defective.
 When a child has alpha thalassemia, there is a mutation in
chromosome 16.
 It can be mild to severe and is most commonly found
in people of African, Middle Eastern, Chinese,
Southeast Asian, and, occasionally, Mediterranean
descent.
 Alpha globin is made on chromosome 16.
 So, if any gene that tells chromosome 16 to produce
alpha globin is missing or mutated, less alpha globin is
made.
 This affects hemoglobin and decreases the ability of red
blood cells to transport oxygen around the body.

Types of Alpha Thalassemia
 Alpha globin is made by four genes and one or more can
be mutated or missing, so there are four kinds of alpha
thalassemia:
 One missing or abnormal gene makes a child a silent
alpha thalassemia carrier.
 Two missing or mutated genes is a condition called
alpha thalassemia minor or having alpha thalassemia
trait.
 Silent alpha thalassemia carriers have no signs or
symptoms of the disease, but are able to pass
thalassemia on to their children.
 Children with this condition may have red blood cells
that are smaller than normal (microcytosis) and
sometimes very slight anemia.
 People with alpha thalassemia minor usually don't have
any symptoms at all, but can pass thalassemia on to their
children.
 The two abnormal genes can be on the same
chromosome (called the cis position) or one on each
chromosome (called the trans position).
 If two genes on the same chromosome are affected, the
person can pass along a two-gene defect to his or her
child.
 This situation is much more common in people of Asian
descent.
 Three missing or mutated genes is called hemoglobin
H disease. Signs and symptoms will be moderate to
severe.
 Four missing or mutated genes is a condition known
as alpha thalassemia major or hydrops fetalis. This
almost always leads to a fetus dying before delivery
or a newborn baby dying shortly after birth.
SIGNS AND SYMPTOMS
 fatigue, weakness, or shortness of breath
 a pale appearance or a yellow color to the skin (jaundice)
 irritability
 deformities of the facial bones
 slow growth
 a swollen abdomen
 dark urine
DIAGNOSTICS
 Blood tests
If both parents are carriers of the alpha thalassemia disorder,
doctors can conduct test on a fetus before birth. This is done
through either:
 chorionic vilius sampling, which takes place about 11
weeks into pregnancy and involves removing a tiny piece
of the placenta for testing
 amniocentesis, which is usually done about 16 weeks
into the pregnancy and involves removing a sample of
the fluid that surrounds the fetus
TREATMENT
 Doctors also might recommend a folic acid supplement for
kids with hemoglobin H disease to help the body make
new red blood cells.
 Blood transfusion
BETA-THALASSEMIA
 when the body has a problem producing beta globin
 occurs when the gene that controls the production of beta
globin is defective.
 Beta thalassemia can be mild to severe and is more
common in people of Mediterranean, African, and
Southeast Asian descent.
 A child can only get beta thalassemia by inheriting it from
his or her parents.
 Genes are "building blocks" that play an important role in
determining physical traits and many other things about
us.
 When someone has beta thalassemia, there is a mutation
in chromosome 11.
 Beta globin is made on chromosome 11 (beta globin,
along with alpha globin, is one of the proteins that makes
up hemoglobin).
 So, if one of the genes that tells chromosome 11 to
produce beta globin is altered, less beta globin is made.
 This affects hemoglobin and decreases the ability of red
blood cells to transport oxygen around the body.
Types of Beta Thalassemia:
 Beta thalassemia minor, or beta thalassemia trait,
happens when one of the beta globin genes is mutated.
 People with this condition typically have very mild
symptoms and require no treatment, but they can
pass thalassemia on to their children.
 Beta thalassemia major (Cooley's anemia) happens when
both of the beta globin genes are mutated.
 This is the most severe form of beta thalassemia.
Babies with beta thalassemia major often seem
healthy immediately after birth but start to develop
symptoms within the first 2 years of life.
 This condition causes severe symptoms with life-
threatening anemia that requires regular blood
transfusions.
 Beta thalassemia intermedia may also occur when both of
the beta globin genes are mutated, but the mutations are
less severe than those that typically cause beta
thalassemia major.
 People with this condition usually have moderately
severe anemia and sometimes require regular blood
transfusions.
SIGNS AND SYMPTOMS
 fatigue, weakness, or shortness of breath
 a pale appearance or a yellow color to the skin (jaundice)
 irritability
 deformities of the facial bones
 slow growth
 a swollen abdomen
 dark urine
 Babies who begin to show symptoms of beta thalassemia
after a few healthy months mAay fail to grow normally
(failure to thrive);
 have trouble feeding; and have episodes of fever,
diarrhea, and other intestinal problems.
DIAGNOSTICS/TREATMENTS
 Same as alpha thalassemia
NURSING CARE
 Avoid excess iron.
 Eat a healthy diet.
 Avoid infections.
POLYCYTHEMIA
 an increased number of red blood cells in the blood.
 Hemoglobin levels greater than 16.5 g/dL (grams per
deciliter) in women and greater than 18.5 g/dL in men
suggest polycythemia.
 In terms of hematocrit, a value greater than 48 in women
and 52 in men is indicative of polycythemia.
 Production of red blood cells (erythropoiesis) occurs in the
bone marrow and is regulated in a series of specific steps.
 One of the important enzymes regulating this process is
called erythropoietin (Epo).
 The majority of Epo is produced and released by the
kidneys, and a smaller portion is released by the liver.
 Polycythemia can result from internal problems with the
production of red blood cells.
 If polycythemia is caused due to another underlying
medical problem, it is referred to as secondary
polycythemia.
CAUSES
 Two main conditions that belong to this category are:
 polycythemia vera (PV or polycythemia rubra vera
[PRV]) and
 primary familial and congenital polycythemia (PFCP).
 Polycythemia vera (PV) is related to a genetic mutation in
the JAK2 gene, which is thought to increase the sensitivity
of bone marrow cells to Epo, resulting in increased red
blood cell production.
 Levels of other types of blood cells (white blood cells
and platelets) are also often increased in this
condition.
 Primary familial and congenital polycythemia (PFCP) is a
condition related to a mutation in the EPOR gene and
causes increased production of red blood cells in
response to Epo.
RISK FACTORS
 Hypoxia from long standing (chronic) lung disease and
smoking are common causes of polycythemia.
 Chronic carbon monoxide (CO) exposure can also be risk
factor for polycythemia
 Chronic carbon monoxide exposure is a risk factor for
people working in underground tunnels or parking
garages, cab drivers in highly polluted and congested
cities, or workers in factories with exposure to engine
exhaust.
 People living at high altitudes may also be at risk of
developing polycythemia due to low environmental oxygen
levels.
 People with genetic mutations and familial types of
polycythemia and certain hemoglobin abnormalities also
carry risk factors for this condition as mentioned in earlier
sections.
SIGNS AND SYMPTOMS
 weakness, fatigue, headache, itching, bruising, joint pain,
dizziness, or abdominal pain
 Polycythemia vera
 bleeding problems or clotting events
 Itching after showers or baths
 Joint pains
 tender redness of the palms and soles is called
erythromelalgia.
Secondary Polycythemia Symptoms
 more closely attributed to the underlying condition, such
as, chronic lung disease
 shortness of breath
 chronic cough,
 Sleep disturbance (sleep apnea)
 dizziness
 poor exercise tolerance, or fatigue may be common in
patients with polycythemia
If Polycythemia Is Related To Kidney Cancer, Liver Cancer, Or
Other Erythropoietin Secreting Tumors:
 weight loss
 abdominal pain or fullness,
 Jaundice may be predominant.
DIAGNOSTICS
 CBC
 A chest X-ray, electrocardiogram (EKG), and
echocardiogram may be performed to screen for lung
disease or heart disease.
 Hemoglobin analysis
TREATMENT
 phlebotomy (drawing blood or blood letting) is the most
essential part of the treatment. The recommended
hematocrit of less than 45 in men and less than 42 in
women is the goal of phlebotomy.
 hydroxyurea (Hydrea)
 Aspirin
NURSING CARE
 Polycythemia due to a secondary cause such as long
standing smoking or exposure to carbon monoxide can be
prevented by omitting these risks.
 Reducing risk factors for heart failure, such as, controlling
high blood pressure and diabetes mellitus, can potentially
reduce the risk of polycythemia.
DISORDERS OF THE WBC
NEUTROPENIA
 an abnormally low count of neutrophils, a
 The lower your neutrophil count, the more vulnerable you
are to infectious diseases.
 neutropenia fewer than about 500 cells per microliter of
blood.
 bacteria normally present in your mouth and digestive
tract can cause infections.
CAUSES
 Cancer or other diseases that damage bone marrow
 Congenital disorders characterized by poor bone marrow
function
 Viral infections that disrupt bone marrow function
 Autoimmune disorders that destroy neutrophils or bone
marrow cells
 Overwhelming infections that use up neutrophils faster
than they can be produced Drugs that destroy neutrophils
or damage bone marrow
Possible Causes Of Neutropenia Include:
 Alcoholism or chronic alcohol use
 Aplastic anemia
 Chemotherapy
 Chronic idiopathic neutropenia in adults
 Drugs, such as antibiotics and diuretics
 Hepatitis A
 Hepatitis B
 Hepatitis C
 HIV/AIDS
SIGNS AND SYMPTOMS
 symptoms from infection or the underlying problem
causing the neutropenia.
 Infections can occur as a complication of neutropenia.
They occur most often in the mucous membranes, such
as the inside of the mouth and the skin.
These infections can appear as:
 Fever (most common sign of infection)
 Ulcers
 Abscesses (collections of pus)
 Rashes
 Wounds that take a long time to heal
LABORATORY AND DIAGNOSTICS
 Blood Test
TREATMENTS
 Antibiotics for bacterial infections
 Drugs to suppress the immune system
 A treatment called granulocyte colony-stimulating factor
(G-CSF). This stimulates the bone marrow to produce
more white blood cells
 Treating an underlying infection
 Stem cell transplants
NURSING CARE
 Good hygiene, including frequent hand washing and good
dental care, such as regular tooth brushing and flossing
 Avoiding contact with sick people
 Always wearing shoes
 Cleaning cuts and scrapes, then covering them with a
bandage
 Using an electric shaver rather than a razor
 Avoiding animal waste and, when possible, not changing
infants' diapers
 Avoiding unpasteurized dairy foods; undercooked meat;
and raw fruits, vegetables, grains, nuts, and honey
 Staying out of hot tubs, ponds, and rivers
NEUTROPHILIA
 Neutrophils are white blood cells (WBC) that move from
the blood into the cells to kill invading bacteria and fungi. 
 Neutrophilia is the most common form of leukocytosis
 This results in a neutrophil count of over 8,000.
 leukocytosis a condition involving an increased
number of leukocytes in the blood. 
CAUSES
 Acute infection. Infection such as caused by certain
agents would trigger neutrophilia.
 Fungal infections are also included in the list.
 Inflammation. There are noninfectious inflammations that
would trigger increase of neutrophils.
 Bacterial and viral infections are just some of the
common neutrophilia-causing infections.
 These inflammation-triggering conditions are burns;
post operation, autoimmune conditions, and an acute
attack of myocardial infarction are just some of the
states that induce elevation of neutrophil levels.
 Trauma or tissue damage induces an inflammatory
reaction.
 Cigarette smoking. This can induce elevation of
neutrophils in the system due to the inflammation that it
results to.
 Stress. Basically, there shall be increased neutrophils
once stress strikes such as instances where a person is
anxious and has a seizure episode.
 Drugs. Taking of certain drugs seem to elevate WBC
count and those are corticosteroids. Malignancy such as
(cancer) carcinoma, sarcoma, etc. could cause
neutrophilia.
SIGNS AND SYMPTOMS
 Infection. This is in congruence with the systemic
inflammatory response from an acquired infection.
 Bleeding leading to hypotension, tachycardia and most
probably sepsis.
 Hypothermia or decreased body temperature.
 Tachypnea and dyspnea would most likely happen. These
are respiratory-related symptoms.
DIAGNOSTICS AND TESTS
 CBC
 ANC (Absolute Neutrophil Count)
TREATMENT ANDF MANAGEMENT
 Referral to a hematologist. This is necessary in order to
identify certain conditions, such as blood problems.
 There might be abnormal enlargement of the spleen
that is why neutrophilia is present.
 Bone marrow aspiration. This shall identify presence of
hematological problem.
 Bone marrow depression may be present that is why
testing the sample from the bone marrow aspiration is
necessary.
 Close supervision of the blood results are indeed
necessary in order to check progress of the condition. This
is needed to be monitored so that success of the
treatment course can be attained.
 Discuss with the doctor the need of taking drugs that could
cause neutrophilia.
 Asking for alternative medications from such should be
helpful in preventing the disease process.
 Maintain a healthy lifestyle so that one can avoid acquiring
acute infections that are highly causative of neutrophilia.
 Having yearly influenza shots can also avoid
acquiring viral infections.
 Reduce or slowly stop bad habits that can alter one’s
natural defenses of the body is a preventive measure
for neutrophilia.
LEUKEMIA
 cancer of the body's blood-forming tissues, including the
bone marrow and the lymphatic system.
 Leukemia usually starts in the white blood cells.
 Your white blood cells are potent infection fighters — they
normally grow and divide in an orderly way, as your body
needs them.
 But in people with leukemia, the bone marrow produces
abnormal white blood cells, which don't function properly.
SIGNS AND SYMPTOMS
 Fever or chills
 Persistent fatigue, weakness
 Frequent or severe infections
 Losing weight without trying
 Swollen lymph nodes, enlarged liver or spleen
 Easy bleeding or bruising
 Recurrent nosebleeds
 Tiny red spots in your skin (petechiae)
 Excessive sweating, especially at night
 Bone pain or tenderness
CAUSES
 occur when some blood cells acquire mutations in their
DNA .
CLASSIFICATION OF LEUKEMIA
The first type of classification is by how fast the leukemia
progresses:
 Acute leukemia. In acute leukemia, the abnormal blood
cells are immature blood cells (blasts).
 They can't carry out their normal work, and they
multiply rapidly, so the disease worsens quickly.
Acute leukemia requires aggressive, timely
treatment.
 Chronic leukemia. This type of leukemia involves more
mature blood cells.
 These blood cells replicate or accumulate more
slowly and can function normally for a period of time.
 Some forms of chronic leukemia initially produce no
early symptoms and can go unnoticed or
undiagnosed for years.
The second type of classification is by type of white blood cell
affected:
 Lymphocytic leukemia. This type of leukemia affects
the lymphoid cells (lymphocytes), which form
lymphoid or lymphatic tissue.
 Myelogenous leukemia. This type of leukemia affects
the myeloid cells. Myeloid cells give rise to red blood
cells, white blood cells and platelet-producing cells.
TYPES OF LEUKEMIA
 Acute lymphocytic leukemia (ALL). This is the most
common type of leukemia in young children. ALL can also
occur in adults.
 Acute myelogenous leukemia (AML). AML is a common
type of leukemia. It occurs in children and adults. AML is
the most common type of acute leukemia in adults.
 Chronic lymphocytic leukemia (CLL). With CLL, the most
common chronic adult leukemia, you may feel well for
years without needing treatment.
 Chronic myelogenous leukemia (CML). This type of
leukemia mainly affects adults.
 A person with CML may have few or no symptoms for
months or years before entering a phase in which the
leukemia cells grow more quickly.
RISK FACTORS
 Previous cancer treatment. People who've had certain
types of chemotherapy and radiation therapy for other
cancers have an increased risk of developing certain
types of leukemia.
 Genetic disorders. Genetic abnormalities seem to play a
role in the development of leukemia. Certain genetic
disorders, such as Down syndrome, are associated with
increased risk of leukemia.
 Certain blood disorders. People who have been
diagnosed with certain blood disorders, such as
myelodysplastic syndromes, may have an increased risk
of leukemia.
 Exposure to high levels of radiation. People exposed to
very high levels of radiation, such as survivors of a nuclear
reactor accident, have an increased risk of developing
leukemia.
 Exposure to certain chemicals. Exposure to certain
chemicals, such as benzene — which is found in gasoline
and is used by the chemical industry — also is linked to
increased risk of some kinds of leukemia.
 Smoking. Smoking cigarettes increases the risk of acute
myelogenous leukemia.
 Family history of leukemia. If members of your family have
been diagnosed with leukemia, your risk of the disease
may be increased.
TESTS AND DIAGNOSTICS
 Physical exam. Your doctor will look for physical signs of
leukemia, such as pale skin from anemia and swelling of
your lymph nodes, liver and spleen.
 Blood tests. By looking at a sample of your blood, your
doctor can determine if you have abnormal levels of white
blood cells or platelets — which may suggest leukemia.
 Bone marrow test. Your doctor may recommend a
procedure to remove a sample of bone marrow from your
hipbone.
 The bone marrow is removed using a long, thin
needle.
 The sample is sent to a laboratory to look for
leukemia cells.
 Specialized tests of your leukemia cells may reveal
certain characteristics that are used to determine your
treatment options.

TREATMENT AND DRUGS

 Chemotherapy. Chemotherapy is the major form of
treatment for leukemia. This drug treatment uses
chemicals to kill leukemia cells.
 Biological therapy. Biological therapy works by helping
your immune system recognize and attack leukemia cells.
 Targeted therapy. Targeted therapy uses drugs that attack
specific vulnerabilities within your cancer cells.
 For example, the drug imatinib (Gleevec) stops the
action of a protein within the leukemia cells of people
with chronic myelogenous leukemia. This can help
control the disease.
 Radiation therapy. Radiation therapy uses X-rays or other
high-energy beams to damage leukemia cells and stop
their growth.
 Stem cell transplant. A stem cell transplant is a procedure
to replace your diseased bone marrow with healthy bone
marrow.

NURSING CARE
 Learn enough about leukemia to make decisions about
your care.
 Keep friends and family close.
 Find someone to talk with.

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