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Hematological System Joyce Smith RN BSN Nursing 202.

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Presentation on theme: "Hematological System Joyce Smith RN BSN Nursing 202."— Presentation transcript:

1 Hematological System Joyce Smith RN BSN Nursing 202

2 Introduction Blood formed in liver & spleen of fetus until 3 rd trimester At birth all bones Throughout life in flat bones

3 Introduction Each day healthy bone marrow produces –2.5 billion erthrocytes, 80- 120 days –2.5 billion thrombocytes, 8-11 day –1 billion leukocytes

4 Functions of Blood Transport of oxygen & absorbed nutrients to cells Transport of waste production to kidney, skin & lungs Transport of hormones from endocrine glands to other tissue Protection of the body from life-threatening microorganisms Regulation of body temperature by heat transfer

5 Bone Marrow Soft organic material that fills the cavities of the bones Produces RBC’s and platlets Majority are produced in the vertebrae, ribs, sternum, skull, pelvis and long bones of the legs

6 Blood Components Plasma –Albumin –Globulin –Fibroinogen Erythrocytes Leukocytes Platelets

7 Blood Components Red Blood Cells (RBC) Largest portion of blood cells Normal range 4.4 to 5.5 million/mm3 Life span 120 days Responsible for producing hemoglobin Serves as a buffer and maintains acid-base balance Eythropoiesis/erythropoietin Anemia

8 Blood Components White Blood Cells (WBC) Formed in the bone marrow Provide immunity Protects from effects of invasion, infection, & injury Types

9 Blood Components Platelets –Smallest of the blood cells –Formed in the bone marrow –Forms plugs to stop flow of blood from an injury site –Maintains blood vessel integrity –Aggregation –Thrombopoietin –80% circulate, 20% stored in spleen –Life span 1 to 2 weeks

10 Spleen Encapsulated organ about size of fist, LUQ under ribs Blood formation Blood storage Blood filtration

11 Lymph System System of organs, tissues, & fluid that deal with inflammation, infection, cancer & allergic response Transports lymph Produces lymphocytes & antibodies Phagocytosis Absorption of fats & fat-soluble matters from intestine

12 Liver Largest organ in body next to skin Beneath diaphragm, most on right side of body 500 functions Reservoir 500-1000cc blood Filters & detoxifies blood, kupffer cells

13 Liver Stores nutrients –Fat soluble vitamins: A, D, E, K, B12, B1, B2, Fe, phospholipid, cholesterol –Synthesizes: bile, serum albumin, globulins, prothrombin, fibrogen, blood coagulation factors V, VII, VIII, IX, XI, XII, urea –Converts bilirubin to bile & stores extra Fe as ferritin

14 Normal Clotting Mechanism Platelet Aggregation –Activated platelets clump together to form plug in vessel wall damage Blood-clotting cascade –Intrinsic Factor –Extrinsic Factor

15 Normal Clotting Mechanism Fibrin Clot Formation –Fibrin molecules link together to form fibrin threads –XIII tightens mesh –Platelets stick to threads Firbrinolysis –Breaks up fibrin clot

16 Gerontological Considerations Hgb level fall after middle age Fe deficiency most frequent in older Reduced dietary intake of iron-rich foods Don’t use oral Fe supplements By age 65 up to 50% of body’s bone marrow converted to inactive

17 Anticoagulants Anticoagulants: interfere with one or steps in blood-clotting cascade –Heparin –Vitamin K antagonists –Platelet aggregation inhibitors

18 Thrombolytic Thrombolytics: degrade fibrin thread –tPA –SK –Reteplase –Anistreplase

19 Key Symptoms Effects every system of body Low RBCs: SOB, weakness,malaise, & fatigue Low platelets: Unusual or prolonged bleeding Low WBCs: fever High lymphocytes: Viral infection

20 Health History Time of onset & duration of symptoms –Continuous or intermittent History of similar signs in parents or siblings History of jaundice or anemia in parents or siblings History of blood loss, bruising, petechiae, or nosebleed

21 Health History Typical dietary pattern Occupational history Medication history Risk factors for hematological disorder: age, sex, marital status, religion, race & ethnic background,& recent illnesses & treatment

22 Health History Family history of illnesses both living & deceased realities as well as cause of death Sexual habits: promiscuity, male homosexuality & bisexuality, & partner’s sexual habits Drug abuse history Medical history, including malignancies

23 Physical Assessment Skin Head & neck Respiratory Cardiovascular Renal & Urinary Muscloskeletal Abdominal CNS Psychosocial

24 Skin Pallor Jaundice Mucous membranes Nail beds Bleeding –Ecchymosis –Petechiae –Bleeding from invasive sites

25 Head & Neck Sclera Jaundice Oral mucosal ulceration Fissures at corner of mouth Lymph enlargement or pain Smooth red tongue

26 Respiratory Rate Depth Rest & activity 10 word sentences Easily fatigued SOB at rest or exertion # of pillows

27 Cardiovascular JVD Edema Phlebitis Murmurs Gallops Irregular rhythm Abnormal B/P –S V anemia –B/P  hypercellular conditions –Severe anemia –R vent. Hypertrophy –Heart disease

28 Renal & Urinary Overt bleeding Occult bleeding Hematuria Proteinuria

29 Musculoskeletal Rib tenderness Sternal tenderness

30 CNS Cranial nerve assessment Neurological function –Mental status –GCS –Neuromuscular evaluation

31 Psychosocial Chronic illness & acute exacerbation of chronic disease –Social support network –Community resources –Financial health –Compliance with therapy

32 Complete Blood Count (CBC) Measures circulating RBCs & WBCs in 1 mm venous blood % of different leukocytes Hct - % of RBCs in total blood volume, total amount of Hct in peripheral blood MCV- average volume or size of single RBC MCH- weight Hgb in average RBC MCHC- concentration of Hgb in each RBC

33 Reticulocyte Count Immature RBCs 2% for circulating RBCs normally  indicates increased production of RBC by bone marrow

34 Hemoglobin Electrophoresis Hemoglobin A normal Abnormal form of hemoglobin Hemoglobin S in sickle cell

35 Coombs’ Test Direct & indirect –Used for blood typing Direct presence of antibodies against RBCs –Certain disease associated with production of antibodies against body’s own RBCs, causes hemolytic anemia Indirect presence of circulating antiglobins –Determines presence of serum antibodies to type of RBCs in blood transfusion

36 Serum Ferritin Measures quantity of Fe present as free Fe in plasma & reflects total body Fe stores Transferrin: protein that transports Fe from GI –Test is TIBC –30% of transferrin is bound to iron in blood Total Fe-binding capacity: % of saturation of transferrin, varies according to intake, reflects livers function

37 Bleeding Time Evaluates vascular & platelet activity Use lancet, small incision in forearm with B/P cuff inflated 40 mm Hg Blood blotted 30 sec. Intervals & timed until bleeding stops Normal 1-9 min.

38 Prothrombin Time Measures time for blood to clot Normal 11 to 13 sec. Clotting factors –II, V, VII, X  when one or more clotting factor deficient or with liver disease Warfarin therapy 1.5 to 2. X normal Not used often currently except when weaning Heparin

39 International Normalized Ratio INR same as PT but standardized 0.7 – 1.8 Warfarin therapy 2.0-3.0

40 Partial Thromboplastin Time PTT Evaluates factors –II, V, VIII, IX, X, XII Intrinsic coagulation cascade Evaluates Heparin therapy 1.5 to 2.5 times normal

41 Bone Marrow Aspiration Aspiration –Needle Needle biopsy –Small incision coring, needle used Site –Posterior superior iliac crest –Spinous process of vertebrae –Tibia –Sternum

42 Bone Marrow Aspiration Nursing considerations –Signed informed consent –Lasts 5 to 15 min –Anesthesia or sedation –Local anesthetic or rapid acting sedative

43 Bone Marrow Aspiration Complications –Soreness at site –Bleeding –Infection

44 Nursing Responsibilities Cover site with drg. Monitor for bleeding q 2 X 24 hours Monitor P, B/P,& T Ice pack, mild aspirin-free analgesic Instruct pt to keep site dry for 24 hours Avoid trauma 48 hours Watch for redness, swelling, & T 


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