MODULE 4M

Miss Perez’s Prerecorded Video:

Oxygen- tasteless, odorless and tasteless gas, originated “oxygene" which means
acid former
-atmospheric air only 20%
-ATP uses oxygen, ATP provides energy which require o2 for aerobic respiration
o2 + glucose = aerobic respiration
body lack o2 -> anaerobic respiration -> production of lactic acid

Carbon Dioxide- primary respiratory stimulant

THE HEMATOLOGIC SYSTEM

• the study of blood and its components
• involved in internal respiration
• components: lymphatic system, blood, spleen and bone marrow

Red blood cell

• 20 seconds to make a complete loop, biconcave (6-8 upm)
• has a glycoproteins which determines blood types
• overproduction causes polycythemia increases viscosity of blood which makes
it difficult for transportation
• anemia- decrease of RBC
• percent saturation, percentage of haemoglobin sites occupied by oxygen,
usually monitored by pulse oximeter which determines oxygenation of
tissues

Hemoglobin:
13.5-18 g/dl men
12-15 g/dl women
11-16 g/dl children

Hematrocrit:
<41% decreased hematocrit male
<36% decreased hematocrit female

Factors affecting lower limits of range of hemoglobin:

1. race
2. gender
3. age

Anemia Grading
1. Mild- 10 to lower limit of normal
2. Moderate- 8-10
3. Severe- 6.5-7.9
4. Life Threatening- 6.5

IRON
• central atom of hgb, functions as storage of oxygen in muscle tissue,
cytochrome system- energy releasing system
• component of myoglobin
• iron deficiency anemia and zinc deficiency affects economy

WHITE BLOOD CELLS

• important for defence against infection
• leukopenia- decrease
• leukocytosis- increase which indicates infection or drugs (cortico) or cancer of
bone marrow such as leukaemia due to release abnormal WBC

PLATELETS
• cell fragments that circulates for clotting
• thrombopoietin stimulant of bone marrow for production of megakayrocytes
which in turn causes its fragments to form platelets
• 7-10 days for circulation
• liver- production
• spleen- storage
• thrombocytopenia
• throbocytosis
• platelet Dysfunction
• bleeding- sign of both increase or decrease due to clotting factor being
absorbed by high number of platelets or proteins found in blood and
some exhibit coagulation(abnormal blood clots)

Definition of Terms:
Petechiae- Tiny, circular, non raised, 1-2 mm in size petechiae
purpura- blood spots, skin haemorrhages, larger than petechiae purport
ecchymosis- skin discolour ecchymosis
hematoma- ecchymosis but in a tissue or organ

ANEMIA
• clinical sign only, a disease of its own but it accompanies other disorders
• depends on the ff:
• severity/ speed of blood loss
• chronicity of anemia- duration
• age
• presence of to her disorders
• effects of anemia on the patient and the nursing care needed are similar for all
types of anemia
• systemic since it affects blood which circulates around the body
Diagnostic Test for Anemia:
Confirmatory Tests:
1. RBC Count
2. Hgb Level
3. Hematocrit level
Identifying the type of Anemia:
1. Bone Sparrow Aspiration- to gather specimen
Identifying RBC size:
Peripheral blood smear (RBC indices)

Goals of Care
1. Controlling Causes
2. Relieving manifestations
3. Preventing complications

Management:
1. Oxygen Therapy- reduction of cardiac stress
2. Erythropoietin (EPO)- subcutaneous route, for production of RBCs
3. Iron replacement- Feosol, Fergon, dextran given IM

Blood Transfusion
- invasive management for anemia, informed consent needed.
Types:
1. Autologous- reinfusion of client’s own blood, made every 3 days, indicated
when Hgb remain <11g/dl BLOOD SALVAGE
2. Directed (Designated)- easier to identify donors but higher incidence of
complications such as hepatitis

Complications of Blood Transfusion

- occur days to years after
1. fever, decreased heamtocrity (delayed haemolytic reaction
2. mild jaundice
3. iron overload- indicative that client receive more than 100 units of blood over a
period of time. This can lead to cardiac myopathies (frequent cause of
death due to blood trans)
4. Post transfusion Graft vs. Host Disease (GVHD)- manifestations include fever
rash, diarrhoea, and hepatitis
5. HIV1 trasnmission- rare occurrence

COAGULATION PROBLEMS
- platelet disorders, quantitative in nature
causes:
1. decreased production
2. increased destruction
3. increased consumption of platelets

Three Types of Thrombocytopenia:

1. Immune Thrombocytopenic Purpura- aka idiopathic thrombocytopenic purport,
unknown cause
2. Thrombotic Thrombocytopenic Purpura- emergency, platelet agglutination,
bleeding and clotting occurs simultaneously
3. Heparin Induced Thrombocytopenia and Thrombosis Syndrome- 2 responses,
(1)platelet destruction,(2) vascular endothelial injury, immune mediated
response due to heparin
Diagnostic:
1. CBC- shows decreased platelet
2. Bone Marrow Biopsy
Manifestations:
1. Petechiae
2. Bleeding in gums and nose
3. excessive menstrual bleeding
4. Git and intracranial bleeding
Management:
1. Avoid aspirin and invasive procedure
2. avoid flossing and mouth wash, valsalva maneuver
3. small needles are preferred
4. smooth bristled brush for brushing.

CLOTTING FACTORS DISORDERS

1. Hemophilia A
• x-linked recessive (Males affected, females are carriers)
• affects factor 8
• treatment includes recombinant factor 8
2. Hemophilia B
• x-linked recessive
• factor 9
• recumbinant factor 9
• christmas disease
Manifestations:
• joint bleeding
• hemorthosis
• hemorrhages
• periperhal nerve compression
• GI bleeding
Managament:
• fresh frozen plasma
• recombinant factors 8 and 9 IV
 • desmopressin
• activity restriction
• prevention of injury
• self care measures

Disseminated Intravascular Coagulation

• results from activation of homeostasis, disturbances in fibrin and coagulation
causing cycles of thrombosis and haemorrhage, microthrombi are formed
• causes: infection, sepsis, obstetric and gynecologic complication, transfusion
S/S:
1. bleeding
2. renal failure
3. infarction
Management:
1. cryoprecipitate
2. ffp
3. electrolytes and fluids
4. oxygen therapy
5. heparin transfusion

ABO INCOMPATIBILITY:
reaction of immune system
Manifesttaions:
1. Fever
2. Hematuria
3. Nausea
4. back pain
5. jaundice
Management:
1. discontinue blood trans, vein open, plain nss
2. maintain blood volume try IV therapy
3. manage dic
4. promote renal perfusion

RH Incompatibilities
• aka erythroblastosis fatalis or hydros fatalis
• mother has rh negative
Managament:
cs. induce labor, exchange trans 5-10 mL, infusion of albumin to decrease
bilirubin levels
phototherapy, rhogam 72 hours after delivery
Book Notes:
Hypoproliferative Anemias:
Iron Deficiency Anemia
• Bleeding as cause if not proven otherwise
• smooth, red tongue brittle and ridged nails and angular cheilosi
• bone marrow aspiration, low serum ferritin levels, low TIBC, occult test
• iron causes staining, GI distress, increase Vit. C, avoid antacids and dairy

Aplastic Anemia
• damage to the marrow
• T cells attack against the bone marrow\
• neutropenia andthrombocytopenia occurs, thus risk for infection
• infection is a common complication
• pancytopenia- decrease in myeloid stem cells
• transplant of hematopoietic stem cell and therapy of immunosuppressive

Megaloblastic Anemia
• deficiency of either Vit B12 or Folic Acid both are needed for DNA synthesis
• hyperplasia in bone marrow analysis, abnormal increase in number of cells but
later on pancytopenia
• poikilocytosis- varied shape of RBCshigh MCV
• prone in Crohn;s Disease due to malabsorption of Vit b12
• Neuro manifestations due to b12
• Schilling Test b12, b12 array test, intrinsic factor antibody test
• Folic given IM
• b12 RICH IN SOY MILK FOR VEGANS IM ALSO
• mild jaundice, nerologic ass, vitiligo, graying of hair

Pernicious Anemia
• absence of intrinsic factor
• disorder of adults
• intrinsic factor is needed for binding of vUT B12
• smooth sore red tongue with mild diarrhoea
• confused, parathesias, difficulty balance and lose of position

Hemolytic Anemia
• increased reticulocyte count, increased bilirubin levels, decreased haptoglobin

Sickle Cell Disease

• due to sickle hemoglobin gene (hbs)
• heridatary
• the gene causes change in formation of RBC thus sickled shape (dehydrated)
• sickle anemia- most severe form
• jaundice (main), enlarge of bone in face skull
• hematopoietic stem cell transplant, RBC transfusion, Hydroxyurea for feral
haemoglobin

G6PD
• G6PD gene
• x-linked, men are affected, women are carriers
• aggravated by oxidant drugs
• asymptomatic unless exposed to oxidant drug
• pallor, jaundice, hemoglobinuria
• G6PD assay test

Immune Hemolytic Anemias

• due to RBC exposure to antibodies
• alloantibodies (IgG)
• BODY TEMP basis for classification warmer, more dangerous
• spherocytes- small sphere of RBC, Coomb’s Test- detection of antibodies
• high dose of crtico, splenectomy
• difficult cross matching

Polycythemia
-increased volume of RBCs, elevated hematocrit
-Primary Polycythemia (Polycythemia Vera) a proliferative disorder
Secondary Polycythemia- excessive production of ERYTHROPOIETIN
-therapeutic phlebotomy to reduce blood viscosity and volume when hematocrit
is too high

Blood Types:
Gycoproteins/Agglutinogens- determines a persons blood type.
A- has antigen A but not antibody A
B- has antigen B but not antibody B
C- AB- has both antigens AB so no antibodies for both, thus a universal
recipient (no antibodies will attach the transfused blood that may either
contain A or B antigen
O- no antigens A and B, therefore has antibodies for both, universal donor