Hematology (Anemia etc)

• WBC
• RBC
• Platelets

test the measures the settling of the rbcs in a test tube

When it is settling it means that that pt may have an acute infection

Hemoglobin and Hematocrit

4,200,000 to 6,100,000/mm3

(5,000-10,000/mm3)

150,000-400,000/mm3

• PT
• PTT
• INR

Prothrombin Time 11-12.5 sec

test to evaluate hemostasis

Partial Thromboplatin Time 30-45 sec

The PTT evaluates thecoagulation factors

International normalized ratio

normal range 0.7-1.8

- when on warfarin – range 2-3

- desired levels may vary according to patient condition

1- 9 mins

They slit your arm and put gauze on it, then time how long it takes for you to stop bleeding

Drugs like aspirin and Motrin will effect the bleeding time

CT and MRI

– Bone marrow, Lymph Node

• Pain
• Infection
• Bleeding

prone or side lying

Educate them on what to expect and feel

Some patients say they can feel the pressure of the needle going into their hip

Tell them they are conscious for sedation (local anesthetic)

Sterile

because you are going right into the bone

•Prevent bleeding (may have to put pressure on site)

•Check for infection

•Pain relief

•Ice packs- vasoconstrict, stop bleeding

•Avoid contact sports

• Deficieny of RBCs
• Low Hgb and Hct

•Not a specific disease but rather a manifestation of a pathologic process

tissue Hypoxia

• Pallor, especially of the ears, the nail beds, the palmar creases, the conjunctivae, and around the mouth
• •Cool to the touch
• •Intolerance of cold temperatures
• •Nails become brittle and may lose the normal convex shape; over time, nails become concave and fingers assume clublike appearance

Tachycardia at basal activity levels, increasing with activity and during and immediately after meals

•Murmurs and gallops heard on auscultation when anemia is severe

•Orthostatic hypotension

• Dyspnea on exertion
• Decreased oxygen saturation levels

• Increased somnolence and fatigue
• Headache

•Decreased Hb synthesis (Fe+ deficiency)

•Defective DNA synthesis (Folic acid deficiency)

•Decreased availability of erythrocyte precursors (Aplastic anemia)

•inadequate diet malabsorption, blood loss, hemolysis

•headache, inflammation of tongue and cheilitis (inflammation of lips),

Inflammation of lips

• increase TIBC,
• low serum iron,
• H/H low

Take a blood test

We need iron for the hgb to attach to the rbc


ron will be low

Hgb/Hct low

Classic for iron deficiency- TIBC (total iron binding capacity) will increase

Iron-Deficiency Anemia


IF you have iron deficiency this test will be increased

If the rbcs are not holding onto the iron- then they have a greater capacity to hold onto iron

•GI side effects esp. constipation

• •Take between meals to reduce GI distress and
• improve absorption

•Liquid take with straw

side effects: black stool, constipation

Hypoxemia

•Administer O2 as ordered

•Alternate rest/activity

•Monitor VS, hgb/hct


•Teach about meds

•Transfuse with blood products if needed- pRBC’s

•Increase protein and iron (b/c hemoglobin is made of protein)

•Small, frequent meals

•Increase iron-rich foods (red meat, kidney beans, green leafy vegetables etc)

Cobalamin Deficiency

Folic Acid Deficiency

Vit B12 deficiency

Lack of Intrinsic Factor (IF)

sore tongue, N/V, weakness, paresthesia of feet and hands, ataxia, confusion, pallor

• macrocytic RBC’s,
• decreased cobalamin,
• Schilling test for IF absorption

Cobalamin

Confusion and Ataxia

Lack of muscle coordination

it allows the absorption of Vit. B12

if you are lacking IF than you are not able to absorb B12 causing Cobalamin anemia

used to determine whether the body absorbs vitamin B12 normally

•supplemental Vit. B12 IM for pernicious anemia,

•Increase dietary B12 (not for pernicious anemia)

•CaloMist – B12 nasal spray – maintain vitamin levels

Intrinsic Factor which causes Vit. B12 Not to be aborbed

supplemental Vit. B12 has to be given IM

B12 but the Intrinsic Factor is still working properly

Supplemental Vit B12 can be given by Diet

poor nutrition, malabsorption, drugs, alcohol abuse,

needed for DNA synthesis leading to RBC formation

sore tongue, N/V, weakness, paresthesia of feet and hands, pallor

No changes in Neuro signs

Folic acid replacement (1mg), diet high in folic acid

deficiency of RBC

•Congenital due to chromosomal alterations

•Acquired due to exposure to chemicals, radiation, medications, bacteria, viruses

deficiency of RBC, WBC and platelets

Signs of infection- increased WBC, fever, depressed

First clue may be a sore throat

RBC, WBC and platelet counts, TIBC, bone marrow study

•Bone marrow transplant

•Immunosuppression with cyclosporin, etc.

•Prevent complications from infection and hemorrhage

Wear Gloves and Wash Hands

NEURO assessment

Can be a sign of hypoxia

For bleeding or infection

Bleeding may occur first in the brain- confusion, change in mental status, stroke like symptoms, septic

Screen visitors

Anyone with a cold or infection should not be in there

Children may not be sick but may be carrying an infection- so some kids may not be aloud in

Avoid invasive Procedures

Private room and possible isolation

private room if their WBC is really low

sudden blood loss due to trauma or surgery

• gradual blood loss where body adapts but there is insufficient RBC’s – GI bleeding, excessive
• menstruation

•replacing volume, prevent shock, blood transfusions, iron supplements etc

• replace blood volume,
• ID source of hemorrhage and stop bleeding,
• administer dextran,
• Hetastarch, a
• lbumin,
• lactated
• Ringer’s,
• supplemental iron.

•Post OP – monitor incision sites, drainage tubes, and dressings for blood loss.

•Administer O2 therapy – monitor O2 saturation

•Administer fluids, electrolytes, blood transfusions

•Administer meds to increase production of RBC’s

•ID source of bleeding and stop bleeding

•Nursing management is same as for iron-deficiency anemia

•Increased production of RBC’s causing impaired circulation due to increased blood viscosity

Hydration for fluid balance because blood is very viscous

– form of cancer in which there is an increase in RBC, WBC and platelets (cells are often impaired)

•hypoxia stimulates erythropoietin in kidneys which increase production of RBCs


•Hepatomegaly, spleenomegaly, intermittent claudication, pain,

•Hb, rbc, wbc, platelets, (frequent)

• bone marrow examination

at some time the dr. takes blood out of body and puts some back in

• Hydration
• frequent small meals
• Avoid iron supplements
• Avoid Citrus with meals

Because this is a clumping problem not a clotting problem that has to do with platelets

So aspiriin will not help

citrus increases absorption of iron

Bruises on places that are not normal for day to day activities and play

Reduce bone marrow activity

used in pts with Polycythemia

Hyperkalemia: becuase Once the cells die they are going to release potassium

Stroke: because blood is viscous and moves slower

Low platelet count

Which means patient has problems with clotting

(idiopathic thrombocytopenic Purpura)

autoimmune disease that causes abnormal platelet destruction

–formation of micro-thrombi/platelets that deposit in arterioles and capillaries resulting in few platelets in circulation

•Petechiae, ecchymoses, prolonged bleeding after routine procedures, major complication is hemorrhage

•Platelet count (decreased), bleeding time (prolonged), bone marrow, Hb/Hct

corticosteroids, IV immunoglobulin,, splenectomy, platelet transfusion

•corticosteroids, plasma exchange, anti-platelet agents

–is a reduction in the total number of WBC

reduction in number of neutrophils (granulocytopenia)

•Syndrome that occurs with a variety of illness

•Classic signs of infection or inflammation may not occur

• Low Neutrophil Count 1000-1500, peripheral
• blood smear to assess for immature cells, bone marrow aspirations

may not have typical signs of infection

Patients may not have the fever

So you have to look outside the box to figure it out

•Alert for minor complaints (sore throat, diarrhea, low grade fever etc)

•Antibiotics

•Screened visitors

•Strict handwashing- MUST

• •Private room (Laminar air flow rooms if needed)- protective isolation (you are protecting the
• patient, not yourself)

•Avoidance of fresh fruits and vegetables (severely compromised)- because of the bacteria on the outside of them

•A group of malignant disorders affecting the blood and blood-forming tissues of

•Bone marrow

•Lymph system

•Spleen

•Accumulation of dysfunctional cells due to loss of regulation in cell division

Chemotherapy

the process that the body uses to form blood clots to help stop bleeding.

liver disease

Pre-surgical procedures to screen for potential bleeding tendencies.

symptom occur rapidly and without intervention will progress to death

•Splenomegaly


•Hepatomegaly


•Lymphadenopathy

• •Bone pain- immature
• cells

•Meningeal irritation

•Oral lesions

•Solid masses

a malignant condition caused by proliferation of abnormal, giant, multinucleated cells called Reed-Steinberg cells located in the lymph nodes

• enlarged cervical, axillary or inguinal nodes, fever,
• fatigue, night sweats

malignant neoplasms of the immune system (lymphoid cancers that do not include Reed-Steinburg Cells)

painless lymph node enlargement