Hematologic Disorders
&
Nursing Priorities
Keith Rischer RN, MA, CEN
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Objectives for Today
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Review pathophysiology related to hematologic cells
and blood forming tissues
Interpret significance of altered hematologic lab values
Review commonly used medications that alter
hematologic function
Identify the patho, clinical manifestations, diagnostic
tests, nursing priorities, and client education in clients
with anemia, sickle cell anemia, leukemia,
lymphomas, and multiple myeloma.
Identify the nursing priorities with blood transfusion
and the most common transfusion reactions.
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Blood Cells

Hematopoesis: Red
bone marrow
•
The blood forming
tissue that produces
the 3 major cell
components of blood

Erythrocytes

Leukocytes

Thrombocytes
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Erythrocytes
•
Function
 Transport
of gases (O2 & CO2)
 Erythropoesis
•
•
Normal Life span: 120 days
Norms
 Hgb

– Women: 12-16 g/dl
– Men: 13.5-18n g/dl
HCT
RBC
4.0-5.0 mm3
4.5-6.0 mm3
– Women: 38-47%
– Men: 40-54%
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Leukocytes
•
Types
 Granulocytes
(Also known as
polymorphonuclear
leukocytes)
–Neutrophils
–Eosinophils
–Basophils
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Leukocytes
•
•
Monocytes
agranular)
Lymphocytes B cells:
mediate the humoral
immune response
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T cells: Mediate
cellular immunity
Normal Blood Count
of all WBC: 4,00011,000/ul
Elderly
considerations
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Thrombocytes
(Platelets)
•
Function:
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•
Aid in blood clotting
Maintain capillary
integrity by working as
“plugs” to close any
openings in the
capillary wall.
Normal Blood Count:
150,000-400,000 mm3
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Anemia
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Mild
•
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Moderate
•
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Hgb 10-14 g/dl
Hgb 6-10 g/dl
Severe
•
Hgb < 6 g/dl
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Anemia:Causes
Macrocytic
 Pernicious Anemia (B12 deficiency)
 Folate deficiency
Microcytic
– Iron deficiency anemia
Normocytic
– Blood loss
– Sickle cell anemia
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Macrocytic Anemia
Megaloblastic Anemias: Presence of large RBC’s)

Caused by defective DNA synthesis
Two common types:
1. Cobalamin (vitamin B12 deficiency)
– Pernicious anemia =most common cause.
2. Folic acid deficiency
–
–
–
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Poor nutrition (Anorexia)
malabsorption in small bowel
ETOH
Hemodialysis
PATIENT EDUCATION
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Microcytic Anemia: Iron Deficiency
Abnormal-small erythrocytes…decr. Hgb
 Most common anemia
 Manifestations
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Pallor
Glossitis
fatigue
Dietary sources
 Patient education
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Normocytic Anemia: Etiology
Blood Loss
• Acute
• Chronic
Extrinsic (acquired) hemolytic anemias –
(damage to RBCs due to external factors)
• Physical factors
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ED Case Study
88 yr women w/dk tarry stools last 5 days.
c/o weakness, nausea.
 Pale, cool-initial VS 80-16-124/30….2
hours later 96-20-94/49
 Wbc 9.8, hgb 6.9 (was 12.7 2 weeks ago),
hct 21.5, plt 176, INR 4.8 (was 2.1 2
weeks ago)
 Nursing priorities
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Sickle Cell Anemia
Patho
 Sickle Cell Crisis
 Nsg Management
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Pain control
Hydration
Patient Education
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•
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Hydration
Tx infection
Psychosocial
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Thrombocytopenia
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Reduction of platelets below normal range
• Normal = 150,000-400,000 mm3
Etiology:
• Immune Thrombocytopenic Purpura (ITP)
• Heparin
• Bone marrow suppression
Critical values
•
•
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50,000 or less- risk of bleeding
<20,000 spontaneous life threatening hemorrhages (brain bleed)
<10,000 transfusions recommended
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Clinical Manifestations
Petechiae
 Purpura
 Ecchymosis
 Bleeding
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Nursing Management
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If acute care-Peripheral IV established
No ASA products for pain control
Prevent/control acute bleeding
Platelet transfusions-assess for reaction
Steroids-pt. teaching
Education-signs of bleeding
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Blood Product Administration
Minimum 22 g.(blue hub) IV-prefer 20g.
(pink) or 18g. (green)
 Blood tubing with filter-use NS to prime/flush
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Validate pt., type of blood product, expiration date,
blood tag #
VS before, 15” after initiation, end of each
Infuse PRBC’s over 2 hours (appx 300cc/unit)
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Complications Blood Products
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Circulatory Overload
Acute Hemolytic Reaction
• Chills, fever, flushing, tachycardia, SOB, hypotension,
acute renal failure, shock, cardiac arrest, death
Febrile-Nonhemolytic Reaction
• Sudden onset of chills, fever, temp elevation >1
degree C. headache, anxiety
Mild Allergic Reaction
• Flushing, urticaria, hives
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Nursing Responsibilities
STOP transfusion
 Maintain IV site-disconnect from IV and
flush with NS
 Notify blood bank/MD
 Recheck ID
 Monitor VS
 Treat sx per MD orders
 Save bag and tubing-send to blood bank
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