Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9 Hematology

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Anatomy, Physiology, and Pathophysiology General Assessment and Management Managing Specific Patient Problems

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hematology The Study of Blood and Blood-Forming Organs –Includes study of blood disorders: Red blood cell disorders White blood cell disorders Platelet disorders Coagulation problems

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Anatomy, Physiology, and Pathophysiology Components –Blood, bone marrow, liver, spleen, kidneys Hematopoiesis –Pluripotent stem cell –Erythropoietin Blood Volume

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of Blood (1 of 6) Plasma –Water 90–92% by volume –Proteins 6–7% by volume –Other 2–3% by volume Fats, carbohydrates, electrolytes, gases, and chemical messengers

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of Blood (2 of 6) Red Blood Cells –Hemoglobin –Oxygen transport –Bohr effect –2,3 DPG –Oxygen–hemoglobin dissociation curve

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of Blood (3 of 6) Red Blood Cells –Production Erythropoiesis Hemolysis Sequestration –Laboratory analysis of red blood cells Red blood cell count Hematocrit Hemoglobin

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of Blood (4 of 6) White Blood Cells –Margination –Phagocytosis –White blood cell count

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of Blood (5 of 6) White Blood Cells –Leukopoiesis Granulocytes Neutrophil Basophil Eosinophil Lymphocytes Monocytes

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of Blood (6 of 6) White Blood Cells –Immunity Subpopulation of lymphocytes known as T cells and B cells T cells develop cellular immunity. B cells produce humoral immunity. –Autoimmune disease –Alterations in the immune process –Inflammatory process

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Immune Response

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Components of Blood Platelets –Megakaryocytes –Thrombocytopenia –Thrombocytosis

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hemostasis (1 of 3) Controlling Blood Loss –Vascular spasms –Platelet plugs –Stable fibrin blood clots

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hemostasis (2 of 3)

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Hemostasis (3 of 3) Fibrinolysis Thrombosis –Fibrinolytics –Medications affecting clot formation Alter the enzyme on the platelet Affect the coagulation cascade Enhance clotting

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Blood Products and Blood Typing (1 of 2) Blood Types –Antigens A, B, AB, O –Universal donors –Rh factor

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Blood Products and Blood Typing (2 of 2)

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Transfusion Reactions (1 of 2) Hemolytic Reactions –Signs and Symptoms Facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, fever, chills, and cyanosis. –Treatment Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringer’s. Consider furosemide, dopamine, and diphenhydramine.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Transfusion Reactions (2 of 2) Febrile Nonhemolytic Reactions –Signs and Symptoms Headache, fever, and chills. –Treatment Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringer’s. Consider diphenhydramine and an antipyretic. Observe closely to ensure reaction is nonhemolytic.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment and Management (1 of 3) Scene Size-up Initial Assessment Focused History and Physical Exam –SAMPLE history Hematological disorders are rarely the chief complaint. –Physical exam Evaluate nervous system function.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Physical exam –Skin signs –Lymphatic signs –Gastrointestinal signs –Musculoskeletal signs –Cardiorespiratory signs –Genitourinary signs General Assessment and Management (2 of 3)

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment and Management (3 of 3) General Treatment Guidelines –Maintain ABCs. Provide high-flow, high-concentration oxygen or assist ventilations as indicated. Consider volume replacement. –Monitor cardiac rhythm and vital signs. Treat rhythm disturbances. –Provide reassurance, comfort care, and transport.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Managing Specific Patient Problems Diseases of the Red Blood Cells Diseases of the White Blood Cells Diseases of the Platelets/Blood Clotting Abnormalities Other Hematopoietic Disorders

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the Red Blood Cells (1 of 4) Anemias –Anemia is a sign, not a separate disease process. Signs and symptoms may not be present until the body is stressed. Differentiate chronic anemia from acute episode. –Treat signs and symptoms. Maximize oxygenation and limit blood loss. Establish IV therapy if indicated.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the Red Blood Cells (2 of 4)

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the Red Blood Cells (3 of 4) Sickle Cell Disease –Sickle cell crises Vaso-occlusive Hematological Infectious –Management Follow general treatment guidelines. Consider analgesics.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the Red Blood Cells (4 of 4) Polycythemia –Overproduction of erythrocytes –Occurs in patients >50 years old or with secondary dehydration. –Results in bleeding abnormalities Epistaxis, spontaneous bruising, GI bleeding –Management Follow general treatment guidelines.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the White Blood Cells (1 of 3) Leukopenia/Neutropenia –Too few white blood cells or neutrophils. –Follow general treatment guidelines and provide supportive care. Leukocytosis –An increase in the number of circulating white blood cells, often due to infection. Leukemoid reaction

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the White Blood Cells (2 of 3) Leukemia –Cancer of hematopoietic cells –Initial presentation Acutely ill, fatigued, febrile and weak, anemic Often have a secondary infection –Management Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the White Blood Cells (3 of 3) Lymphomas –Cancers of the lymphatic system –Presentation Swelling of the lymph nodes Fever, night sweats, anorexia, weight loss, fatigue, and pruritis –Management Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Diseases of the Platelets Thrombocytosis and Thrombocytopenia –Thrombocytosis An abnormal increase in the number of platelets –Thrombocytopenia An abnormal decrease in the number of platelets –Management Provide supportive care and follow general treatment guidelines.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Blood Clotting Abnormalities (1 of 2) Hemophilia –Deficiency or absence of a blood clotting factor Deficiency of factor VIII causes hemophilia A. Deficiency of factor IX causes hemophilia B. Deficiency is a sex-linked, inherited disorder. Defective gene is carried on the X chromosome. –Signs and Symptoms Numerous bruises, deep muscle bleeding, and joint bleeding.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Blood Clotting Abnormalities (2 of 2) Hemophilia –Management Treat the patient similarly to others. Administer supplemental oxygen. Establish IV access. Be alert for recurrent or prolonged bleeding, and prevent additional trauma. Von Willebrand’s Disease –Deficient component of factor VIII Generally results in excessive bleeding. Generally is not serious; provide supportive care.

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Other Hematopoietic Disorders Disseminated Intravascular Coagulation –System activation of coagulation cascade –Results from sepsis, hypotension, OB complications, severe tissue or brain injury, cancer, and major hemolytic reactions Multiple Myeloma –Cancerous disorder of plasma cells –Pathologic fractures common

Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Anatomy, Physiology, and Pathophysiology General Assessment and Management Managing Specific Patient Problems