Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 20
NURSING CARE OF
THE CLIENT:
HEMATOLOGICAL &
LYMPHATIC
SYSTEMS
Blood
The heart pumps 5-6 liters of blood per
minute through the circulatory system.
 Blood is an aqueous mixture consisting of
plasma and cells.

Plasma
A straw-colored liquid consisting of
approximately 90% water and 10%
proteins.
 The proteins are albumin, globulins, and
fibrinogen.

Red Blood Cells
Also called erythrocites, these are the
most numerous blood cells in the body.
 RBCs in conjunction with the respiratory
and circulatory systems oxygenate body
tissues.
 Hematocrit is the percentage of blood
cells in a volume of blood.

White Blood Cells
Also called leukocytes, these fight
infection and assist with immunity.
 An increased number of WBCs
(leukocytosis) may signify the presence of
an infection, inflammation, tissue
necrosis, or leukemia.
 A decreased number (leukopenia) may
indicated bone marrow failure, a massive
infection, dietary deficiency, drug toxicity,
or autoimmune disease.

Platelets

Platelets (thrombocytes) are
nonnucleated, granular, ovoid, or spindleshaped cell fragments that are active in
the clotting mechanism of the body.
Blood Types
There are 14 different blood groups and
over 100 different antigens. The different
blood groups vary in number with different
ethnic groups.
 AB blood types are universal recipients; O
types are called universal donors. These
terms, however, are only theoretical.

Rh Factor

A factor to consider during blood
transfusions.
Blood Transfusions
Given to replace needed blood
components because of hemorrhage,
anemia, clotting disorders, or blood
deficiencies.
 Three types of blood reactions: hemolytic
(severe, shock); febrile (elevated
temperature, usually mild); allergic (may
be mild or severe).

Autotransfusion
The collection and storage of a patient’s
own blood for purposes of transfusion.
 May be used for elective surgeries.

Lymphatic System
A separate vessel system.
 The two main functions are to transport
excess fluid from the interstitial spaces to
the circulatory system and to protect the
body against infectious organisms.

Components of the Lymph
System
Lymph Fluid: pale yellow; moves from the
plasma through the capillary walls and
becomes interstitial fluid.
 Lymph Nodes: scattered through the body
and contain dense patches of
lymphocytes and macrophages.
 Lymph Organs: the spleen and the
thymus.

Red Blood Cell Disorders:
Anemia
Anemia is a common hematopoietic
disorder in which the client has a
decreased number of RBCs and a low
hemoglobin level.
 Causes are a decreased production of
RBCs, an increased destruction of RBCs,
or loss of blood.
 Types include: Iron-deficiency, hypoplastic
(aplastic), pernicious, acquired hemolytic
anemia, and sickle-cell.

Red Blood Cell Disorders:
Iron Deficiency Anemia
Most common type. Body does not have
enough iron to synthesize functional Hgb.
 Symptoms are fatigue, loss of appetite,
decreased ability to concentrate, and
pallor.

Red Blood Cell Disorders:
Hypoplastic (Aplastic) Anemia
The bone marrow decreases or stops
functioning in a client with aplastic
anemia.
 Develops without a known cause and
thought to be genetic.
 Secondary aplastic anemia caused by
exposure to viruses, chemicals (benzene
or airplane glue), radiation, or
medications.
 Clients are extremely ill.

Red Blood Cell Disorders:
Pernicious Anemia
An autoimmune disease in which the
parietal cells of the gastric mucosa are
destroyed and the gastric mucosa
atrophies, so that Vitamin B12 cannot be
absorbed.
 Symptoms include extreme weakness,
sore tongue, numbness and tingling of
extremities, edema of the legs, etc.
 African American women are especially
affected with the disease and often

Red Blood Cell Disorders:
Acquired Hemolytic Anemia
In hemolytic anemias, hemolysis, or
destruction of RBCs, occurs and iron and
hemoglobin are released.
 Causes include autoimmune reaction,
radiation, blood transfusion, chemicals,
arsenic, lead, or medications.
 Symptoms include mild fatigue and pallor
or, more severely, jaundice, palpitations,
dyspnea, and back and joint pain.

Red Blood Cell Disorders:
Sickle Cell Anemia




Also known as Inherited Hemolytic Anemia, this
genetic disorder has abnormal hemoglobin S
rather than hemoglobin A.
Condition occurs most frequently in African
Americans.
Symptoms are enlarged heart, fatigue,
jaundice, chronic leg ulcers, dyspnea, and
arrhythmias.
Sickle cell crisis, which occurs periodically,
involves severe pain, fever, and loss of blood to
organs.
Red Blood Cell Disorders:
Polycythemia
A disease in which there is an increased
production of red blood cells.
 Occurs most frequently in the middleaged and in Jewish men.

White Blood Cell Disorders:
Leukemia
A malignancy of blood-forming tissues in
which the bone marrow produces
increased numbers of immature white
blood cells that are incapable of
protecting the body from infections.
 The increased numbers of WBCs crowd
out the other cells in the bone marrow,
causing a decreased production of RBCs
and platelets, resulting in anemia and
bleeding.

Classifications of Leukemia
Acute (rapid onset; quick treatment
necessary for good prognosis
 Chronic (occurs over months or years;
prognosis depends on severity of the
disease at time of diagnosis).

White Blood Cell Disorders:
Agranulocytosis
A severely reduced number of
granulocytes.
 Primary cause is adverse reaction to
medication or medication toxicity.
 Symptoms are those typical of infection:
fever, headache, chills, fatigue. Also
mucous membrane ulcerations.

Coagulation Disorders
Disseminated intravascular coagulation (a
condition of alternating clotting and
hemorrhaging; a syndrome that occurs
because of a primary disease or
condition).
 Hemophilia (an inherited bleeding
disorder in which there is a lack of clotting
factors).
 Thrombocytopenia (a decrease in the
number of platelets in the blood).

Lymph Disorders
The two types of malignant lymphomas
are Hodgkin’s Disease and non-Hodgkin’s
lymphoma. Clients with both types of
lymphoma have enlarged lymph nodes.
 Hodgkin’s disease is diagnosed by the
presence of the Reed Sternberg cell in
the swollen lymph nodes. Non-Hodgkin’s
lymphoma arises from the B lymphocytes
and T lymphocytes and does not have the
Reed Sternberg cell in the lymph system.

Plasma Cell Disorder
The main plasma cell disorder is Multiple
Myeloma.
 The plasma cells, mainly in bone marrow,
become malignant, crowd out normal cell
production, destroy bone tissue and
thereby cause pain.
