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Hematology

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Numbness, tingling, & burning in arms, legs & feet. Muscle weakness ... Gastorscopy with biopsy: assess parietal cell atrophy R/O CA. Diagnostic Tests ... – PowerPoint PPT presentation

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Title: Hematology


1
Hematology
  • By
  • Joyce Smith RN BSN

2
Introduction
  • Red Blood Cell Disorders
  • White Blood Cell Disorders
  • Coagulation Disorders
  • Clotting Factor Disorders

3
RBC Destruction Sickle Cell Disease
  • Hereditary, chronic form of anemia
  • Abnormal sickle or crescent-shaped erythrocytes
    are present
  • D/t abnormal Hemoglobin S (Hb S) in the RBCs
  • High presence of disease in Mediterranean
    African population African American population
    in US

4
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5
Sickle Cell Disease
  • Sickle Cell Crisis
  • Exact cause of sickling crisis unknown
  • 2 factors
  • 1. Hypoxia caused by ? O2 tension in blood
  • 2. ? blood viscosity/? plasma volume, ? hydrogen
    ion concentration, ? plasma osmolality, caused
    by concentration of cells dehydration

6
Sickle Cell Crisis
  • Sickle cell interferes with O2 transport
  • Obstruction of capillary blood flow
  • Causes fever severe pain in joints abdomen
  • Crisis is precipitated by ? O2

7
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8
Diagnostic Tests
  • Stained blood smear
  • Sickle cell observed
  • Sickle cell preparation of blood
  • Sickling noted after deoxygenation
  • Sickle solubility test
  • Turbid solution indicates presence of Hb S

9
Diagnostic Tests
  • Hemoglobin electrophoresis
  • Presence of Hb S Hb A indicates sickle cell
    trait lt 40 Hb S
  • Presence of Hb S only indicates sickle cell
    anemia 85-95
  • Erythrocyte life span
  • Decreased 10 to 20 days

10
Clinical Manifestations
  • Hemolytic anemia
  • Pallor
  • Jaundice
  • Fatigue
  • Irritability
  • Extensive Sickling
  • Vaso-occlusive or thrombotic crisis
  • Aplastic Crisis
  • Sequestration Crisis
  • Hyperhemolytic Crisis

11
Health History
  • Previous crisis
  • Precipitating events
  • Severity
  • Usual treatment
  • Review of activities last 24 hours
  • Food fluid intake
  • Exposure to temperature extremes
  • Type of clothing worn
  • Meds taken, ingestion of alcohol recreational
    drugs
  • Exercise, trauma, stress

12
Health History
  • Activity toleration
  • Fatigue
  • Activity intolerance
  • ADLs
  • Sleep rest pattern
  • Climbing stairs
  • SOB
  • Measure on Likert scale 0-10

13
Assess
  • Skin
  • Jaundice or Pallor, ulcerations
  • Skeletal structures
  • Joint swelling, disproportionably long arms
    legs, skeletal fragility
  • GI function
  • Enlarged liver spleen

14
Assess
  • Comfort
  • Bone, abdominal pain
  • Cardiac Function
  • Systolic murmurs, tachycardia, dysrthythmias,
    cardiac enlargement, hyportension, ? pulse
    pressure
  • Respiratory Function
  • Dyspnea, acute respiratory distress

15
Assess
  • Sensory Function
  • Altered LOC, abnormal pupillary response,
    abnormal reflexes
  • Renal Function
  • Decreased UO, edema
  • Sexuality
  • Delayed sexual maturity

16
General Management
  • Supportive Care
  • Rest
  • O2 therapy
  • IV fluids elytes
  • Analgesics
  • Sedatives
  • Blood transfusion
  • Genetic counseling

17
Drug Therapy
  • Experimental use of antisickling agents
  • Hydroxyurea
  • Erythropoientin
  • Nitric Oxide
  • Flurocor
  • Oral administration
  • Folic acid /or Fe
  • Bone Marrow Transplant
  • Gene Replacement Therapy

18
Immunohemolytic Anemiaor Autoimmune Hemolytic
Anemia
  • ? RBC hemolysis due to attack by own immune
    system
  • Attacks antigen on RBC cell membrane
  • Against universal component of Rh system
  • Immune system is not able to recognize self as
    normally would
  • Cause may be infections, drug reactions, and
    certain cancers
  • Hemolytic anemia of newborn can occur with a Rh
    neg mother and Rh positive baby
  • Blood transfusions can also cause a problem

19
Immunohemolytic Anemiaor Autoimmune Hemolytic
Anemia
  • Signs and symptoms
  • Pallor
  • Fatigue
  • Tachycardia
  • Shortness of breath
  • Hypotension

20
Treatment
  • Glucocorticoids for mild to moderate immune
    suppression
  • Cytoxin, Imuran
  • Plasma exchange therapy
  • Splenectomy
  • Transfusion limited or no benefit

21
  • PERNICIOUS ANEMIA
  • or
  • Vitamin B 12 Deficiency

22
Vitamin B12 Deficiency
  • Rare chronic progressive condition
  • Abnormal formation function of RBCs
  • Inadequate intake or inability to absorb Vitamin
    B12
  • Fatal if not treated

23
A P
  • Can be results of atrophied parietal cells in the
    stomach
  • Absence of intrinsic factor (IF), preventing
    absorption of B12
  • IF secreted by parietal cells gastric mucosa
  • B12 absorbed in distal ileum
  • Digested B12 attached to IF in stomach, able to
    pass into blood stream in ileum

24
A P
  • If not attached to IF, B12 passed through the
    body through the stool
  • Insidious onset, several months for symptoms to
    manifest

25
Symptoms
  • Affect 3 major body systems
  • Hematopoietic system
  • Fatigue
  • Dizziness
  • Ringing in ears
  • Pale or yellowish skin
  • HR, enlarged heart with murmur
  • Chest pain

26
Symptoms
  • GI system
  • Sore, beefy red tongue
  • Loss of appetite, Weight loss
  • Diarrhea abd cramping

27
Symptoms
  • Nervous system
  • Numbness, tingling, burning in arms, legs
    feet
  • Muscle weakness
  • Difficulty loss of balance while walking
  • Changes in reflexes
  • Irritability, confusion depression

28
Diagnostic Tests
  • CBC abnormally large RBCs, may be abnormal
    shaped, retic ct. low
  • WBC may be decreased
  • Gastric analysis NG inserted gastric contents
    aspirated, acholohydria
  • Gastorscopy with biopsy assess parietal cell
    atrophy R/O CA

29
Diagnostic Tests
  • Schilling test Patient given Injection to
    saturate liver
  • Radioactive B12 orally
  • 24 hour urine collection
  • Impaired absorption radioactive B12 will not be
    excreted in urine

30
Treatment
  • Prognosis good if treatment started
  • Up to 18 month for improvement
  • Dietary replacement if absorption normal
  • Red meat, liver, fish, poultry, shellfish, milk,
    dairy products, eggs, some fortified foods

31
Treatment
  • If absorption abnormal Cynocobalamine IM 200ug/d
    X 2 weeks, Biweekly for 2 weeks, monthly for
    life
  • Stop smoking, maintain ideal weight, teaching for
    med. Action, side effects, daily skin care, mouth
    foot care, assess for breakdown, alt. Rest
    activity, promote safe environment, avoid heat
    pad etc.

32
Folic Acid Deficiency
  • Vitamin B complex
  • Seen in alcoholism, malabsorption syndromes,
    pregnancy
  • Most prevalent in infants, adolescents, pregnant
    lactating females, alcoholics elderly
  • Increase incidence of drugs use during pregnancy

33
Food Sources
  • Found in asparagus spears, beef liver, broccoli,
    collards, mushrooms, oatmeal, peanut butter, red
    beans, wheat germ

34
Clinical Manifestations
  • Develop slowly over a period of months
  • Symptoms related to tissue hypoxia
  • Glossitis
  • Jaundice
  • Spleenomegaly

35
Treatment
  • Administer folic acid every day until deficiency
    is corrected
  • High dises to patients with malabsorption
    problems
  • Folvite adults 250 to 1,000 mcg/d until
    hematological responses increases
  • Maintainance 400 mcg/day X 2
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