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Hematologic System, Oncologic Disorders

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Title: Hematologic System, Oncologic Disorders


1
  • Hematologic System, Oncologic Disorders Anemias

2
Hematology
  • Study of blood and blood forming tissues
  • Key components of hematologic system are
  • Blood
  • Blood forming tissues
  • Bone marrow
  • Spleen
  • Lymph system

3
What Does Blood Do?
  • Transportation
  • Oxygen
  • Nutrients
  • Hormones
  • Waste Products
  • Regulation
  • Fluid, electrolyte
  • Acid-Base balance
  • Protection
  • Coagulation
  • Fight Infections

4
Components of Blood
  • Plasma
  • 55
  • Blood Cells
  • 45
  • Three types
  • Erythrocytes/RBCs
  • Leukocytes/WBCs
  • Thrombocytes/Platelets

5
Erythrocytes/Red Blood Cells
  • Composed of hemoglobin
  • Erythropoiesis
  • RBC production
  • Stimulated by hypoxia
  • Controlled by erythropoietin
  • Hormone synthesized in kidney
  • Hemolysis
  • destruction of RBCs
  • Releases bilirubin into blood stream
  • Normal lifespan of RBC 120 days

6
Leukocytes/White Blood Cells
  • 5 types
  • Basophils
  • Eosinophils
  • Neutrophils
  • Monocytes
  • Lymphocytes

7
Types and Functions of Leukocytes
TYPE
CELL FUNCTION
8
Thrombocytes/Platelets
  • Must be present for clotting to occur
  • Involved in hemostasis

9
Normal Clotting Mechanisms
  • Hemostasis
  • Goal Minimizing blood loss when injured
  • Vascular Response
  • vasoconstriction
  • Platelet response
  • Activated during injury
  • Form clumps (agglutination)
  • Plasma Clotting Factors
  • Factors I XIII
  • Intrinsic pathway
  • Extrinsic pathway

10
Anticoagulation
  • Elements that interfere with blood clotting
  • Countermechanism to blood clottingkeeps blood
    liquid and able to flow

11
Development of Blood Cells
Fig. 29-1
12
Structures of the Hematologic System
  • Bone Marrow
  • Liver
  • Lymph System

13
Bone Marrow
  • Bone Marrow
  • Soft substance in core of bones
  • Blood cell production (Hematopoiesis)
  • RBCs
  • WBCs
  • Platelets

14
Liver
  • Located in upper right quadrant
  • Receives 24 of the cardiac output (1500 ml of
    blood each minute)
  • Liver has many functions
  • Hematologic functions
  • Liver synthesis plasma proteins including
    clotting factors and albumin
  • Liver clears damaged and non-functioning
    RBCs/erythrocytes from circulation

15
Spleen
  • Located in upper L quadrant of abdomen
  • Functions
  • Hematopoietic function
  • Produces fetal RBCs
  • Filter function
  • Filter and reuse certain cells
  • Immune function
  • Lymphocytes, monocytes
  • Storage function
  • 30 platelets stored in spleen

16
Effects of Aging on the Hematologic System
  • CBC Studies
  • ? Hemoglobin (Hb or Hgb)
  • ? response to infection (WBC)
  • Plateletsno change
  • Clotting Studies
  • ? PTT

17
Assessment of the Hematologic System
  • Subjective Data
  • Important Health Information
  • Past health history
  • Medications
  • Surgery or other treatments

18
Assessment of the Hematologic System (cont.)
  • Functional Health Patterns
  • Health perception health management
  • Nutritional metabolic
  • Elimination
  • Activity exercise
  • Sleep rest
  • Cognitive perceptual
  • Self-perception self-concept
  • Role relationship
  • Sexuality reproductive
  • Coping stress tolerance
  • Value belief

19
Assessment ofthe Hematologic System (cont.)
  • Objective Data
  • Physical Examination
  • Skin
  • Eyes
  • Mouth
  • Lymph Nodes
  • Heart and Chest
  • Abdomen
  • Nervous System
  • Musculoskeletal System

20
Diagnostic Studies of the Hematologic System
Complete Blood Count (CBC)
  • WBCs
  • Normal 4,000 -11,000 µ/l
  • Associated with infection, inflammation, tissue
    injury or death
  • Leukopenia-- ? WBC
  • Neutropenia -- ? neutrophil count
  • RBC
  • ? 4.5 5.5 x 106/l
  • ? 4.0 5.0 x 106/l
  • Hematocrit (Hct)
  • The hematocrit is the percent of whole blood that
    is composed of red blood cells. The hematocrit is
    a measure of both the number of red blood cells
    and the size of red blood cells.

21
Diagnostic Studies of the Hematologic System
Complete Blood Count (CBC) Contd
  • Platelet count
  • Normal 150,000- 400,000
  • Thrombocytopenia-? platelet count
  • Spontaneous hemorrhage likely when count is below
    20,000
  • Pancytopenia
  • Decrease in number of RBCs, WBCs, and platelets

22
Diagnostic Studies of the Hematologic System
  • Radiologic Studies
  • CT/MRI of lymph tissues
  • Biopsies
  • Bone Marrow examination
  • Lymph node biopsies

23
Anemia
  • Anemia is a reduction in the number of RBCs, the
    quantity of hemoglobin, or the volume of RBCs
  • Because the main function of RBCs is oxygenation,
    anemia results in varying degrees of hypoxia

24
Anemia
  • Prevalent conditions
  • Blood loss
  • Decreased production of erythrocytes
  • Increased destruction of erythrocytes
  • Signs Symptoms
  • Same as hypoxia

25
Nursing Management Anemia
  • Nursing Assessmentsee tables 30-3 30-4
  • Nursing Diagnoses
  • Planning
  • Nursing Implementation

26
Nursing Actions for a Patient who is Anemic or
Suffered Blood Loss
  • Administer oxygen as prescribed
  • Administer blood products as prescribed
  • Administer erythropoietin as prescribed
  • Allow for rest between periods of activity
  • Elevate the pts head on pillows during episodes
    of shortness of breath
  • Provide extra blankets if the pt feels cool
  • Teach the pt/family about underlying
    pathophysiology and how to manage the symptoms of
    anemia

27
Anemia Caused by Decreased Erythrocyte Production
  • Iron Deficiency Anemia
  • Thalassemia
  • Megablastic Anemia

28
Iron-Deficiency Anemia
  • Etiology
  • Inadequate dietary intake
  • Found in 30 of the worlds population
  • Malabsorption
  • Absorbed in duodenum
  • GI surgery
  • Blood loss
  • 2 mls blood contain 1mg iron
  • GI, GU losses
  • Hemolysis

29
Iron-Deficiency Anemia
  • Clinical Manifestations
  • See table 30-3
  • Most common pallor
  • Second most common inflammation of the tongue
    (glossistis)
  • Cheilitisinflammation/fissures of lips
  • Sensitivity to cold
  • Weakness and fatigue
  • Diagnostic Studies
  • CBC
  • Iron studies
  • Endoscopy/Colonscopy

30
Iron-Deficiency Anemia
  • Collaborative Care
  • Treatment of underlying disease/problem
  • Replacing iron
  • Food sources cited in table 30-5
  • Drug Therapy
  • Iron replacement
  • Oral iron
  • considerations pg 711
  • Feosol, DexFerrum, etc
  • Absorbed best in acidic environemtn
  • GI effects
  • Parenteral iron
  • IM or IV
  • Less desirable than PO

31
Iron-Deficiency AnemiaNursing Management
  • Assess cardiovascular respiratory status
  • Monitor vital signs
  • Recognizing s/s bleeding
  • Monitor stool, urine and emesis for occult blood
  • Diet teachingfoods rich in iron
  • Provide periods of rest
  • Supplemental iron
  • Discuss diagnostic studies
  • Emphasize compliance
  • Iron therapy for 2-3 months after the hemoglobin
    levels return to normal

32
Thalassemia
  • Etiology
  • Autosomal recessive genetic disorder of
    inadequate production of normal hemoglobin
  • Found in Mediterranean ethnic groups
  • Clinical Manifestations
  • Asymptomatic ? major retardation ? life
    threatening
  • Splenomegaly, hepatomegaly

33
ThalassemiaCollaborative Care
  • No specific drug or diet are effective in
    treating thalassemia
  • Thalassemia minor
  • Body adapts to ? Hgb
  • Thalassemia major
  • Blood transfusions with IV deferoxamine

34
Megaloblastic Anemias
  • Characterized by large RBCs which are fragile and
    easily destroyed
  • Common forms of megaloblastic anemia
  • Cobalamin deficiency
  • Folic acid deficiency

This picture shows large, dense, oversized, red
blood cells (RBCs) that are seen in megaloblastic
anemia.
35
Cobalamin (Vitamin B12) Deficiency
  • Cobalamin Deficiency--formerly known as
    pernicious anemia
  • Vitamin B12 (cobalamin) is an important
    water-soluble vitamin.
  • Intrinsic factor (IF) is required for cobalamin
    absorption
  • Causes of cobalamin deficiency
  • Gastric mucosa not secreting IF
  • GI surgery ?loss of IF-secreting gastric mucosal
    cells
  • Long-term use of H2-histamine receptor blockers
  • Nutritional deficiency
  • Hereditary defects of cobalamine utilization

36
Cobalamin (Vitamin B12) Deficiency
  • Clinical manifestations
  • General symptoms of anemia
  • Sore tongue
  • Anorexia
  • Weakness
  • Parathesias of the feet and hands
  • Altered thought processes
  • Confusion ? dementia

37
Cobalamin Deficiency Diagnostic Studies
  • RBCs appear large
  • Abnormal shapes
  • Structure contributes to erythrocyte destruction
  • Schilling Test

38
Cobalamin Deficiency
  • Collaborative Care
  • Parenteral administration of cobalamin
  • ? Dietary cobalamin does not correct the anemia
  • Still important to emphasize adequate dietary
    intake
  • Intranasal form of cyanocobalamin (Nascobal) is
    available
  • High dose oral cobalamin and SL cobalamin can use
    be used

39
Cobalamin Deficiency
  • Nursing Management
  • Familial disposition
  • Early detection and treatment can lead to
    reversal of symptoms
  • Potential for Injury d/t patients diminished
    sensations to heat and pain
  • Compliance with medication regime
  • Ongoing evaluation of GI and neuro status
  • Evaluate patient for gastric carcinoma frequently

40
Folic Acid Deficiency
  • Folic Acid Deficiency also causes megablastic
    anemia (RBCs that are large and fewer in number)
  • Folic Acid required for RBC formation and
    maturation
  • Causes
  • Poor dietary intake
  • Malabsorption syndromes
  • Drugs that inhibit absorption
  • Alcohol abuse
  • Hemodialysis

41
Folic Acid Deficiency
  • Clinical manifestations are similar to those of
    cobalamin deficiency
  • Insidious onset
  • Absence of neurologic problems
  • Treated by folate replacement therapy
  • Encourage patient to eat foods with large amounts
    of folic acid
  • Leafy green vegetables
  • Liver
  • Mushrooms
  • Oatmeal
  • Peanut butter
  • Red beans

42
Anemia of Chronic Disease
  • Underproduction of RBCs, shortening of RBC
    survival
  • 2nd most common cause of anemia (after iron
    deficiency anemia
  • Generally develops after 1-2 months of sustained
    disease
  • Causes
  • Impaired renal function
  • Chronic, inflammatory, infectious or malignant
    disease
  • Chronic liver disease
  • Folic acid deficiencies
  • Splenomegaly
  • Hepatitis

43
Aplastic Anemia
  • Characterized by Pancytopenia
  • ? of all blood cell types
  • RBCs
  • White blood cells (WBCs)
  • Platelets
  • Hypocellular bone marrow
  • Etiology
  • Congenital
  • Chromosomal alterations
  • Acquired
  • Results from exposure to ionizing radiation,
    chemical agents, viral and bacterial infections

44
Aplastic Anemia
  • Etiology
  • Low incidence
  • Affecting 4 of every 1 million persons
  • Manageable with erythropoietin or blood
    transfusion
  • Can be a critical condition
  • Hemorrhage
  • Sepsis

45
Aplastic Anemia
  • Clinical Manifestations
  • Gradual development
  • Symptoms caused by suppression of any or all bone
    marrow elements
  • General manifestations of anemia
  • Fatigue
  • Dyspnea
  • Pale skin
  • Frequent or prolonged infections
  • Unexplained or easy bruising
  • Nosebleed and bleeding gums
  • Prolonged bleeding from cuts
  • Dizziness
  • headache

46
Aplastic Anemia
  • Diagnosis
  • Blood tests
  • CBC
  • Bone marrow biopsy

47
Aplastic Anemia
  • Treatment
  • Identifying cause
  • Blood transfusions
  • Antibiotics
  • Immunosuppressants (neoral, sandimmune)
  • Corticosteroids (Medrol, solu-medrol)
  • Bone marrow stimulants
  • Filgrastim (Neupogen)
  • Epoetin alfa (Epogen, Procrit)
  • Bone marrow transplantation

48
Aplastic Anemia
  • Nursing Management
  • Preventing complications from infection and
    hemorrhage
  • Prognosis is poor if untreated
  • 75 fatal

49
Anemia Caused By Blood Loss
  • Acute Blood Loss
  • Chronic Blood Loss

50
Acute Blood Loss
  • Result of sudden hemorrhage
  • Trauma, surgery, vascular disruption
  • Manifestations
  • d/t attempts to maintain adequate blood volume
    and meet oxygen requirements
  • Table 30-10 details manifestations of Acute Blood
    Loss
  • Collaborative Care
  • Replacing blood volume
  • Identifying source of hemorrhage
  • Stopping blood loss

51
Chronic Blood Loss
  • Sources/Symptoms
  • Similar to iron deficiency anemia
  • GI bleeding, hemorrhoids, menstrual blood loss
  • Diagnostic Studies
  • Identifying source
  • Stopping bleeding
  • Collaborative Care
  • Supplemental iron administration

52
Anemia caused by Increased Erythrocyte Destruction
  • Hemolytic Anemia
  • Sickle Cell disease (peds)
  • Acquired Hemolytic Anemia
  • Hemochromatosis
  • Polycythemia

53
Hemolytic Anemia
  • Destruction or hemolysis of RBCs at a rate that
    exceeds production
  • Third major cause of anemia
  • Intrinsic hemolytic anemia
  • Abnormal hemoglobin
  • Enzyme deficiencies
  • RBC membrane abnormalities
  • Extrinsic hemolytic anemia
  • Normal RBCs
  • Damaged by external factors
  • Liver
  • Spleen
  • Toxins
  • Mechanical injury (heart valves)

54
Sequence of Events in Hemolysis
Fig. 30-1
55
Acquired Hemolytic Anemia
  • Causes
  • Medications
  • Infections
  • Manifestations
  • S/S of anemia
  • Complications
  • Accumulation of hemoglobin molecules can obstruct
    renal tubules ? Tubular necrosis
  • Treatment
  • Eliminating the causative agent

56
Potential Nursing Dx for Patients with Anemia
  • Activity Intolerance r/t weakness, malaise m/b
    difficulty tolerating ?d activity
  • Imbalance nutrition less than body requirements
    r/t poor intake, anorexia, etc. m/b wt loss, ?
    serum albumin, ? iron levels, vitamin
    deficiencies, below ideal body wt.
  • Ineffective therapeutic regimen management r/t
    lack of knowledge about nutrition/medications
    etc. m/b ineffective lifestyle/diet/medication
    adjustments
  • Collaborative Problem Hypoxemia r/t ?hemoglobin

57
Hemochromatosis
  • Iron overload disease
  • Over absorption and storage of iron causing
    damage especially to liver, heart and pancreas

58
Polycythemia
  • Polycythemia is a condition in which there is a
    net increase in the total number of red blood
    cells
  • Overproduction of red blood cells may be due to
  • a primary process in the bone marrow (a so-called
    myeloproliferative syndrome)
  • or it may be a reaction to chronically low oxygen
    levels or
  • malignancy

59
Polycythemia
  • Complications
  • ?d viscosity of blood
  • ? hemorrhage and thrombosis
  • Treatment
  • Phlebotomy
  • Myelosupressive agents

60
Problems of Hemostasis
  • Thrombocytopenia
  • Inherited clotting disorders (peds)
  • Disseminated intravascular coagulation (DIC)

61
Thrombocytopenia
  • Disorder of decreased platelets
  • platelet count below 150,000
  • Causes
  • Low production of platelets
  • Increased breakdown of platelets
  • Symptoms
  • Bruising
  • Nosebleeds
  • Petechiae (pinpoint microhemorrhages)

62
Thrombocytopenia
  • Types of Thrombocytopenia
  • Immune Thrombocytopenic Purpura
  • Abnormal destruction of circulating platelets
  • Autoimmune disorder
  • Destroyed in hosts spleen by macrophages
  • Thrombotic Thrombocytopenic Purpura
  • ?d agglutination of platelets that from
    microthrombi

63
Heparin-Induced Thrombocytopenia (HIT)
  • HIT
  • Associated with administration of heparin
  • Develops when the body develops an antibody, or
    allergy to heparin
  • Heparin (paradoxically) causes thrombosis
  • Immune mediated response that casues intense
    platelet activation and relaese of
    procoaggulation particles.
  • Clinical features
  • Thrombocytopenia
  • Possible thrombosis after heparin therapy
  • Can be triggered by any type, route or amount of
    heparin

64
Thrombocytopenia
  • Diagnostic Studies
  • Platelet count
  • Prothrombin Time (PT)
  • Activated Partial Thromboplastin Time (aPTT)
  • Hgb/Hct
  • Treatment
  • Based on cause
  • Corticosteroids
  • Plasmaphoresis
  • Splenectomy
  • Platelet transfusion

65
Nursing Management Thrombocytopenia
  • NCP 30-2 pg 725
  • Nursing Assessment
  • Nursing Diagnoses
  • Planning
  • Nursing Implementation
  • Health Promotion
  • Acute Intervention
  • Ambulatory and Home Care
  • Evaluation

66
Neutropenia
  • Abnormally low number of neutrophil granulocytes
    (type of WBC)
  • Neutrophil make up 50-70 of circulating WBCs and
    are the primary defense against infection
  • Susceptible to bacterial infections

67
Neutropenia
  • Diagnostic Studies
  • WBC Count
  • lt4,000 Total WBCs Leukopenia
  • Neutrophil count 1,000-1,500 moderate risk for
    infection
  • Neutrophil count lt 500 severe risk for
    infection
  • Bone Marrow aspirations Biopsies
  • Spleen and liver function test

68
Neutropenia
  • Nursing and Collaborative Care
  • ID cause
  • ID organism of infection
  • Antibiotic therapy
  • Hematopoietic growth factors
  • Neupogen
  • Neulasta
  • Protective isolation measures

69
Leukemia
  • Leukemia is the general term used to describe
    four different disease-types called
  • Acute Myelogenous Leukemia (AML)
  • Acute Lymphocytic Leukemia (ALL)
  • Chronic Myelogenous Leukemia (CML)
  • Chronic Lymphocytic Leukemia (CLL)
  • The four types of leukemia each begin in a cell
    in the bone marrow. The cell undergoes a leukemic
    change and multiplies into many cells. The
    leukemia cells grow and survive better than
    normal cells and, over time, they crowd out
    normal cells.

70
Leukemia
  • Clinical Manifestations
  • Tiredness or no energy
  • Shortness of breath during physical activity
  • Pale skin
  • Mild fever or night sweats
  • Slow healing of cuts and excess bleeding
  • Black-and-blue marks (bruises) for no clear
    reason
  • Pinhead-size red spots under the skin
  • Aches in bones or joints (for example, knees,
    hips or shoulders)
  • Low white cell counts, especially monocytes or
    neutrophils.

71
Leukemia
  • Often thought of as a childhood disease
  • The number of adults affected with leukemia is 10
    times that of children

72
Leukemia
  • Diagnostic Studies
  • To diagnose and classify
  • Peripheral blood evaluation
  • Bone marrow evaluation
  • To identify cell subtype and stage
  • Morphologic, histochemical, immunologic, and
    cytogenic methods

73
Leukemia
  • Goal is to attain remission
  • Chemotherapeutic treatment
  • Gleevac-used to treat CML
  • Combination chemotherapy
  • Mainstay treatment
  • 3 purposes
  • ? drug resistance
  • ? drug toxicity to the patient by using multiple
    drugs with varying toxicities
  • Interrupt cell growth at multiple points in the
    cell cycle

74
Leukemia
  • Bone Marrow and Stem Cell Transplantation
  • Goal
  • Totally eliminate leukemic cells from the body
    using combinations of chemotherapy with or
    without total body irradiation

75
Nursing Management Leukemia
  • Nursing Assessment
  • Nursing Diagnoses
  • Planning
  • Nursing Implementation
  • Acute Intervention
  • Ambulatory and Home Care
  • Evaluation

76
Nursing Management
  • Overall goals
  • Understand and cooperate with the treatment plan
  • Experience minimal side effects and complications
    of disease and treatment
  • Feel hopeful and supported during the periods of
    treatment, relapse, and remission

77
Nursing Management
  • Many physical and psychological needs
  • Evokes great fear
  • Family also needs help
  • Balance demanding technical needs with a
    humanistic, caring approach

78
Nursing Management
  • Ongoing care is necessary to monitor for signs
    and symptoms of disease control or relapse
  • Teach patient and significant other
  • Diligence in disease management
  • Need for follow-up care
  • When to seek medical attention

79
Lymphoma
  • Malignant neoplasms originating in the bone
    marrow and lymphatic structures
  • Result in the proliferation of lymphocytes
  • Two major types
  • Hodgkins disease
  • Non-Hodgkins lymphoma

80
Myelodysplastic Syndrome
  • Etiology and Pathophysiology
  • Unknown etiology
  • Results in change of quantity and quality of bone
    marrow elements
  • Clinical Manifestations
  • Infection
  • Bleeding
  • d/t ineffective granulocytes or platelets
  • Diagnostic Studies
  • Bone marrow aspiration

81
Blood Component Therapy
  • Administration Procedure
  • Large bore needle
  • 19 gauge or higher
  • Blood Tubing
  • Y type
  • Microaggregate filter
  • Isotonic Solution
  • Normal Saline
  • Strict Identification process

82
Blood Component Therapy
  • Red Blood Cell Transfusions
  • One unit contains
  • 200 ml red blood cells
  • 100 ml storage solution
  • 30 ml plasma
  • Must be ABO/Rh compatible
  • In dire emergencies O- can be used
  • Do not provide viable platelets nor do they
    contain significant amounts of coagulation
    factors

83
Blood Component Therapy
  • Red Blood Cell Transfusions
  • Indications
  • Pts with symptomatic anemia who are not treatable
    with specific therapy such as iron, vitamin B12,
    folic acid or Erythropoietin
  • Therapeutic Effect
  • In 70 kg adult, each unit should increase
    hematocrit by 3-4

84
Blood Component Therapy
  • Platelets
  • Platelet concentrate contains
  • Platelets concentrated by centrifuging whole
    units of blood
  • 60 ml plasma
  • Small numbers of RBCs and WBCs
  • Pooled platelets
  • Up to 8 units of platelets from separate donors
    can be pooled into single bag for transfusion
  • Expire 4 hours after pooling

85
Blood Component Therapy
  • Platelets
  • Platelet Phoresis
  • Collected from a single donor. Equivalent to 4
    pooled units
  • Contains 200-400ml of plasma
  • Expire 4 hours after processing for release
  • Indications
  • Prevent bleeding d/t thrombocytopenia
  • Bleeding
  • Abnormal platelet function

86
Blood Component Therapy
  • Fresh Frozen Plasma (FFP)
  • One unit of FFP is plasma taken from one unit of
    whole blood
  • FFP contains all coagulation factors
  • One unit 250 ml
  • Must be ABO compatible, Rh factor is not
    considered
  • Thawed plasma may be transfuse for 5 days after
    thawing
  • Indications
  • Documented coagulation factor deficiencies (r/t
    liver disease, Warfarin, DIC)
  • Active bleeding

87
Blood Component Therapy
  • Cryoprecipitate (Cryo)
  • Prepared from plasma and contains fibrinogen
  • 1 bag contains
  • 350 mg Fibrinogen
  • Pooled 6 bags or 2100 mg Fibrinogen
  • Indications
  • Bleeding
  • Immediately prior to invasive procedures

88
Blood Component Therapy
  • Blood Transfusion Reactions
  • Acute Transfusion Reactions
  • Acute hemolytic reactions
  • d/t antibodies in ABO antigen system
  • May cause acute renal failure, DIC
  • Treatment fluids, diuresis, support for
    bleeding
  • Most errors are clerical or d/t patient
    misidentification
  • Febrile reactions
  • D/t sensitization on cell components (usually
    leukocytes)
  • Treatment leukocyte depleted RBCs

89
Blood Component Therapy (cont.)
  • Allergic reactions
  • Most common
  • D/t proteins on donors plasma
  • Treatment pretransfusin treatment with
    antihistamines or steroids
  • Circulatory overload
  • Sepsis
  • Delayed Transfusion Reactions
  • Autotransfusion

90
  • In Class Project

91
Present to Class
  • Demographics
  • Clinical Manifestations
  • Treatment
  • Nursing Management
  • 2-3 Possible Nursing Diagnoses
  • Prevention/Client Teaching
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