C H A P T E R
7
THE HEMATOLOGIC
SYSTEM
CHAPTER OUTLINE
88 Anatomy and Physiology of
the Hematologic System
89 Blood Transfusions and Blood
Products
90 Disorders
87
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Anatomy and Physiology of the Hematologic System
Bone Marrow
A. Found inside all bones in the body; primary
function is hematopoiesis (manufacture of blood
cells)
B. Kinds of bone marrow
1. Red:
a. Carries out hematopoiesis
b. Found in ribs, vertebral column, and other
flat bones
2. Yellow:
a. Red marrow that has changed to fat
b. Does not carry out hematopoiesis
3. All blood cells start as stem cells in bone
marrow.
C.
Blood
A. Plasma
1. Liquid part of blood
2. Yellow in color
3. Consists of serum and fibrinogen
4. Contains plasma proteins
B. Red blood cells (RBCs) contain hemoglobin, which
is needed to carry oxygen.
1. Normal: male = 4.6 to 6.0 million; female = 4.0
to 5.0 million
2. Decreased RBCs may be caused by hemorrhage,
anemias, chronic infections, leukemias,
multiple myeloma, chronic renal failure,
pregnancy, or overhydration.
3. Increased RBCs may be caused by disease,
dehydration, hemoconcentration, high
altitudes, chronic obstructive pulmonary
disease (COPD), or cardiovascular disease.
4. Hematocrit (Hct): the percentage of blood that is
RBCs
a. Normal: male = 40% to 54%; female = 36%
to 46%
b. Decreased level may be caused by acute
blood loss, anemias, lymphomas, leukemias,
multiple myeloma, malnutrition, vitamin
deficiencies, pregnancy, rheumatoid
arthritis, or drug toxicity.
c. Increased level may be caused by
dehydration, hypovolemia, diarrhea,
polycythemia vera, diabetic acidosis, COPD,
transient ischemic attack (TIA), or eclampsia.
5. Hemoglobin (Hgb): a protein found in RBCs that
contains iron, which carries oxygen and gives
blood its red color
a. Normal: male = 13.5 to 18 g/dL; female = 12
to 16 m/dL
7
88
D.
E.
F.
b. Decreased level may be caused by anemias,
hemorrhage, cirrhosis, leukemias, Hodgkin’s
disease, cancer, pregnancy, kidney diseases,
or drug toxicity.
c. Increased level may be caused by
dehydration/hemoconcentration,
polycythemia, high altitudes, COPD, burns,
or drug toxicity.
Platelets (thrombocytes): necessary for clotting
1. Normal: 150,000 to 500,000
2. Thrombocytopenia may be caused by
leukemias, aplastic anemia, or idiopathic
thrombocytopenia purpura (ITP), liver diseases,
kidney diseases, or drug toxicity.
3. Increased levels may be caused by
polycythemia vera, trauma, acute blood loss,
metastatic carcinoma, high altitudes, or severe
exercise.
White blood cells (WBCs): part of the body’s
defense system to fight infections
1. Also called neutrophils or leukocytes
2. Normal: 5000 to 10000
3. Leukopenia (low WBC) is a common side effect
of chemotherapy treatment.
4. Leukocytosis (too many WBCs) may indicate an
infection.
Blood groups
1. RBCs carry antigens, which determine the
blood groups.
2. ABO groups
a. Client has A antigens (type A blood), B
antigens (type B blood), both A and B
antigens (type AB blood), or no antigens
(type O blood).
b. If a person receives blood with A or B
antigens that are not in their own blood,
RBC antibodies are formed against them.
Rh typing
1. Identifies presence (Rh positive) or absence (Rh
negative) of Rh antigen
2. Anti-Rh antibodies are not automatically
formed in an Rh-negative person, but if
Rh-positive blood is given, antibody formation
starts and a second exposure to the Rh antigen
will trigger a transfusion reaction.
SPLEEN
A. Largest lymphatic organ; lies beneath the
diaphragm, behind and to the left of the
stomach
B. Functions
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1. Blood filtration system and reservoir
2. Important hematopoietic site in fetus;
postnatally produces monocytes and
lymphocytes
3. Important in phagocytosis; removes old and
misshapen RBCs
4. Involved in antibody production by plasma
cells
5. Involved in iron metabolism
6. In an adult, functions of the spleen can be taken
over by the reticuloendothelial system if spleen
is removed.
Blood Transfusions and Blood Products
A. Purpose
1. Improve oxygen transport—RBCs
2. Volume expansion—whole blood, plasma, and
albumin
3. Provide proteins—fresh frozen plasma,
albumin, and plasma protein fraction
4. Coagulation factors—cryoprecipitate, fresh
frozen plasma, and fresh whole blood
5. Platelets—platelet concentrate and fresh whole
blood
B. Types of blood and blood products
1. Whole blood
a. Provides all components
b. Takes 12 to 24 hours for Hgb and Hct to rise
c. Volume overload can occur from large
volume.
d. Complications include hepatitis, acquired
immunodeficiency syndrome (AIDS),
transfusion reaction, sodium (Na) and
potassium (K) excess, and calcium depletion
from citrate (preservative) in massive
transfusions.
e. Usually administered at rate of three to four
hours for 1 unit
2. RBCs (packed RBCs)
a. RBCs provide twice the amount of Hgb as an
equivalent amount of whole blood.
b. Complications include transfusion reactions;
less frequently than with whole blood
because plasma proteins are not given
c. Takes two to four hours to administer 1 unit
3. Fresh frozen plasma
a. Contains all coagulation factors
b. Can be stored for 12 months
c. Takes 20 minutes to thaw and then is hung
immediately and infused quickly because it
loses its coagulation factors rapidly at room
temperature
4. Platelets
a. Will raise the recipient’s platelet count by
10,000/L
b. One unit pooled from 4 to 8 units of whole
blood
c. Single donor platelet transfusions
may be necessary for clients who
have developed antibodies; may need
compatibility testing
d. Infused quickly
5. Factor VIII fractions (cryoprecipitate)
a. Contains factor VIII, fibrinogen, and factor XIII
b. Used in the treatment of hemophilia
c. Infused quickly
C. Management of clients receiving blood products
1. Determine a prior history of transfusions or
transfusion reactions.
2. 18- or 19-gauge needle used
3. Sodium chloride always used as intravenous
(IV) solution; never use dextrose solution;
dextrose causes agglutination of blood cells
4. Two nurses (usually registered nurses [RNs])
MUST verify ABO group, Rh type, patient and
blood numbers, and expiration date.
5. Before starting transfusion, take baseline vital
signs including temperature.
6. Initially, infusion rate is 2 cc/min.
7. Stay with client for first 15 minutes and
monitor vital signs, including temperature,
frequently (temperature elevation suggests a
transfusion reaction).
8. Monitor for transfusion reactions:
a. Hemolytic
(1) Causes
(a) ABO or Rh incompatibility
(antibodies in recipient plasma react
with antigen in donor cells)
(b) Use of dextrose solutions (agglutinated
cells block capillary blood flow)
(2) Manifestations include headache,
lumbar or sternal pain, nausea,
vomiting, chills, flushing, jaundice,
dyspnea, signs of shock, renal
shutdown, or disseminated intravascular
coagulation (DIC).
(3) Stop IV infusion; saline IV; send blood
unit and client blood to the lab
b. Allergic
(1) Transfer of an antigen or antibody from
donor or recipient; client has immune
sensitivity to foreign serum protein;
allergic donors
7
THE HEMATOLOGIC SYSTEM
89
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(2) Manifestations are allergies—urticaria,
laryngeal edema, wheezing, dyspnea,
bronchospasm, or anaphylaxis
(3) Stop transfusion; give antihistamine and
epinephrine as ordered.
9. Document carefully. Include type of blood
component, blood unit number, date and time
infusion starts and ends, amount infused, client
reaction, and vital signs.
Disorders
ANEMIAS
Anemia is an insufficient number of RBCs. Anemia
can be caused by blood loss, manufacture of
insufficient RBCs, or abnormal destruction of RBCs.
Iron Deficiency Anemia
A. Chronic microcytic (little cells), hypochromic
(little color) anemia caused by either inadequate
absorption or excessive loss of iron
B. Assessment
1. Fatigue, dizziness
2. Pallor
3. Cold sensitivity
4. Palpitations
5. Brittle hair and nails
6. Decreased Hgb, Hct, and RBC
C. Nursing diagnoses (Table 7–1)
D. Management
1. Assess for bleeding; stool for occult blood
2. Rest
3. Iron administration
a. Intramuscular (IM); give Z track deep IM; do
not massage after IM injection; encourage
walking
b. Oral
(1) Preferred route
(2) Liquid stains teeth; administer with a
straw.
(3) Give WITH meals to decrease
gastrointestinal (GI) irritation.
c. Increase intake of iron-containing foods
(1) Iron-containing foods include meats, egg
yolks, green leafy vegetables, raisins,
enriched breads, and cereals.
Table 7–1 Nursing Diagnoses Related to Anemia
• Activity intolerance related to impaired oxygen transport
secondary to diminished RBC count
• Deficient knowledge
Source: Delmar/Cengage Learning
7
90
(2) Give iron foods with vitamin C to
enhance absorption of iron.
Pernicious Anemia
A. Chronic, progressive anemia caused by a
deficiency of vitamin B12 in the blood stream.
The most common cause is deficiency of intrinsic
factor, which is normally produced by the gastric
mucosa.
1. Intrinsic factor is necessary for the absorption
of vitamin B12 into the blood stream.
2. Vitamin B12 deficiency diminishes DNA
synthesis, which results in defective maturation
of RBCs and GI tract cells and poor functioning
of the nervous system.
3. Factors related to development of pernicious
anemia
a. Aging
b. Immune system destroys stomach (parietal)
cells that produce intrinsic factor.
c. Gastric surgery such as gastrectomy and
gastric bypass
d. Intestinal disease such as Crohn’s disease
that decreases absorption of vitamin B12
from the intestines
B. Assessment
1. Anemia and pallor
2. Fatigue
3. Sore mouth and beefy red tongue
4. Decreased hydrochloric acid (HCl) in stomach
5. Paresthesias and paralysis
6. Depression and psychosis
C. Diagnosis
1. Complete blood count (CBC) and blood studies
to detect anemia, vitamin B12 levels, and
homocysteine levels (elevated in pernicious
anemia)
2. Gastric analysis to determine HCl level
3. Schilling test
a. Radioactive vitamin B12 given orally (PO)
b. 24-hour urine collected; decreased amount
of vitamin B12 in urine if pernicious anemia
D. Nursing diagnoses (Table 7–1)
E. Management
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1. Vitamin B12 administration for life as monthly
injections, gel or nasal spray, or patches
2. Iron and folic acid
3. Transfusions if severe
Aplastic Anemia
A. Depression of WBC, RBC, and platelet production
due to bone marrow destruction; can be either
idiopathic or secondary; secondary causes include
chemical toxins, drugs (chloramphenicol),
radiation, and immunologic therapy
B. Assessment
1. Fatigue and dyspnea (due to decreased RBCs)
2. Infections (due to decreased WBCs)
3. Bleeding tendencies (due to decreased platelets)
4. Bone marrow biopsy shows fatty marrow with
few developing cells.
C. Management
1. Remove offending agent
2. Blood transfusions
3. Prevent and treat infections:
a. Protective isolation
b. High-protein, high-vitamin diet
c. Good mouth care
4. Bone marrow transplant
5. Prevent and treat bleeding episodes:
a. Use a soft toothbrush and electric razor
b. No IM injections
c. Observe for bleeding
D. Management
1. Eliminate causative factors if possible.
2. Corticosteroids (autoimmune types)
3. Folic acid to assist in RBC production
4. Transfusions
5. Splenectomy (in adults; children need spleen
for antibody formation)
Sickle Cell Anemia
A. Most common inherited disorder in African
American population; 10% of African Americans
have sickle cell trait
B. Transmitted as autosomal recessive gene
(Figure 7–1)
1/4
25%
2/4
50%
1/4
25%
Dark side of circle = sickle cell trait
Hemolytic Anemia
A. Anemia caused by increased destruction of
RBCs; can be inherited (sickle cell anemia or
thalassemia), acquired (transfusion reaction), or of
an unknown cause
B. Assessment
1. Pallor due to decreased RBCs; jaundice as a
result of rapid destruction of RBCs
2. Fatigue due to decreased RBCs
3. Chills, fever, and pain
4. Hematuria
5. Decreased Hgb and Hct
C. Nursing diagnoses (Table 7–2)
Table 7–2 Nursing Diagnoses Related to Sickle Cell
Anemia
•
•
•
•
•
•
•
•
•
Activity intolerance
Ineffective health maintenance
Impaired gas exchange
Risk for ineffective gastrointestinal perfusion
Risk for ineffective renal perfusion
Risk for decreased cardiac tissue perfusion
Acute pain
Deficient knowledge
Disabled family coping
Source: Delmar/Cengage Learning
Figure 7–1 Sickle cell anemia: method of inheritance.
Source: Delmar/Cengage Learning
1. Both parents must carry the gene for a child to
develop the condition.
2. When both parents carry the gene, there is a
25% chance with each pregnancy of having
a child with the disorder; a 50% chance with
each pregnancy of having a child who is a
carrier; and a 25% chance with each pregnancy
of having a child who will be disease and
carrier free.
3. Inherited diseases transmitted as autosomal
recessive include sickle cell anemia, cystic
fibrosis, phenylketonuria (PKU), and TaySachs.
C. Pathophysiology (Figure 7–2)
1. Structure of Hgb is changed; Hgb S contains
deformed, rigid, S-shaped cells and has
reduced oxygen-carrying capacity; Hgb S
replaces all or part of Hgb in RBCs.
2. When oxygen is released, the shape of the RBCs
changes from round and pliable to crescentshaped, rigid, and inflexible.
3. RBCs live for six to 20 days instead of 120 days,
causing hemolytic anemia.
7
THE HEMATOLOGIC SYSTEM
91
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RBC
Normal Red Blood Cell
9. Splenectomy
10. Bone marrow transplant; not routinely
performed because of difficulty finding suitable
donor and high risk of complications
CLOTTING DISORDERS
Hemophilia
Sickled RBC
Figure 7–2 Pathophysiology of sickle cell anemia.
Source: Delmar/Cengage Learning
4. Local hypoxia and continued sickling lead to
blockage of blood vessels.
5. No symptoms before six to 12 months of age
because of high fetal Hgb
6. Sickling is caused by decreased oxygen
saturation, which is caused by high altitudes,
dehydration, and acidosis.
7. Sickle cell crisis (Figure 7–3)
a. Sickled cells clump together and obstruct
blood vessels, causing increased blood
viscosity and producing more sickling and
hypoxia.
b. Symptoms occur in areas where circulation
is obstructed; may be renal, joint pain,
pneumonias, leg ulcers, abdominal pain,
stroke, etc.
c. Enlarged liver and spleen from rapid RBC
breakdown
D. Assessment findings
1. Decreased Hgb
2. Sickle cell test and Sickledex: screening test
results do not differentiate between trait and
disease
3. Hgb electrophoresis—differentiates between
trait and disease
E. Management
1. Hydration (PO and IV)
2. Oxygenation
3. Correct acidosis
4. Analgesics for pain (no aspirin; may cause
acidosis, which causes sickling)
5. Antibiotics for infections
6. Hydroxyurea (Droxia, Hydrea) for adults; daily
use reduces painful crises
7. Exchange transfusions
8. Bed rest during crises
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92
A. Inherited bleeding disorder caused by a deficit of
one of the clotting factors
B. Classic hemophilia (factor VIII deficiency) most
common
C. Transmission
1. Carried on the X chromosome
2. Manifested primarily in the male
3. European Caucasians primarily affected
D. Pathophysiology of classic hemophilia: deficiency
of factor VIII affects intrinsic clotting mechanism
E. Assessment findings
1. Bleeding after minor injuries
2. Hemarthrosis (bleeding into joints such as
knees, ankles, elbows, or wrists)
F. Nursing diagnoses (Table 7–3)
G. Management
1. Control acute bleeding
a. Ice compresses to promote
vasoconstriction
b. Immobilization of bleeding area
c. Fibrin foam
d. Topical epinephrine
e. Cryoprecipitate (frozen factor VIII)
f. Desmopressin (DDAVP) IV or nasal spray
2. Prevent bleeding episodes
a. No aspirin or ibuprofen or other
anticoagulants
b. Factor can be given two or three times a
week to prevent bleeding episodes in clients
with severe hemophilia.
c. Avoid activities such as contact sports that
are likely to cause bleeding.
3. Care for hemarthrosis
a. Immobilize joint
b. Bed cradle to keep bed clothes off joint
c. Passive range of motion (ROM) 48 hours
after bleeding is controlled; stop if there is
pain
Disseminated Intravascular
Coagulation (DIC)
A. Widespread formation of thromboses in the
microcirculation, mainly within the capillaries,
with subsequent depletion of clotting factors,
resulting in hemorrhage from kidneys, brain,
adrenals, heart, and other organs; clientss are
usually critically ill with a surgical, hemolytic,
obstetric, or neoplastic disease
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Effects of Sickle Cell Anemia on the Body
Acidosis, Dehydration
Oxygen Tension
Hemolysis
Slowed Circulation
Sickled RBC
Anemia
Clumping & Thrombosis
Ischemia
Kidneys
Extremities
Brain
Lung
Eyes
GI
Figure 7–3 Effects of sickle cell anemia on the body. Source: Delmar/Cengage Learning
Table 7–3 Nursing Diagnoses Related to
Hemophilia
•
•
•
•
Acute pain
Impaired walking
Impaired oral mucus membranes
Ineffective health maintenance
Source: Delmar/Cengage Learning
B. Pathophysiology
1. Underlying disease causes release of
thromboplastic substances into blood that
promote fibrin deposits throughout the
microcirculation.
2. Microthrombi form in many organs, causing
microinfarcts and tissue necrosis.
3. RBCs are trapped in fibrin strands and
hemolyzed. Platelets, prothrombin, and other
clotting factors are destroyed, causing bleeding.
4. Excessive clotting activates the fibrinolytic
inhibiting platelet function, causing further
bleeding.
C. Assessment findings
1. Petechiae and ecchymoses
2. Excessive bleeding from IVs, surgery, or childbirth
3. Oliguria and acute renal failure
4. Prothrombin time (PT) and partial
thromboplastin time (PTT) prolonged
5. Decrease in clotting factors
7
THE HEMATOLOGIC SYSTEM
93
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D. Management
1. Control of underlying disease process
2. Transfusions of blood, platelets, and clotting
factors
3. Heparin (stops clotting in microcirculation and
frees clotting materials)
4. Prevent bleeding:
a. No injections
b. Handle gently
c. Nontraumatic mouth care
d. No aspirin
WHITE CELL DISORDERS
Infectious Mononucleosis (“Kissing
Disease”)
A. An acute infectious disease caused by the EpsteinBarr virus characterized by increased monocytes
that affects primarily children and young adults
B. Assessment findings
1. Lymphadenopathy
2. Headache, sore throat
3. Mental and physical fatigue
4. Spleen and liver enlargement
5. Heterophil antibody agglutination and
Monospot tests positive
6. Incubation period of two to six weeks;
spread by oral secretions
C. Management
1. No specific treatment or immunization (rarely
hospitalized)
2. Rest for several weeks to months
3. Treat secondary infections if they develop.
Table 7–4 Nursing Diagnoses Related to Leukemia
•
•
•
•
•
Risk for infection
Risk for injury
Delayed growth and development
Powerlessness
Social isolation
Source: Delmar/Cengage Learning
5. Enlarged liver and spleen
6. Abdominal pain, weight loss, and nausea
7. Bone pain due to expansion of marrow
D. Nursing diagnoses (Table 7–4)
E. Management
1. Chemotherapy: side effects include bone
marrow depression, nausea, vomiting, alopecia,
and/or stomatitis
2. Radiation therapy
3. Biological therapy such as monoclonal
antibodies or interferon
4. Stem-cell transplantation
a. Autologous: stem cells taken from client,
treated to kill leukemia cells, and frozen to
be given to client after chemotherapy and
radiation have destroyed sick bone marrow
b. Allogeneic (donor): stem cells (bone
marrow) taken from compatible donor and
administered to client after chemotherapy
and radiation have destroyed sick bone
marrow
5. Support child during painful procedures, such
as bone marrow aspirations, lumbar punctures,
and venipuncture.
6. Help client and family cope with a possible
fatal illness.
Leukemia
A. A progressive, malignant disease of the bloodforming organs marked by distorted proliferation
and development of leukocytes and their
precursors in the blood and bone marrow; the most
common form of childhood cancer; some forms
occur in adults
B. Pathophysiology
1. Uncontrolled proliferation of WBC precursors
2. Normal WBCs, RBCs, and platelets crowded out
by leukemic cells
3. Type of leukemia is designated by the type of
cell proliferating (myelocytic leukemia, acute
lymphocytic leukemia).
C. Assessment findings
1. Anemia, pallor, and dyspnea (due to decreased
RBCs)
2. Ecchymoses and bleeding (due to decreased
platelets)
3. Infections (due to decreased normal WBCs)
4. Lymphadenopathy
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94
OTHER MALIGNANT DISORDERS
Hodgkin’s Lymphoma
A. A primary lymph node neoplastic disease
characterized by painless progressive enlargement
of the lymph nodes, spleen, and lymphoid tissues;
often begins in a cervical node and spreads
through the body; occurs primarily in adolescents
and young adults
B. Assessment findings
1. Lymphadenopathy usually starting with
cervical nodes
2. Sweating, weakness, fever
3. Itching
4. Staging:
a. Stage I—only one lymph node involved
(good prognosis)
b. Stage II—two or more nodes on same side of
diaphragm (good prognosis)
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c. Stage III—nodes on both sides of diaphragm
involved (poor prognosis)
d. Stage IV—diffuse involvement with one or
more extralymphatic organs involved (very
poor prognosis)
C. Management
1. Radiation used alone for localized disease
2. Chemotherapy
a. Used in combination with radiation for
advanced disease
b. Usually, a combination of drugs is used.
3. Protect client from infections; remember that
both the disease and the treatment reduce
ability to fight infections.
4. Splenectomy in advanced disease
Non-Hodgkin’s Lymphoma
A. Tumor originating in the lymphoid tissue that is
diffuse, disseminates easily, and is difficult to
control
B. Assessment findings: similar to Hodgkin’s
lymphoma
C. Management
1. Chemotherapy
2. Radiation
3. Surgery for diagnosis and staging
4. Nursing care similar to Hodgkin’s lymphoma
Multiple Myeloma
A. A malignant neoplasm in which the plasma cells
proliferate and invade the bone marrow, causing
destruction of the bone and resulting in pathologic
fractures and bone pain; affects primarily men
after the age of 40
B. Pathophysiology
1. Bone demineralization and destruction with
osteoporosis and a negative calcium balance
2. Disruption of RBC, WBC, and thrombocyte
production
C. Assessment findings
1. Headache and bone pain
2. Pathological fractures and skeletal deformities
of sternum and ribs
3. Osteoporosis and loss of height
4. Renal calculi
5. Anemia, infections, and bleeding tendencies
6. Hypercalcemia
7. Spinal cord compression and paraplegia
8. Urine positive for Bence-Jones protein
D. Management
1. Drug therapy
a. Analgesics for bone pain
b. Cancer chemotherapy to reduce tumor mass
c. Antibiotics to treat infections
d. Gamma globulin to prevent infections
e. Corticosteroids and mithramycin for severe
hypercalcemia
2.
3.
4.
5.
6.
7.
f. Medications such as etidronate (Didronel)
or alendronate (Fosamax) to slow the loss of
calcium from the bones
Radiation therapy to reduce tumor mass
Transfusions
Comfort measures for bone pain
Ambulation to slow demineralization
Push fluids to prevent kidney stones from
calcium overload
Safety: clients prone to pathological fractures,
bleeding, and infection
Human Immunodeficiency Virus (HIV)
and Acquired Immunodeficiency
Syndrome (AIDS)
A. HIV positive means that person has been exposed
to HIV and has developed antibodies to try to
fight the virus. HIV decreases human T-cell
lymphocytes and suppresses the cellular immune
response.
B. AIDS occurs when the T-cell lymphocyte count is
below 200 and the person develops opportunistic
infections and unusual neoplasms.
C. Risk factors
1. Sexually active homosexual and bisexual men
2. IV drug abusers
3. Hemophiliacs and recipients of blood
transfusions
4. Children of persons with AIDS
5. Heterosexual partners of persons with AIDS
6. Tattoos and body piercings if unsterile
equipment used
D. Assessment findings
1. Nonspecific symptoms such as weight loss,
fatigue, diarrhea, fever, and pallor
2. Dyspnea and hypoxemia due to pneumonia
3. Neurological dysfunction secondary to
acute meningitis, dementia, and
encephalopathy
4. Opportunistic infections
a. Pneumocystis carinii pneumonia
b. Herpes simplex virus, cytomegalovirus, and
Epstein-Barr virus
c. Fungal infections in brain, lungs, and
esophagus
d. Infections caused by mycobacterium avium
complex (MAC), which causes fever and
weight loss
5. Neoplasms
a. Kaposi’s sarcoma
b. CNS lymphoma
c. Burkitt’s lymphoma
d. Non-Hodgkin’s lymphoma
6. Leukopenia, anemia, and thrombocytopenia
7. Elevated transaminases and alkaline
phosphatase
8. Low serum albumin
7
THE HEMATOLOGIC SYSTEM
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