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Reticuloendothelial System (RES)- monocytes spend a short time inthe circulation (about 24 hours). Function RES: Phagocytosis, Breakdown of RBC
Blood Made Up Of RBC: (erythrocyte)- carries hemoglobin to provide oxygen to tissue, lives 120 days, WBC: normal blood, the total leukocyte count is 4000 to 11,000 cells/mm3. neut.- limiting bacterial infection via phagocytosis;mono- enters as macrophage fights fungal; eosin:allergic reaction;,baso-contain histamine hypersensivity; T-lymph- recognizes foreign material;b- cell-plasma cell to form antibodies, Platelets: (thrombocyte)- for coagulation, lifespan 10 days Major Component Hgb- Protein,Transport O2 & Co2, Maintain pH In Bone Marrow- Called Erythopoiesis Maturation RBC Requires: Vitamin B12-The vitamin B12–intrinsic factor complex is absorbed in the distal ileum. People who have had a partial or total gastrectomy may have limited amounts of intrinsic factor, and therefore the absorption of vitamin B12 may be diminished. Folic Acid, Protein, Enzymes, Minerals: Iron And Copper, Erythropoietin - Normally found in Kidney, Stimulates
RBC Formation
- Two Groups: Granulocytes: neut. Baso. Eos.,, , Agranulocytes: mono.,lymph.
- Released As Thromboplastin; Plasma: 3 Major Components
- Lymphatic System: 2 Types: T-Lymphocyte, B- Lymphocyte;
- Spleen- Largest Organ, Causes- Blood Dyscrasias, Drugs Cause Problems
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Anemia-
hypoproliferative anemias, the marrow cannot produce adequate numbers of erythrocytes.
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Hemolytic Anemia-
- the erythrocytes have a shortened lifespan; Inherited forms include sickle cell anemia, thalassemia and thalassemia major,G-6-PD deficiency, and hereditary spherocytosis.
- The increased erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production. . Hemolysis can result froman abnormality within the erythrocyte itself or within the plasma
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Iron Deficiency: The most common cause of iron deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease, or GI tumors. Iron store replenishment takes much longer, so it is important that the patient continue taking the iron for as long as 6 to 12 months food sources high in iron include organ meats(eg, beef or calf’s liver, chicken liver), other meats, beans(eg, black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (eg, orange juice) enhances the absorption of iron.
Treatment- forms of ferrous sulfate. Many patients have difficulty tolerating iron supplements because of GI side effects (primarily constipation, but also cramping, nausea, and vomiting). Liquid forms of iron that cause less GI distress are available but, they can stain the teeth; the patient should be instructed to take this medication through a straw, to rinse the mouth with water, iron salts may color the stool dark green or black.
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APlastic Anemia-
caused by a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow,(r/t radiation and chemo). The precise etiology is unknown, but it is hypothesized that the body’s T cells mediate an inappropriate attack against the bone marrow; by a bone marrow transplant (BMT) or peripheralblood stem cell transplant (PBSCT). In others, the disease can be managed with immunosuppressive therapy, commonly using a combination of antithymocyte globulin (ATG) and cyclosporine or androgens. Side effects during the infusion are common and may include fever and chills. use reverse isolation and antibiotics, Tx: blood replacement
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Pernicious Anemia-
by deficiencies of vitamin B12 or folic acid, Inadequate dietary intake in strict vegetarians who consume no meat or dairy products.S/S-weakness, pale, fever, anorexia; determining the cause of vitamin B12 deficiency is the Schilling test, in which the patient receives a small oral dose of radioactive vitamin B12, followed in a few hours by a large, nonradioactive parenteral dose of vitamin B12(this aids in renal excretion of the radioactive dose). If the oral vitamin is absorbed, more than 8% is excreted in the urine within 24 hours; therefore, if no radioactivity is present in the urine (ie, the radioactive vita-min B12stays within the GItract), the cause is GI malabsorption of the vitamin B12. Conversely, if radioactivity is detected in the urine, the cause of the deficiency is not ileal disease or pernicious anemia. Later, the same procedure is repeated, but this time intrinsic factor is added to theoral radioactive vitamin B12. If radioactivity is now detectedin the urine (ie, the vitamin B12 was absorbed from the GItract in the presence of intrinsic factor)
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Polycythemia Vera, S/S, TX-
- to an increased volume of erythrocytes. The term is used when the hematocrit is elevated (more than 55% in males, more than 50% in females). Phlebotomy is an important part of therapy. It in-volves removing enough blood (initially 500 mL once or twice weekly) to reduce blood viscosity and to deplete the patient’s iron stores
- S/S- red face, purple lips, weak, dizzy, HA, spleen enlarged
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Idiopathic Thrombocytopenia-
Treatment, Cause, Nursing Interventions-condition of having an abnormally low platelet count, can lead to an increased risk of bleeding , formation of bruises (purpura) and petechiae (tiny bruises), bleeding from the nostrils, bleeding at the gums, and menorrhagia, any of which may occur if the platelet count is below 20,000 per μl., Secondary causes could be leukemia, medications (e.g.,quinine, heparin), lupus erythematosus, cirrhosis, HIV, hepatitis C, congenital causes, forms the treatment may consist of oral prednisone or prednisolone. Once the platelet count has improved, the dose of steroid is gradually reduced while monitoring for relapses
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Blood Administration,
Safety, Hanging Blood Products-
Complications
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DIC-Disseminated intravascular coagulation
is a serious disorder in which the proteins that control blood clotting become abnormally active.,symptoms: Bleeding, possibly from multiple sites in the body, Blood clots, Bruising, Drop in blood pressure. TX: Blood clotting factors may be replaced with plasma transfusions. Platelet transfusions can raise the blood count. Heparin, a medication used to prevent clotting, is sometimes used to interrupt clotting events.
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Multiple Myeloma- Survival Rate-
is a malignant disease of the most mature form of B lymphocyte, the plasma cell., bone pain, usually in the back or ribs. No cure
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Leukemia-
is cancer of the white blood cells. the bone marrow produces abnormal white blood cells. In acute myeloid leukemia (AML), there are too many of aspecific type of white blood cell called a myeloblast.
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Acute Myelogenous -
is the most common type of acute leukemia in adults. This type of cancer usually gets worse quickly if it is not treated. Possible risk factors include smoking, previous chemo. treatment, and exposure to radiation. S/S: Fever, joint pain, liver and spleen enlarged, N/V, SOB, Easy bruising, Bleeding under the skin, Weakness, Treatments include chemotherapy, other drugs, radiation therapy, stem cell transplants, and targeted immune therapy.
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Chronic Myelogenous -
there are too many of a specific type of white blood cell called a granulocyte. does not cause any symptoms at all. If you have symptoms, they may include: Feeling very tired, Weightloss, Night sweats, Fever, Pain or a feeling of fullness below the ribs on the left side; . Treatments include chemotherapy, radiation therapy, stem cell transplants, infusion of donated white blood cells following stem celltransplants, immune therapy, or surgery to remove the spleen.
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Acute Lymphatic-
there are too many of specific types of white blood cells called lymphocytes or lymphoblasts.Possible risk factors include being male, being white, being older than 70, previous chemotherapy treatment, or exposure to radiation.S/S: Weakness, Fever, Easy bruising, Bleeding under the skin, SOB, Weight loss or loss of appetite, Pain in the bones or stomach, Pain or a feeling of fullness below the ribs, Painless lumps in the neck, underarm, stomach, or groin Treatments include chemotherapy, radiation therapy, stem cell transplants, and targeted immune therapy.
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Chronic Lymphatic-
Most common Leukemia inthe United States, Neoplastic accumulation of mature Lymphocytes Involves Blood and Bone MarrowMay infiltrateSpleen and lymph nodesB. S/S: Weakness, Fatigue, Anorexia, Pruritus,Frequent infections Signs: Hepatomegaly, Splenomegaly, Lymphadenopathy, Fever; Stage A: Lymphocytosis(<3 lymph node groups involved) Median survival: over 10 yearsIII.Stage B: Lymphocytosis (>3lymph node groups involved) Median survival: 5 yearsIV. Stage C: Lymphocytosis with Anemia or Thrombocytopenia ,Median survival: 2 years
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Component of therapy- CNS intact, intra
medullary bone marrow therapy
Medications Used, Prednisone, VincristineSulfate( used with others), Danarobinicinor Aspanganase – starts to work in 4-6 weeks Side Effects Prednisone-masksymptoms, buffalo hump on back of neck Methotrexate & 6Mercaptopurine, Side Effects- immunosuppressive drug. Transfusions, O2, IronTherapy, Vitamins
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Hemophilia-
Prolonged Coagulation,- An inherited deficiency of coagulation factor VIII hemophilia A is the most common hemophilia,A. Sex linked recessive deficiency of factor VIII. Symptoms-Excessive bleeding from slight trauma. Labs- Partial Thromboplastin Time (PTT) elevated, ProTime normal. Give Factor VIII to obtain 15% Factor VIII levelb. Severe Bleeding- Give Factor VIII to obtain 50% Factor VIII level
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HIV A Retrovirus-
Transmission, 8-10 Years After Exposure -Occurs 2-3 weeks after exposure in patients,I. CD4 & T-cell Count Affect Symptoms, Stages- A. Protocol Start with HIV ELISA Test and HIV RNA LoadHIV positive ifa. HIV ELISA Test positive orb. HIV RNA >10,000 HIV equivocal (HIV ELISA negative andHIV RNA <10,000) . Retest HIV RNA Load in 1-2 weeksB. HIV ELISAAntibody Test Positive 3-8 weeks from infectionOften negative initially in acute onsetC. HIV staging labs, CD4 Count, Obtain 2 assays at 1-2 weeks apart; Asymptomatic, Symptomatic, AIDS, CD4 & CD 8 Ratio- look at notes
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Hodgkin’s Disease-
Localized disease with contiguous nodal spread Mediastinal involvement Curability >75%S/S: (Fever, Night Sweats, weight loss).Epstein-Barr Family History of Hodgkin Lymphoma-Same-sex sibling confers 10 fold risk, Higher risk in monozygotic twins, Immunocompromised conditions, Human Immunodeficiency Virusinfection (10 fold increased risk)B. Age of onset, Bimodal peaks: Age 15 to 34 years old and over age 60 years, Rare under age 5 S/S- cough striders, difficulty swallowing, Painless lymph node enlargement, Fatigue, Abd. Pain, Periodic low grade fever and Night Sweats, II. Staging (Ann Arbor classification) .Stage IA.Stage IIB.Stage IIIC.Stage IV- worse stage- spreads Abundance of Reed-Sternberg CellsIII. Management: Chemotherapy Regimens- Stage IA - Radiation Therapy ; In stage III-IV, radiation directed at sites, Combination Chemotherapy
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Non-Hodgkin’s Lymphoma-
- Non-contiguous nodal spread, Extranodalinvolvement, Abdominal and Bone Marrow involvement, Curability <25%
- linked to viruses, stine-barr, herpes, aids, toxin exposure
- chemo and rad- once a month for 6 months
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