Two types:

BLOOD FUNCTIONS - T lymphocytes B lymphocytes

Platelets (Thrombocytes)
- Normal: 150,000 – 400,000/mm3
Blood Components
Function in blood coagulation
Plasma
- Adhere to each other and to damaged areas of
Proteins (albumin, globulin, fibrinogen, inorganic
circulatory system to limit or prevent blood loss
constituents and organic constituents)
- Release chemicals that constrict damage blood
Cellular component (RBC, WBC and platelets)
vessels
BLOOD
METHODS FOR STUDYING BLOOD
Albumin
Descriptive term and methods of measurement
ROLE: maintenance of BV by providing colloid
- Blood Cell Count
osmotic pressure, pH and electrolyte balance, and
- Differential Blood Cell Count
the transport of metal ions, fatty acids, steroids,
- Red Cell Count Hematocrit
hormones and drugs
- White Cell Count Platelet Count
Globulin
- Reticulocyte Count Study of Bone
Helps establish colloid osmotic pressure
Marrow
Fibrinogen
- Biochemical Studies
accounting for only 4%; essential for blood clotting
HEMATOLOGIC DISORDERS
Blood Cells
Hematopoiesis formation and maturation of blood
ANEMIA
cells;
ETIOLOGY
takes place in the bone marrow of the skull,
- Loss of RBCs (occurs from bleeding)
vertebrae, pelvis, sternum, ribs and proximal
- Decreased production of RBC
epiphysis of long bones.
- Increased destruction of RBC
RED BLOOD CELLS (ERYTHROCYTES)
Signs and Symptoms
5M/mm3 of blood in the average adult
- Weakness Fatigue
life span of 120 days
- general malaise
RBC production is stimulated by a glycoprotein
- pallor of the skin and mucous membranes
hormone, erythropoietin, believed to originate in
(sclera, oral mucosa)
the kidney
- tongue may be smooth and red (in iron
Erythropoietin production is influenced by
deficiency anemia) or beefy red and sore (in
tissue hypoxia caused by changes in
megaloblastic anemia)
athmospheric O2, decreased O2 content of
- Individuals with iron deficiency anemia may
arterial blood and decreased hemoglobin
crave ice, starch, or dirt (known as pica);
concentration
their nails may be brittle, ridged, and
concave
WHITE BLOOD CELL (LEUKOCYTES)
- tachycardia, palpitations, dyspnea, dizziness,
- Normal range is 5,0000-10,000/mm3
orthopnea, and exertional dyspnea.
Types:
- nausea, vomiting
Granulocytes - originate in red marrow
- Melena or dark stools, diarrhea, anorexia,
Neutrophils Eosinophils Basophils
and glossitis (inflammation of the tongue)
Agranulocytes – originate in red marrow and
- presence and extent of peripheral numbness
lymphatic tissue
and paresthesias, ataxia, poor coordination,
Monocytes Lymphocytes
and confusion.
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 Therapeutic Intervention – lifelong injections of
cyanocobolamin (B12)
Iron Deficiency Anemia
Nursing Interventions
Clinical Findings - Explain the disease process and the need for
Fatigue Headache continued treatment
Paresthesia Ankle edema - Teach family members how to give IM
Dry, pale mucous membrane Pearly white sclera injections or make referral to visiting nurse
Decreased hemoglobin and erythrocytes
Increased iron-binding capacity Aplastic Anemia (Hypoplastic Anemia)
Megaloblastic of blood
Cheilosis –fissures in the mouth Clinical Findings
- Headache Weakness
- Anorexia Dyspnea
- Fever
- Bleeding from mucous membrane
- Decreased leukocytes, erythrocytes and
platelets
Therapeutic Interventions
- Identify and eliminate causative agent
- Blood transfusions
- Maintenance of fluid and electrolyte balance
- Corticosteroids and androgens to stimulate
bone marrow function
- Splenectomy when enlarged organ destroys
normal RBCs
Therapeutic Interventions Nursing Interventions
- Improve diet: include ascorbic acid, which - Prevent infection by protective isolation
stimulates iron uptake - Provide blood transfusion therapy as ordered
- Appropriate supplements of iron, vitamin
B12 and folic acid Hemolytic Anemia
- RBCs have a shortened life span; thus, the
Nursing Interventions number of RBCs in circulation is reduced.
- Teach clients food high in iron, folic acid
and vitamin B12 Sickle Cell Anemia
- Teach about the side effects of medications
- Assist client with ADL as needed Signs and Symptoms
anemic, usually with hemoglobin values of 7 to 10
Pernicious Anemia g/dL
Clinical Findings Jaundice
- Weakness Sore mouth tachycardia, cardiac murmurs, and often an enlarged
- Paresthesia Dyspnea heart (cardiomegaly).
- Pallor Beefy red tongue Dysrhythmias and heart failure
- Positive Romberg test (loss of balance when low hematocrit
eyes close)
- Gastric analysis: no intrinsic factor Medical Management
- Schilling test; urine test for B12 absorption PHARMACOLOGIC THERAPY
- Hydroxyurea (Hydrea)
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 - History of epistaxis History of gum
bleeding
- Low platelet count Ecchymotic areas
- Hemorrhagic petechiae
TRANSFUSION THERAPY
- RBC transfusion Medical Interventions
- Corticosteroids Immunosuppressive
Medical Management agents
SUPPORTIVE THERAPY - Splenectomy Platelet transfusions
- Pain management
- Adequate hydration Nursing Interventions
- intravenous hydration with dextrose 5% in - Prevent injury and bruises
water (D5W) or dextrose 5% in 0.25 normal - Encourage client to adhere to medical
saline solution (3 L for 24 hours) regimen
- O2 adm - Teach the side effects of meds, particularly
proneness to infection
Nursing Management
Relieve pain Disseminated Intravascular Coagulation (DIC)
- Support and elevate swollen joints until the
swelling diminishes. Clinical Findings
- Relaxation techniques, breathing exercises, - Restlessmess Anxiety
and distraction are helpful for some patients. - Low fibrinogen and prolonged prothrombin
Prevent infection and partial thromboplastin times
- Antibiotic therapy - Hemorrhage
- Monitor signs of infection
Therapeutic Interventions
Polycythemia Vera - Heparin to prevent the formation of thrombi
- Transfusion of blood products
Clinical Findings
- Headache Weakness Nursing Interventions
- Itching Increased hemoglobin - Observe for bleeding
- Purple-red complexion Dyspnea - Minimize skin punctures
- Bleeding from mucous membrane - Prevent injury
- Provide emotional support
Therapeutic Interventions
- Phlebotomy
- Diet low in iron
- Radioactive phosphorus; busulfan (Myleran)

Nursing Interventions
- Discuss diet with the client and family
- Provide supportive care and prevent
hemorrhage
- Assist with phlebotomy
- Instruct client to elevate legs while sitting

Thrombocytopenic Purpura

Clinical Findings
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