Hematology

• blood
• bone marrow
• spleen
• liver
• lymphatics
• thymus

• Bone marrow
• RES
• -blood is specialized ORGAN that exists in a fluid state

• fluid portion of blood (55%)
• water, electrolytes, proteins, nutrients, waste products

same as plasma, just without Fibrinogen

• 40-45%
• RBCs
• WBCs
• Platelets

• producition of RBCs
• site is Bone marrow
• during embryonic developement the liver and the spleen may be involved

• Myeloid: RBCs, WBCs, Platelets
• Lymphoid: T and B lymphocytes

• macrophages which are made from monocytes
• spleen is site of activity for macrophages

• preventing or stopping blood loss from an injured vessel
• needs funtional platelets: >100,000
• Primary-vessel contricts, platelets come
• Secondary- formation of fibrin which reinforces platelets plug and anchors it to injury site

• CBC
• H & H
• Sed rate of erythrocytes, monitors course of inflammatory disease
• PT, PTT
• INR
• D-Dimer (blood clotting >500)
• BNP (fluid overload as in CHF)

• Dietary deficiencies: Iron, folic acid, B12 (as in hypoproliferative-not making enough RBCs)
• Hereditary disorders:sickle cell
• Bone marrow damage : due to meds (chemo and radiation)
• malignancy: tumors
• overactive spleen
• Bleeding

decreased production of RBCs

Bone marrow failure to produce blood cells

most common

• deficiency in B12 and folic acid
• abnormally large RBCs

• resulting from RBC destruction (hemolysis)
• can cause jaundice

• loss of RBC= anemia
• can be from GI bleed (check for OB), menorrhagia, epitaxis

• "bone marrow failure" decrease in marrow stem cells, replacement of marrow w/fat
• S/S: pallor, fatigue, anemia, dyspnea
• Tx: BMT Nursing: monitor blood counts, and for signs of infection

• inherited sickle hemoglobin gene
• Hgb defective, rigid and sickle shaped, adhere to endothelium and to each other

• caused by: infection, cold weather, decreased O2 levels, stress
• S/S: Hgb 7-10 (normal men 14-17), pain in joints, swelling, low grade fever in adults, jaundice, weakness
• NEED: pain control, O2, fluids
• Dx: Hgb electrophoriesis

• Hydroxyuria: antineoplastic med, increase fetal Hgb level and decrease sickle cell formation.
• folic acid and B6
• Vanillin & Arginine: so that sickle cells dont stick together
• Desferal

• iron chelating agent (helps excrete iron)
• managment of secondary iron overload syndromes assoc with multiple transfusions

O2, fluids, antibiotics, remove contrictive clothing, transfusion, itching (could be from hypoxia or pain meds) need Benydril, NSAIDs do not seem to help, avoid IM injections

uncontrolled proliferation of leukocytes in bone marrow with infiltration of lymph nodes, spleen, liver

• Myelogenous- mono and granulocytes
• Lymphocytic

• genetic, viral, or radiation
• Dx: decreased RBCs, platelets, WBCs can be low normal or high, bone marrow aspiration (excess immature blasts cells), Ayer rods in cytoplasm show AML

• lymphadenpathy (swelling of lymph nodes)
• pain (enlarged liver or spleen), infection (neutropenia), anemia, weakness, fatigue, bleeding (thrombocytopenia) bruises and petichiae,
• Tx: chemo, BMT

• genetic abnormality (Philedelphia chromosome) 90-95% pts
• Dx: bone marrow
• S/S: similar ot AML but less severe
• Tx: chemo, BMT

• most prevalent cancer in young kids
• Dx: CBC, bone marrow aspiration
• S/S: hemorrhage, infection, pain
• Tx: chemo, radiation

• malignancy of older adults (30-50)
• genetic, viral, radiation
• Dx: CBC
• S/S: infection, anemia, enlarged lymphs
• Tx: Chemo, chlorambucil

monitor for infections, bleeding, provide comfort, emotional support

• unknown origin, originates in lymphatic system
• histiocytes: Reed-Sterberg cells (giant tumor cells)
• Dx: excisional lymph biopsy
• s/s: painless enlargment of lymph nodes, puritis
• Tx: chemo, radiation

local bleeding, petecjiae, eccymosis with trauma, see blood infeces, urine, pain may indicate internal bleeding, hypovolemia- decreased BP, tachy, pallor, clammy skin, oliguria

• rupture of small vessels that are defective or injured results in blood leaking into the skin
• Vit C deficiency
• S/S petechiae, eccymosis

• platelets below 20,000/mm3 see petechiae along nose and gingival bleeding
• below 5,000/mm3 spontaneous CNS or GI hemorrhage can occur

• genetic
• s/s: joint pain, bruises
• Dx: deficient/defective factor VIII and IX
• so GIVE factors 8-9

• coumadin: warfarin: Vit K
• Heparin: Protamine sulfate

• graft versus host disease
• occurs in about 1/2 allogenic transplants
• T-lymphocytes of new marrow attack the pts liver, skin and GI
• can be acute or chronic- 3-6 motnhs after BMT

maculopapular rash on palms and soles, green diarrhea, liver enlargement and elevated liver enzymes