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Chapter 35 Hematology
HematologyThe study of blood and blood-forming ______________________________________ Includes the study of the following blood disorders:
– Red blood cell disorders– ______________________________________ blood cell disorders– Platelet disorders– ______________________________________ problems
Blood ComponentsPlasma
-sticky yellowish-carries blood cells and ______________________________________
Erythrocytes (red blood cells)-contain ______________________________________-gives blood it’s color-carries ______________________________________
Blood Components______________________________________ :
-Iron containing oxygen-transport malloprotein in the red blood cells______________________________________(white blood cells)
-fights infection______________________________________
-clot formation-usually clots in 4 to 6 minutes
Lab Values
Hemoglobin LevelsThe amount of ______________________________________ carrying protein within the
red blood cellsNormal Adult Female 12-16g/dLNormal Adult Male: 14-18g/dL Low hemoglobin suggests ______________________________________High hemoglobin can suggest lung disease, living at high altitudes, or excessive bone
marrow production
HematocritA measure of how much space red blood cells take up in the bloodThe proportion of blood volume that is occupied by red blood cellsNormal adult male: __________%Normal adult female: ___________%Elevated hematocrit indicates ______________________________________ Low levels indicate ______________________________________
White Blood Cell LevelsNumber of white blood cellsNormal adult range: 3.8-10.8 thousand/mcLOptimal reading: 7.3
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High readings could indicate ______________________________________ or leukemia Low readings can indicate bone marrow disease or enlarged
______________________________________
Red Blood Cell LevelsNumber of red blood cellsNormal adult female: 3.9-5.2 mill/mclNormal adult male: 4.2-5.6 mill/mclHigh readings could indicate ______________________________________ disease, cor
pulmonale, or dehydration Low readings could indicate anemia, leukemia, malnutrition, bone marrow failure, multiple
myeloma, blood loss, or ______________________________________
Platelet ValuesNumber of platelet cellsNormal adult range: 150-450 thousand/mclOptimal range: 265 thousandHigh readings could indicate ______________________________________, cigarette
smoking, or excessive production by the bone marrow Low readings could indicate acute blood loss, drug effects
(______________________________________), infections, enlarged spleen
TroponinTroponin is a muscle ______________________________________, that helps muscles
contractWhen the ______________________________________, muscle is damaged, troponins
leak out of cells and into the bloodstreamNormal reading is <__________ng/mLElevated readings could indicate an __________________Troponin levels can remain high for 1-2 weeks after an MI
Blood Products and Blood Typing______________________________________
– A, B, AB, OType A blood
– Has the A antigen– __________% of population
Type B blood– Has the B antigen– ____________% of the population
Blood Products and Blood TypingType O blood
- Has ______________________________________ antigens- Universal ______________________________________ - ___________% of the population
Type AB blood - Has both A and B antigens- Can receive any type of blood (universal ______________________________________ )- ___________% of the population
Rh factor: + or -
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Rh Factor______________________________________ FactorConsists of 50 blood group antigensRh factor is based on the ___________ antigen
– Positive or NegativeUsed to determine the risk of hemolytic disease of the
______________________________________ as well as transfusion compatibility
Types of Transfusions______________________________________ blood
– Contains all cells, platelets, clotting factors, and plasma– Replaces blood loss from hemorrhage
Packed Red Blood Cells (PRBC)– Red blood cells with some ______________________________________ – Replaces RBC in anemic patients
______________________________________– Platelets with some plasma– Replaces platelets in a patient with thrombocytopenia
Types of TransfusionsFresh Frozen Plasma (FFP)
– Plasma, a combination of fluids, ______________________________________ factors, and proteins
– Replaces volume in a ______________________________________ patientClotting Factors
– Specific clotting factors needed for ______________________________________ – Replaces factors missing due to inadequate production as in
______________________________________
Transfusion Reactions
Hemolytic ReactionsOccurs when a donor’s and ______________________________________ blood are not
compatibleSigns & Symptoms
– Facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, rales, fever, chills, and ______________________________________
Treatment– Stop transfusion, change all IV tubing, and initiate IV therapy with NS or LR– Consider ______________________________________ , Dopamine, and
Diphenhydramine.
Febrile Nonhemolytic ReactionsFebrile Nonhemolytic ReactionsCaused by ______________________________________ to antigens on the white blood
cells, platelets, or plasma proteinsSigns & SymptomsHeadache, fever, and chillsTreatment:Stop ______________________________________ , change all IV tubing, and initiate IV
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therapy with NS or LRConsider ______________________________________ and an antipyretic.Observe closely to ensure reaction is nonhemolytic.
General Assessment and Management of Hematologic PatientsScene Size-upPrimary AssessmentFocused History and Physical ExamSAMPLE history
– Hematological disorders are rarely the chief complaint.– “Weak and Dizzy” is a ______________________________________ complaint
Physical exam– Evaluate ______________________________________ system function.
Physical Exam of Hematologic PatientsSkin signs
– Jaundice– Pallor– ______________________________________ : tiny red dots– ______________________________________ : large purplish blotches
Gastrointestinal signs– ______________________________________– Bleeding gums– Abdominal pain, N/V
Physical Exam of Hematologic PatientsMusculoskeletal signs
– Pain and swelling of the ______________________________________ Cardiorespiratory signs
– Dyspnea, tachycardia, chest pain– Pulmonary edema
Genitourinary signs– ______________________________________– Blood in scrotal sac on males– ______________________________________(later stages of sickle cell anemia)
General Management of Hematologic PatientsMaintain ABCs.
– Provide high-flow oxygen or assist ______________________________________ as indicated.
– Consider ______________________________________ replacement.Monitor cardiac rhythm and vital signs.
– Treat rhythm ______________________________________ .Provide reassurance, comfort care, and transport.
Managing Specific Patient ProblemsDiseases of the ______________________________________ Blood CellsDiseases of the White Blood CellsDiseases of the ______________________________________ /Blood Clotting
Abnormalities
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Other Hematopoietic Disorders
Anemia______________________________________ number of red blood cellsAnemia is a sign, not a separate ______________________________________ process.Signs and symptoms may not be present until the body is stressed.S/S include: mild dyspnea, fatigue, ______________________________________ , and
syncope. Possible S/S of shockDifferentiate chronic anemia from ______________________________________ episode.
Prehospital Treatment of AnemiaTreat signs and symptoms Maximize ______________________________________ Limit ______________________________________ loss.Establish IV therapy if indicated
Types of Anemias3 causes of Anemias: Inadequate ______________________________________ of red blood cells Increased red blood cell ______________________________________ Blood cell loss or ______________________________________
Anemias Caused by Inadequate Production of Red Blood Cells______________________________________ Anemia
– Failure to produce red blood cells______________________________________ Deficiency
– Iron is primary component of hemoglobin
Anemias Caused by Inadequate Production of Red Blood Cells______________________________________
– Vitamin B12 is necessary for correct rbc division during it’s development– Decreased levels of B12
______________________________________ Cell Anemia– Genetic alteration changes the shape of red blood cells to a C, or sickle, in low oxygen
states
Anemias Caused by Increased Red Blood Cell Destruction______________________________________ Anemia
– Body destroys RBCs at greater rate than production
Anemias Caused by Blood Cell Loss or Dilution______________________________________ Anemia
– Hemorrhage leads to cell loss while excessive fluid leads to a dilution of RBC concentration
Diseases of the Red Blood Cells
Sickle Cell Disease Inherited disorder of red blood cell production, so named because the RBCs become sickle
shaped when ______________________________________ levels are lowPatients with sickle cell disease has chronic anemiaAverage life span of a RBC is _________-__________ days as compared to 120 days for
normal RBC
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Primarily affects ______________________________________ -Americans
Sickle Cell Disease
Sickle Cell Crises______________________________________ Crises: causes musculoskeletal pain,
abdominal pain, priapisms, pulmonary problems, renal infarctions, and CNS problems______________________________________ Crises: fall in the hemoglobin level and
problems with bone marrow function______________________________________ Crises: vulnerable to infectionsManagement
– Supportive measures– Fluid replacement as indicated – Consider analgesics.
Polycythemia Overproduction of RBCs.
– Occurs in patients > 50 years old or with secondary dehydration.– Increases risk of ______________________________________
Results in bleeding abnormalities:– ______________________________________ , spontaneous bruising, GI bleeding.
Management:– Follow general treatment guidelines.
Diseases of the White Blood Cells
Leukopenia/NeutropeniaToo few white blood cells or ______________________________________ .Person is very susceptible to ______________________________________ Follow general treatment guidelines and provide supportive care.
LeukocytosisAn ______________________________________ in the number of circulating white blood
cells, often due to infection or stressCauses include bacterial infections, ______________________________________ ,
rheumatoid arthritis, leukemiaFollow general treatment guidelines and provide supportive care.
Leukemia______________________________________ of hematopoietic cellsCommon types of Leukemia
– Acute lymphocytic leukemia (ALL)– Acute myeologenous leukemia (AML)– Chronic lymphocytic leukemia (CLL)– Chronic myeologenous leukemia (CML)– Hairy cell leukemia
Leukemia Initial presentation
– Acutely ill, fatigued, febrile and weak, anemic, ______________________________________
– Often have a secondary ______________________________________ .
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Management– Follow general treatment guidelines.– Utilize isolation techniques to limit risk of ______________________________________ .– IV therapy– ______________________________________
LymphomasCancers of the ______________________________________ systemPresentation
– Swelling of the lymph nodes– Fever, night sweats, ______________________________________ , weight loss,
fatigue, and pruritis (itching)Management
– Follow general treatment guidelines.– Utilize ______________________________________ techniques to limit risk of infection.
Diseases of the Platelets and Blood Clotting Abnormalities
ThrombocytosisAn abnormal increase in the number of ______________________________________ Often complicates chronic myelogenous leukemiaMay be secondary to other disorders such as autoinflammatory diseases, acute
hemmorrhage, and malignant diseasesMost persons are ______________________________________ Prehospital care is ______________________________________
ThrombocytopeniaAn abnormal ______________________________________ in the number of platelets Due to decreased platelet production, sequestration of platelets in the spleen, destruction of
platelets, or a combination of the threeCharacterized by easy ______________________________________ , bleeding, and a
falling plate count• Prehospital care is supportive
HemophiliaDeficiency or absence of a blood clotting factorDeficiency of factor ___________ causes hemophilia A.Deficiency of factor ____________ causes hemophilia B.Delays or prevents the stoppage of ______________________________________ ______________________________________ injuries can be life threatening
HemophiliaDeficiency is a sex-linked, inherited disorder.Defective gene is carried on the ___________ chromosome.Females have 2 X chromosomes and ______________________________________ must
have the defective gene for the female to develop hemophilia– Females with only 1 X chromosome with defective gene are
______________________________________ Males have 1 X (from mother) and 1 Y chromosome (from father)
– If that X chromosome has the defective gene, then that person will have hemophilia
Hemophilia
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Signs & Symptoms:Numerous bruises, deep muscle bleeding, and
______________________________________ bleeding.Often use Medic Alert ______________________________________ Most will know of their condition
Management of HemophiliaAdminister supplemental oxygenEstablish IV access with great ______________________________________ Be alert for recurrent or prolonged bleeding Prevent additional ______________________________________ Consider ______________________________________ if needed
Multiple MyelomaA ______________________________________ disorder of plasma cellsMutation in a plasma cell in the bone marrow leading to decreased reduced red blood cell
productionSigns/Symptoms
– Pain in back or ribs– ______________________________________ fractures– Fatigue – Elevated calcium levels which lead to ______________________________________
failure
Multiple MyelomaNormally treated with chemotherapy, bone marrow transplants, and radiationPrehospital care is supportive
– IV if s/s of ______________________________________ – Administer analgesics if needed– Protect from ______________________________________
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