Hematologic &
Immunologic
Conditions
Lisa Walsh Ph.D.,RN
Northeastern University ABSN Program
Lesson Objectives
• Review basic anatomy and physiology of the hematologic system.
• Differentiate normal and abnormal laboratory values of the complete blood count.
• Apply the nursing process as a framework for hematologic and immunologic problems.
• Differentiate major categories of anemia and treatment.
• Prioritize nursing interventions in the administration of blood component therapy.
• Apply the nursing process as a framework for hypersensitivity and autoimmune
disorders.
• Prioritize nursing interventions in allergic responses including anaphylaxis.
• Prioritize nursing interventions in rheumatologic disorders.
Hematologic System – Blood Cell Development
◦ Erythrocytes – Red Blood Cells
◦ Leukocytes – White Blood Cells
◦ Thrombocytes – Platelets
◦ Plasma – Fluid portion of blood
◦ Blood cells created in bone marrow, spleen and reticuloendothelial
system
◦Hematologic Assessment
Table 32-2,
◦ Health History
◦ Physical Assessment
◦ Diagnostic Evaluation
◦ https://medlineplus.gov/lab-tests/complete-blood-count-cbc/
Anemias table 33-1
◦ Hypoproliferative (Defective RBC Production)
◦ Bleeding (RBC Loss)
◦ Hemolytic (RBC Destruction)
◦ Nursing Care:
◦ Assessment
◦ Education
◦ Transfusion
Blood Product Administration
Indications
Prescription
Consent
American Red Cross Blood
Transfusions
Preparation
Assessment (pre, during, & post Tx)
Education
RegisteredNurseRN Blood
Transfusion Procedure Nursing |
Reaction Types, Complications
(Hemolytic/Febrile)
Transfusion Complications
◦ Febrile nonhemolytic reaction
◦ Acute hemolytic reaction
◦ Allergic reaction
◦ Transfusion-Associated Circulatory Overload (TACO)
◦ Bacterial contamination
◦ Transfusion-Related Acute Lung Injury (TRALI)
◦ Delayed hemolytic reaction
◦ Disease acquisition
◦ Long-term transfusion therapy
Coagulation Disorders
◦ Liver disease
◦ Antithrombin deficiency
◦ Vitamin K deficiency
◦ Protein C & S deficiency
◦ Complications of anticoagulant ◦ Activated protein C resistance
therapy
and factor V Leiden mutation
◦ Disseminated intravascular
coagulation (DIC)**
◦ Thrombotic disorders
◦ Hyperhomocysteinemia
◦ Acquired thrombophilia
◦ Malignancy
DIC – Sign of underlying disorder
◦ Triggers may include sepsis, trauma, shock, cancer, abruptio placentae, toxins, and allergic
reactions
◦ Altered hemostasis mechanism causes massive clotting in microcirculation. As clotting factors are
consumed, bleeding occurs.
◦ Treatment: treat underlying cause, correct tissue ischemia, replace fluids and electrolytes,
maintain blood pressure, replace coagulation factors, use heparin or LMWH
Hypersensitivity & Autoimmune -WBC Problems
◦Hypersensitivity Reaction: when the immune system has a
harmful effect on the body
◦Autoimmune Disease: abnormal immune response to a
antigen that is part of the human body
◦Immunopathology: the study of diseases that results from
dysfunction of the immune system
Immunity Assessment
◦ Health history
◦ Physical exam
◦ Bone marrow biopsy
◦ Humoral and cellular immunity tests
◦ Phagocytic cell function test
◦ Hypersensitivity tests
◦ Specific antigen–antibody tests
◦ HIV infection tests
Allergy & Anaphylaxis
◦ Manifestation of tissue injury resulting from interaction
between an antigen and an antibody
◦Body encounters allergens that are types of antigens
◦Body's defenses recognize antigens as foreign
◦Series of events occurs in an attempt to render the invaders
harmless, destroy them, and remove them from the body
Allergy Assessment:
◦History and manifestations; comprehensive allergy history
◦Diagnostic tests
◦CBC: eosinophil count
◦Total serum IgE
◦Skin tests: prick, scratch, and intradermal
Anaphylaxis
Mayo Clinic video
◦Mild, moderate, and severe systemic reactions
◦Symptoms are sudden in onset and progress in severity over
minutes to hours
◦ Flushing
◦ Urticaria
◦ Angioedema
◦ Hypotention
◦ Bronchoconstriction
◦Common Causes; Refer to Chart 37-2
◦ Antibiotics most common; penicillin
Allergy & Asthma Network
Rheumatic Disorders
◦ Autoimmune, degenerative, inflammatory, and systemic conditions
◦ Affect the joints, muscles, and soft tissues of the body
◦ Marked by periods of remission and exacerbation
◦ Classification
◦ Monoarticular or polyarticular
◦ Inflammatory or noninflammatory
Three distinct characteristics:
◦Inflammation
◦Complex process resulting in pannus
◦Autoimmunity
◦Hallmark of rheumatologic disease
◦Body recognizes own tissue as foreign
◦Degeneration
◦Secondary process to inflammation
Nursing Care:
◦Relief of pain and discomfort
◦Relief of fatigue
◦Increased mobility
◦Maintenance of self-care
◦Improved body image
◦Effective coping
◦Absence of complications
Lesson Objectives
• Review basic anatomy and physiology of the hematologic system.
• Differentiate normal and abnormal laboratory values of the complete blood count.
• Apply the nursing process as a framework for hematologic and immunologic problems.
• Differentiate major categories of anemia and treatment.
• Prioritize nursing interventions in the administration of blood component therapy.
• Apply the nursing process as a framework for hypersensitivity and autoimmune
disorders.
• Prioritize nursing interventions in allergic responses including anaphylaxis.
• Prioritize nursing interventions in rheumatologic disorders.