AUGUST 5, 2021

• Types of Blood Cells

Hematopoietic System
• Hematology - study of blood and blood forming
tissues

Blood
• Functions:
• Carry O2, and Nutrients
• Remove O2, and Metabolic Waste
• Hormone Transport
• Inflammatory, Immune Response
(Platelets)
• Temperature Regulation
• Fluid And Electrolyte, and Acid-Base
Balance

• Formed Elements:

• Production of Blood Cells

• Bone Marrow - production is in the red bone
marrow because yellow bone marrow is
more on fats.
o Erythropoietin - hormone secreted
by kidney going to bone marrow
§ Stimulates bone marrow to
produce blood cells
• Liver - has hematologic function.
o Liver synthesis plasma protein
including clotting factors and
albumin.
o Liver clears damage and
nonfunctioning RBCs/erythrocytes
from circulation.
o Hepatomegaly - enlargement of
• Components of Blood: liver.
• Spleen - has hematologic function.
o Produces fetal RBCs.
o Filter Function (filter and reuse
certain cells)
o Immune Function (lymphocytes,
monocytes)
o Storage Function (30% platelets
stored in spleen)
§ Graveyard of blood cells
o Splenomegaly- enlargement of
spleen.

• Effects of Aging on the Hematologic System

CBC Studies shows:
o ⌄ Hemoglobin (Hb or Hgb)
• Properties of Whole Blood
• Temp: 38ºC o ⌄ Response to infection (WBC)
• pH: 7.35-7.45 o No changes to platelets
• 5-6L M > 4-5L F o Clotting Studies (⌄ PTT)
• 5x viscous than water
1
• Blood Dyscrasia • Blood Test
Dyscrasia - meaning abnormalities. Test Normal Implications
Inc: Deficiency of
4 Basic Reason Why There Is Blood Problems: Activated
factor VIII, IX, X, XI,
1. Decreased production of blood cells Partial 25-41
XII
(pancytopenia) Thromboplastin sec.
Dec: Extensive
2. Overproduction of both normal and Time
Cancer, DIC
defective cells Inc: DIC, Hepatic
3. Disorder of the spleen Disease,
4. Defect in blood coagulation mechanism Anticoagulant
therapy
• Blood Forming Tissues: Prothrombin 10-13
o Bone Marrow Time sec
Dec: Digitalis
o Spleen therapy, diuretic
o Lymph System reaction, Vit. K
therapy
3-6 min Time it takes for
Bleeding Time (< 10 platelet plug to
LABORATORY min) form.
• Complete Blood Count (CBC)
• APTT
Hematocrit
o ^ clotting problems
• hematocrit - % of RBC in plasma • PT
• evaluate if there is hemodilution or o Dapat within the normal time, mag
hemoconcentration clot na sya.
o ^ DIC (disseminated intravascular
White Blood Cell - WBC coagulation)
• ^ leukemia, bacterial infection
• ⌄ viral infection, SLE, bone marrow • Erythrocyte Index
suppression MCV - Mean corpuscular volume
• done to evaluate the size of the RBC
Platelets • 80-90 Cu. Microns.
• ^ polycythemia vera (^ RBC), cancer • Microcytic Cells - Macrocytic Cells
• ⌄ bone marrow suppression leukemia, liver • anisocytosis - abnormal size
cirrhosis, chemotherapy MCH - Mean Corpuscular Hemoglobin

Red Blood Cells - RBC • done to evaluate the Hgb content of the RBC
• Hypochromic
• ^ polycythemia, chronic hypoxia • Hyperchromic
• ⌄ anemia, hemorrhage
MCHC - Mean Corpuscular Hemoglobin
Erythrocyte Sedimentation Rate - ESR Concentration
• M: 0-15mm/hr || F: 0-20mm/hr • Done to evaluate the Hgb content in grams
• ^ inflammatory process, cancer, infectious per 100 ml of packed RBC
disease • 30-36 grams per 100 ml packed RBC
• ⌄ Polycythemia vera, sickle cell disease
Hemoglobin
• ^ dehydration, polycythemia vera, CHD DIAGNOSTIC TESTS
congestive heart disease 1. Shilling’s Test
• ⌄ anemia, hemorrhage, leukemia, dietary
• Done to evaluate the rate of absorption of
Cobalamin (Vitamin B12).
• How to:
o Administer per orem of radioactive
Vitamin B12 and collect the 24 hours
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 urine specimen and find out the
presence/absence of Vitamin B12.
o Normal Excretion: 8-10% of oral
radioactive Vitamin B12
• Use to diagnose Pernicious Anemia
• An extrinsic factor coming from gastric
mucosa, digest, absorb, and excrete Vita.
B12.
o Excretion of B12 means normal
o If there is no presence of Vita. B12 in
urine then + Pernicious Anemia
o Local anesthetic agent
o For excisional biopsy:
§ Instruct the patient to restrict
food from midnight and drink
clear liquids only.
o For a needle biopsy, no restriction of
fluid or foods is necessary.
o Monitor for bleeding and infection.
• Location of Lymph Node:

2. Bone Marrow Puncture

• Evaluate size, shape, and characteristic of
blood cells.
• Size: microcytic / macrocytic
• Shape:
o Poikilocytosis (abnormality in shape
of RBC)
o RBC normal shape - biconcave
o Platelet under microscope - oval
(abnormal)
o WBC - kidney shape/skeletal shape
• Characteristic:
o Metarubricyte Cell - RBC with
nucleus
o Normal:
§ Erythroblast - immature RBC 4. COOMBS’ Test
with nucleus, then • “antiglobulin test”
§ Mature Cells - without • Evaluate for the presence of immune bodies
nucleus that adhere to the RBC causing hemolysis
• Site where bone marrow is aspirated: and agglutination of the RBC.
o Sternum (supine position) • A test done for pregnancy patient to check
o Vertebral body (supine) for RH incompatibility.
o Posterior (prone/lateral) and anterior
iliac crest
o Child:
§ long bones of child (femur / BLOOD GROUPS
humerus) ABO Typing
• Nursing Responsibilities:
o Consent
o Local Anesthetic
o Position, Sterile Field
§ Depends on the site of
puncture
o Pressure 5 Minutes
o Check Site
o Send to Laboratory

3. Lymph Node Biopsy

• Surgical incision of inactive lymph node or
needle aspiration for histological
examination
• Nursing Responsibility:
o Consent
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BLOOD TRANSFUSION AND COMPONENT
THERAPY
• Purpose:
o Improve O2 transport (RBCs)
o volume expansion (WB, plasma,
albumin)
o provision of proteins (FFP, albumin,
plasma protein fraction)
o provision of coagulations factors
(cryoprecipitate, FFP, fresh WB)
o provision of platelets (platelet conc.,
FWB)
** provision - meaning providing
** WB - whole blood
** FFP - fresh frozen plasma
** (…) - meaning doctor’s order depending on the
purpose.
Blood Products
Whole Blood
Volume: 450 mL
Indications:
• To restore blood volume in hemorrhaging,
trauma, or burn patients.
Nursing Considerations:
• Don’t infuse over more than 4 hours.
o If more than 4 hours, blood will clot
and attract bacteria.
• Warm blood if giving large quantity.
o Warm Blood - when getting blood
from refrigerator, set temperature first
to low.
o Ex. 3 units - 3 bags (too much,
therefore warm blood first before
giving to patient)
• Avoid giving when the patient can’t tolerate
the circulating volume.
o When patient is having fever (side
effects), then stop infusion.
4
Packed RBC (PRBC)
Volume: 250 mL
Indications:
• To restore or maintain oxygen-carrying
capacity.
• To correct anemia and surgical blood loss.
Nursing Responsibilities:
• Don’t infuse over more than 4 hours.
• RBCs have the same oxygen-carrying
capacity as whole blood
o PRBC is given instead of WB to
minimize the hazed of volume
overload.
Platelets
Volume: 35-50 mL
Indication:
• To treat thrombocytopenia (lack of platelet).
• To treat acute leukemia and marrow aplasia.
Nursing Considerations:
• ABO compatibility is not necessary but is
preferable with repeated platelet transfusion;
RH type much is preferred.
• Infuse 100 mL over 15 minutes.
• Administer at 150 to 200 mL/hour, or as
rapidly as the patient can tolerate; do not
exceed 4 hours.
• Avoid administering platelets when the
patient has a fever.
Fresh Frozen Plasma - FFP
Indications:
• To expand the plasma volume.
• To treat post-surgical hemorrhage or shock.
• To correct an undetermined coagulation
factor deficiency.
Nursing Responsibilities:
• Cross-matching: ABO compatibility is not
necessary but is preferable with repeated
plasma transfusions; RH type match is
preferred.
• Large volume transfusions of FFP may
require correction for hypocalcemia. Citric
acid in FFP binds calcium.
Factor VIII Fractions (Cryoprecipitate)
• Contains factor VIII, fibrinogen, and factor XIII
• Clotting factor
 Allergic
Nursing Responsibilities
1. Assess client for history of previous blood Signs & Symptoms:
transfusion, adverse RX • Urticaria
2. G 18-19, 0.9% Plain NSS • Wheezing
a. Needles are big because molecules are • Dyspnea
also big. • Headache
b. 0.9% plain normal saline solution is the
safest partner of blood. If there is complication: stop blood, on the
3. 2 nurses: ABO group, RH type, blood number, saline, give antihistamine/epinephrine.
expiration date
Pyrogenic
a. Wrong blood type transfusion can lead
patient to die. • Elevated body temperature, fever.
4. Baseline VS
5. Start slow: 2 mL/min. Signs & Symptoms:
a. Some hospitals: 10-15 gtt/min (slow) for • Fever
15 minutes to check for any adverse • Chills
reaction, then follow the order of • Flushing
physician. • Tachycardia
6. Stay with client. First 15 minutes, take VS.
7. Maintain prescribed transfusion rate If there is complication: stop blood, treat
8. Monitor for adverse reactions temperature, antibiotics.
9. Document:
Circulatory Overload
a. Blood component unit number (apply
sticker) • Volume overload
b. Date infusion starts and ends • If patient has CVD or kidney problems, bawal
c. Type of component and amount ang overload.
transfused
d. Client reaction and VS Signs & Symptoms:
e. Signature of transfusionist • Dyspnea
• Tachycardia
Complications of Blood Transfusion • ^ BP
Hemolytic
If there is complication: stop blood, get VS,
• Destruction of RBC notify physician.
Signs & Symptoms: Air Embolism
• Headache
• When one or more air bubbles enter a vein or
• Lumbar pain
artery and block it.
• N/V (nausea or vomiting)
• Diarrhea
Signs & Symptoms:
• Jaundice
• Dyspnea
• signs of shock/renal shutdown
• Chest pain
• dyspnea
• ⌄ BP
If there is complication: stop blood, on the
If there is complication: clamp the tube, left
saline, send the blood to lab.
head down (lower head of the bed), O2, notify
physician.

CELLULAR COMPONENTS
1. Erythrocytes (RBC)
• Anucleated, biconcave disc
• Hemoglobin:
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 o Heme: Each heme group bears an atom 3. Thrombocytes (Platelets)
of iron • 150 000 - 450 000 / mm3
o Globin: Protein molecule made up of • Function: clot formation
two alpha and two beta chains. • Lifespan: 7-10 days
• Production: Bone Marrow • Stored in the spleen and destroyed by
• Life Span: 120 days phagocytosis.

2. Leukocytes (WBC) 4. Plasma

• Protect body against infection and tissue injury. • Straw colored consists of water and dissolved
• Divided into two general categories: solutes.
o Granulocytes • Means solute is sodium but also consists of
§ Presence of granules in the other ions such as bicarbonate and calcium ion.
cytoplasm of the cell. • Contains hormones such as insulin and
§ 3 main sub-groups: testosterone.
Eosinophils • Plasma proteins
o Alpha - antiviral bodies
• Have bright-red granules in their cytoplasm. o Gamma - serum antibodies that crosses
• Important in phagocytosis of parasites. placenta.
• In allergic reaction > neutralize histamine.
Basophils
• Deep blue granules. HEMATOPOIETIC DISORDERS
• Produce and store histamine as well as other • Anemia
substance involved in hypersensitivity o depends on the cause:
reactions. § blood loss
§ increase hemolysis
Neutrophil § bone marrow depression
• Pink to violet hue granules
• Phagocytosis. Erythropoiesis
• Production and maturation of blood cells
o Lymphocytes • Elements:
§ Produce substances that aid in o Protein - cell membrane and cell
attacking foreign material. structure of RBC to be formed.
§ Complete their differentiation o Iron - pigment of hemoglobin.
and maturation primarily in the o Vitamin C - catalyst to absorb iron.
lymph nodes and in the lymphoid o Folic Acid - for cell to grow.
tissue of the intestine and o Vitamin B12 - synthesis of nucleic acid.
spleen. • Absence of these elements will cause anemia.
T Lymphocytes
• Kills foreign cells directly or releases a variety
of lymphokines (substances that enhance the
activity of phagocytic cells).
• Responsible for delayed allergic reactions,
rejection of foreign tissue, and destruction of
tumor cells. Known as cellular immunity.
B Lymphocytes
• Capable of differentiating into plasma cells.
• Produce munogloblin (Ig), or antibodies -
protein molecules that destroy foreign material
by several mechanisms. Known as humoral
immunity.

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 NCM112j - Hematology • DOE, Cold Sensitivity
AUG. 12, 2021 o DOE: dyspnea on excursion.
• Brittle Hair, Spoon-
Anemia Shaped Nail
• Reduction below normal in the number of (Koilonychias)
erythrocytes, quality of Hgb, and the volume of • Stomatitis/Glossitis,
erythrocytes. Angular Cheilosis
• Cause: o Glossitis:
o Decreased RBC production inflammation of tongue.
o Increased RBC destruction • Pica Or Ice Craving
o Acute or chronic blood loss o Pica: eating disorder in which a person
eats things not usually considered food.
o Ex. Soil, hair.
Types:
1. Iron Deficiency Anemia Diagnostic Test
• Total body iron content is decreased below • CBC
normal level and inadequate Hgb production. o RBC microcytic (dec. size), hypochromic
• Most common type of anemia. (dec. Hgb)
o ⌄ reticulocyte, Hgb, Hct
§ Reticulocyte - baby RBC
Microcytic & Hypochromic
Management
⌄ Iron • Start iron-fortified supplemental feedings at 4-6
months
• Iron supplements + Vitamin C for adults
⌄ Hgb o Iron will not be absorbed without Vita. C.
• Side effects: oral, liquid & parenteral
o Constipation, dark stools = increase
liquid intake
Pale
o Stains the teeth: use straw
o Stains the skin: z track
o Decreased absorption with food: milk,
Small
dairy products, coffee, and tea (avoid
Causes foods to not decrease iron absorption)
• Chronic blood loss • Increase iron rich food
• Insufficient intake of iron o Organ meats (liver), meat products,
green leafy vegetable, dark dried foods
Risk Factors • Adequate rest
• Pregnancy - mother is sharing with baby
• Female gender - menstruation
• Exclusively breast - feeding clients 2. Folic Acid Deficiency Anemia (Megaloblastic
• Vegans - they don’t eat meat. Anemia)
• Decreased dietary intake of folic acid
Assessment
• Pallor
• Easy Fatigability Macrocytic & Hypochromic
• CNS: Headache, Dizziness, Paresthesia
o Headache: due to lack of oxygen to the
brain
o Paresthesia: tingling sensation Immature Big
• Cardio: Tachycardia, Palpitations, Angina
o Palpitations: 1st sign when you have
heart problem Causes
o Angina: chest pain • Poor diet
1
• Pregnancy o 1st week: everyday
o 1st month: weekly
Diagnostic Tests o 2nd month: monthly
• CBC: ⌄ RBC, Hgb, hematocrit o Then for life
• RBC are large with fragile membranes that
rupture easily
• Low Serum Folate 4. Aplastic Anemia
• Stem cell disorder
Management o Hypoplastic
• Replacement: 1-5 mg oral folate/day o Fatty BM
• Prenatal vitamin o Pancytopenia - decreased blood cell
• Diet: dark green leafy vegetables, liver, broccoli,
fortified cereals, citrus fruit, nuts, grains Cause
• Assess client’s tolerance to activity • Idiopathic (unknown) /Autoimmune
o Anemic patient cannot take stressful • Drugs/Chemical: Chloramphenicol, Zidovudine
activities
• Provide adequate rest Pathophysiology
Risk Factors; exposure to benzene derivatives
(insecticides/pesticides)
3. Pernicious Anemia
• Inability to absorb Vitamin B12 because of Benzene deravatives serves as toxin to BM
Intrinsic Factor (IF) deficiency. (myelotoxins)
o Absorption is in ileum (distal end of
gastrointestinal)
Myelotoxins suppress BM formation
Cause
• Malabsorption
• Ileal disease (Chron’s Disease) BM fails to replace blood cells

Assessment/Signs & Symptoms

• Weakness, Pallor, Fatigue ⌄ WBCs
• Sore Tongue, Smooth Beefy Red Tongue
o Indicative from other type: smooth beefy
⌄ RBCs
red tongue
• Constipation Or Diarrhea
• Tachycardia ⌄ Platelets
o Indicative that there is poor distribution
of oxygen If patient is expose to insecticides > myelotoxins >
• Loss Of Sense of Balance, Paresthesia myelotoxin suppress bone marrow formation > BM
fail to replace blood cell.
Diagnostic Tests
• CBC: macrocytic, abnormally shaped Assessment
o Decreased erythrocyte • Fatigue, Dyspnea, Pallor
• BM: increased megaloblasts • Fever, Infections: Neutrophil Count < 1,000/Ul
• Bilirubin: elevated • Bleeding (Petechiae, Epistaxis)
• Schilling’s test
Diagnostic Tests
Management • BMA
• Diet: high in iron, protein, vitamins • CBC (⌄RBC, ⌄WBC, and ⌄Platelets)
• Mouth care
Management
• Bed rest (for severe anemia)
• Low WBC
• Safety
o Prevent infection: neutropenic
• Vitamin B12 injection
precautions
o Route: IM
2
 § Handwashing, no visitors • Blood Transfusion
§ Avoid exposure to others with
acute infection b. Sickle Cell Disease
§ Mouth care, antibiotic, antipyretic • Recessive autosomal trait disorder that
• Low Platelets develops in a child when both parents are
o Prevent bleeding carrier of sickle cell trait.
§ Minimize invasive procedures • Lifespan of normal RBC: 120 days
§ Soft toothbrush, electric razor, o Sickle Cell: 14 - 16 days
Hematest
• Oxygen bonding capacity of the cell is
• Hematest - checking of reduced
Hema (check if there’s o Sickling
bleeding inside) o Moon shape
o Crescent form
Nursing Intervention o Hgb S
§ BT: FWB (fresh whole blood?) o Its pointed end will lead to pain in
§ BM transplant care blood vessel.
§ Immunosuppressive therapy
o Cyclosporine Transmission

5. Hemolytic Anemia
• There is an increased rate of RBC destruction
o G6PD deficiency
o Sickle cell anemia
o Thalassemia
a. Glucose 6 Phosphate Dehydrogenase
(G6PD) Deficiency
RBC burst in contact with certain substances:
• Sulfas
• Antimalarial
• Naphthalene • If both parents are carrier, 1st is unaffected, 2nd
• Fava beans and 3rd are also unaffected but carrier like
parents, while the 4th child is affected.
Risk Factors • No guarantee that the 1st born is unaffected,
• Male while the 4th child has sickle cell.
• African American
• Middle Eastern Risk factor
• Family History • Hereditary

Assessment Predisposing factors

• Jaundice • Dehydration
o because of the destruction of RBC • High Altitude
• Headache, Dizziness • Infection Decrease O2 or
increase O2
• Easy Fatigability • Physical Stress demand/consumption
• Acidosis
Diagnostic Test • Cold
• G6PD level during nonhemolytic phase
o nonhemolytic phase: no distraction of Pathophysiology
RBC
• Newborn Screening Test

Management
• Rest
• Hydration
3
 During State Of Hypoxia And Dehydration § Hydroxyurea: studies shows
effectiveness both in reversing
and blocking sickling RBC
Cells Sickle (Stiff And Distorted) o Analgetic/narcotic (acetaminophen,
ketorolac, morphine, avoid aspirin)
Block Small Blood Vessels § Aspirin > bleed patient
o Antibiotic (infection)
• Avoid: mountain climbing, flying unpressured
Less Blood • Assist with splenectomy
o Splenectomy - removal of spleen
Tissue Damage
Complications
Hypoxia: a region in the body is deprive from • Vaso-Occlusive Crisis
oxygen. o Occurs when the microcirculation is
obstructed by sickled rbcs, causing
Assessment ischemic injury to the Oregon supplied
• Infants: Colic (first sign - excessive crying) and pain.
• Dactylitis (inflammation of fingers) - sausage o Management: Pain
shaped due to infection o Hydration, oxygenation and rest
• Splenomegaly (because of RBC), Weak • Splenic Sequestration
Bones or Spinal Defects o Avoid palpating the abdomen of the
• Frequent Infections, Leg Ulcers aeg to prevent rupture of the spleen.
• Priapism (prolonged erection) o Because there are lots of RBC in
• Jaundice spleen
• Pain: Vaso-Occlusive Crisis (because of the • Splenectomy
pointed ends) o Spleen is okay to be removed but
• Infection prevent infection
o Pre-OP
Diagnostic Test § Pneumococcal vaccine (to
• CBC prevent infection)
o Decreased RBC, increased bilirubin, o Post-OP
decreased hemoglobin and § Monitor hemorrhage, shock
hematocrit, increased reticulocytes § Monitor temp elevation
• Sickledex § Early ambulation - easy
• Hemoglobin Electrophoresis hospitalization, early cured
o A blood test that measures different
types of a protein called hemoglobin in Summary of Complication In Sickle Cell
your red blood cells. It is sometimes Organ Physical Findings Symptoms
Involved
called hemoglobin evaluation or sickle ABD, Pain, Fever,
Spleen Increased Infection
cell screen. Infection
Lungs Pulmonary Infiltrates Chest Pain, Dyspnea
Management CNS CVA Weakness
• Hydration (Oral, IV) Kidney
Hematuria, Renal
Dehydration
Failure
• Oxygenation Tachycardia, Weakness, Fatigue,
• Avoid tight clothing Heart
Cardiomegaly, CHF Dyspnea
• Provide Bed Rest Bone
Osteosclerosis,
Bone Pain (Hips)
Avascular Necrosis
• Blood Transfusion (BT) Jaundice, Gallstone
• Good Skin Care (because of prone to Liver Formation, Abdominal Pain
Hepatomegaly
infection) Skin Ulcers, Poor
• Genetic Counseling, Newborn Screen Skin
Wound Healing
Pain

• Prevent The Infection Eye Retinal Detachment

Decreased Vision,
Blindness
• Administer Medication Penis Priapism, Impotence Pain
o Hydroxyurea
CVA - Cerebro Vascular Accident
CHF - Congestive Heart Failure
4
 c. Thalassemia If person is in high altitude (less oxygen), then we
• Decreased production of hemoglobin due to have tissue hypoxia, then cont.
abnormal hemoglobin synthesis.
• Autosomal recessive transmission Signs & Symptoms
• Two types: • Reddening of the skin and mucous membrane
o Thalassemia Minor • Bleeding > anemia
o Thalassemia Major o ^ RBC accumulate vascular bed which
result blood vessel to dilate, engorge and
Assessment later rupture causing bleeding and
• Skin: Pale, Jaundice anemia.
• Fatigue, Shortness of Breath (SOB) • Headache, dizziness, blurring of vision
• Splenomegaly, Hepatomegaly o ^ RBC = highly concentrated blood
• Increase peripheral resistance > HPN
hyperplasia - big bone marrow (hypertension)
• Thrombus formation
Nursing Intervention o Highly viscous/concentrated > blood flow
• Regular blood transfusion, monitor reactions will slow, sluggish = thrombus formation
• Folic acid (presence of clot formation)
• Hemosiderosis: Iron Overload • Hepatomegaly
o Chelation therapy • Splenomegaly
o Reduces liver iron concentration o Since BM produce ^ RBC - enlarged
o Deferoxamine (Desferal, Exjade 250 spleen and liver (to compensate for the
mg) overproduction)
• Splenectomy • Increase body temperature > decreased body
• Bone marrow transplant weight
• Genetic counseling o If BM is hyperactive and produce ^ RBC
> increase act. cell (any increase act. in
cells) > increase body temp. > dec. body
6. Polycythemia Vera weight
• Increase blood cell levels • Pruritus (late symptoms)
• Overproduction by bone marrow
• Types:
o Primary Polycythemia Vera - hypo
ploriferative hyper active of bone marrow
on unknown cause.
o Secondary Polycythemia Vera - tissue
hypoxia > high RBC

area of
high
altitude

stimulate tissue
the bm hypoxia

erythrop
oietin

5
 NCM112j - Hematology Distribution of The Genes
August 19, 2021

Disorders of Platelets and Clotting Mechanism

If patient has low WBC, then patient will have
bleeding tendencies.

Clotting Factors
I - Fibrinogen VIII - Antihemophilic
II - Prothrombin IX - Plasma
III - Tissue Thromboplastin
Thromboplastin (Christmas)
IV - Calcium X - Stuart
XI - Thromboplastin
V - Proaccelerin
Antecedent
VI - XII - Hageman Factor
Two Types of Hemophilia
XIII - Fibrin Stabilizing
VII - Procenvertin 1. Hemophilia A
Factor
All this factor will help blood to clot. • X- linked recessive
• Decrease the synthesis of factor VIII (8)
Blood Coagulation • Treat with recombinant factor VIII
• Hemostasis - the balance between these two
2. Hemophilia B
systems, clot (thrombose) formation and clot
dissolution or fibrinolysis. • X- linked recessive
• Phases: • Decreased synthesis of factor IX (9)
o Vascular Constriction - there is wound, • Treat with recombinant factor IX
the first coping mechanism is vascular • Also known as christmas disease.
constriction.
§ When lining of vessels is
damage, they stop bleeding Hemophilia Assessment
o Platelet Aggregation - platelets • Prolong bleeding after cut or minor injury
immediately form a plug to prevent blood • Bruising and hematomas but no petechiae
bleeding. Compensatory mechanism. • Peripheral neuropathies:
o Coagulation Phase: activation of clotting o Pain
factors and cloud formation. Thrombin o Paresthesia
converts fibrinogen to fibrin. o Muscle atrophy
o Fibrinolysis (clot breakdown / falls off) • Hemarthrosis
o Bleeding inside the joint cavity
1. Hemophilia § Knees
• Hereditary bleeding disorder (sex link) caused by § Ankles
low or lack of coagulation factor in which the § Elbows
blood does not clot properly. § Wrist
• There are two types of sex chromosomes, X&Y • No Cure
chromosomes. X chromosomes carry the genes o We can only treat the symptoms but there
for hemophilia A and B. is no cure
• The lower the level of clotting factors, the more o Avoid injury and medications that promote
serious the hemophilia. bleeding
• Primarily affecting males - but females can also o Good nutrition
have hemophilia o Good dental hygiene
o IV administration of deficient clotting
factor
• Visual disturbances
• Prolonged nosebleed
1
• Bruises easily
• Warm, painful, swollen joints with small
movement
Diagnostic Test
• Platelet counts = Normal
• PTT increased (XII, XI, IX, VIII)
o A blood test that looks at how long it
takes for blood to clot.
o Normal range 60-70 seconds
• Measuring the clotting factors (VIII and IX) in the
blood:
o Healthy people (no hemophilia): 50%-
100%
o Mild hemophilia: more than 5% and less
than 50%
o Moderate hemophilia: 1% to 5%
o Severe hemophilia: less than 1%
• Prenatal Testing
o If a pregnant woman has history of
hemophilia, a hemophilia gene test can
be done during pregnancy.
o A sample of placenta is removed from the
uterus and tested. This test is known as
a CVS (chorionic villus sampling) test.
Management
• Control acute bleeding
o RICE
• Manual pressure for 15 minutes.
• Avoid sutures, cauterization
• Avoid drugs that promote bleeding
o Aspirin - either anticoagulant / NSAIDS
but here it is anticoagulant
o Heparin
o Warfarin
• Avoid contact sports
• Hemostatic agents
o Take hemostatic agents to stop bleeding
§ Hemostan
§ Tranexamic acid
2
o Ex. tooth extraction
• Provide care for hemarthosis
o Immobilize, elevate slightly flexed
o Administer analgesic (no aspirin)
• Avoid weight bearing: 48 hours
• Active/Passive exercise
o Active exercise - patient will do the
exercise alone
§ Swimming
o Passive exercise - someone will do the
exercise
• Blood Transfusion
o Cryoprecipitate
§ contains clotting factor 8
o FFP (fresh frozen plasma)
§ RBC is removed from plasma,
which then contains factor 8 and
9
o Desmopressin: mild hemophilia A
§ Synthetic hormone that
stimulates the release of clotting
factor 8
• Teaching
o Prevention of trauma
o Genetic counselling
2. Disseminated Intravascular Coagulation
(DIC)
• Widespread coagulation and followed by a
depletion of clotting factors.
o The coagulation factor is empty because
of too much use
• In which small blood clots develop in the
bloodstream which block the small blood
vessels.
o Will obstruct the blood flow
o Happens inside the vein.
• The increase clotting, depletes the platelets and
clotting factors needed to control bleeding,
causing excessive bleeding.
Cause
• By another disease or condition, such as an
infection or injury, that makes the body’s normal
blood clotting process become overactive
Assessment
• Petechiae, Ecchymosis
• Prolonged bleeding, severe bleed (childbirth,
surgery)
• Convulsions
• Coma
Diagnostic Tests
• PT, PTT prolonged
• Fibrinogen depressed Main Pathophysiology
• Immature WBC
Nursing Intervention: o will not protect us from infection
• Monitor blood loss • Multiplying Cells
• Blood transfusion o ^ act. of cell > ^ cellular metabolism > ^
• Medication (avoid aspirin) body temp
• Prevent further injury • Proliferating Cells
o congest, accumulate, crowd inside bone
3. Idiopathic Thrombocytopenic Purpura (ITP) marrow > cause joint pain and swelling
• An autoimmune disorder in which the blood • Cells Congesting Inside Bone Marrow
doesn’t clot normally. o hinder, prevent production of other blood
o Autoimmune Disorder - our immune cells > cause (RBC) anemia,
system attacks our own body. thrombocytopenia (platelet) > bleeding,
• This condition is now more commonly referred to epistaxis, gum bleeding hematoma,
as immune thrombocytopenia (ITP) heavy menstruation
• Multiplying Cells Can Invade Vital Organs
Cause o can invade your spleen > splenomegaly
• Unknown (autoimmune) o liver > hepatomegaly
• Sudden onset often preceded by a viral illness o brain > s/sx of increase intracranial
pressure
Assessment o kidney > renal insufficiency > renal failure
• Petechia, ecchymosis, purpura
• Bleeding from mucous membrane, nosebleed How to Classify Leukemia
WBC derived from:
Diagnostic Tests Lymphoid Tissue
• Decreased platelet count Bone Marrow (Lymph nodes,
• Bleeding time is prolonged thymus)
Granulocytes Non-Granulocytes
Nursing Interventions • Myeloblast - • Lymphoblast -
• Control bleed: plate transfusion Immature Immature
• Prevent bruising, protect infection • Myelocytes - • Lymphocytes -
• Administer medication (oral, rectal, IV) not IM Mature mature
o Not IM because patient might bleed. o Neutrophil
• Acetaminophen, avoid aspirin o Eosinophil
• IV immunoglobulin, glucocorticoids o Basophil
(corticosteroid)
o IV immunoglobulin G will decrease the Non-Granulocytes
destruction of platelet. • Monoblast -
o Glucocorticoids - drug will reduce anti Immature
body production and prevent platelet • Monocytes -
destruction. mature
• Pad cribs, soft toys, knee/elbow pads,
headgears Blast stages are immature stages of WBC.
• Soft toothettes, stool softener, avoid contact
sports Classifying leukemia depends on what type of
o Stool softener - to prevent strain cells present in the aspirated bone marrow:
Acute Myelocytic Acute Lymphotic
Leukemia (CML) Leukemia (ALL)
Leukemia • Myeloblast/Monoblast • Lymphoblast is
• Neoplastic Disease - Cancer of WBC is found. found.
• Most common disorder of WBC • Adult • Children
• Bone marrow is producing more immature WBC
known as blast cells.
3
 • Because of the
immaturity of the
lymphoid organ.

Acute Leukemia Chronic Leukemia

Sudden Gradual

Short course / short Long course /

duration (less than 6 long duration (2-
months) 8 years)

Predominant cells Predominant

are immature blast cells are mature
cells. WBC

Risk Factors
• Radiation, Chemotherapy
o Chemotherapy - treatment for cancer
patients to kill cancer cells.
o They are at risk because of too much
exposure on the bone marrow.
• Chemical: Benzene
• Smoking, Family History, Genetic Disorder

Diagnostic Tests
• Blood Tests
• Bone Marrow Aspiration and Biopsy

Management
• Radiation
o Administered through a high energy x-ray
beam.
• Chemotherapy
o A drug treatment that uses powerful
chemical to kill fast-growing cells in your
body
o Will not only kill the cancer cells but also
the healthy cells
o Maintenance: chemo (2-3 years)
• Bone marrow / stem cell transplant