Hematologic & Lymphatic System

Chapter 19-20

Hematologic

• BONE MARROW– Location

• Spongy center of bones– Function

• RBCs production• WBC production• Platelets production

Hematologic

• LIVER– Function:• Manufactures

clotting factors • Filter old & damaged

RBC’s from circulation

Hematologic

• SPLEEN– Function• Works with the liver

removes old RBC’s from circulation• Stores platelets

Hematologic

• BLOOD

Blood

• Function– Transport• Oxygen• Nutrients • Essential

substances

• Waste products

To cells/tissue

Away from cells / tissue

Blood composition

• Plasma• Red blood cells– Erythrocytes

• White blood cells– Leukocytes

• Platelets– Thrombocytes

Plasma

• Color–Clear yellow

• Contains–Protein • Formed in the– LIVER

Red Blood Cells

• AKA:– Erythrocytes

• Function– Carry O2 to body tissues

• Formed – Bone marrow– Erythropoiesis

Erythropoiesis

• The process of red blood cell formation Tissue

hypoxia

Kidney

erythropoietinBone marrow

h RBC production

3-5 days

Hemoglobin

• Function– Carry oxygen

• Main ingredient– Iron

Hemolysis

• Hemo = –Blood

• Lysis– -breakdown

• Breakdown of RBC

•Death of a RBC

Hemolysis

• Life span of RBC– @120 days

• Old / damaged cells– Liver filters blood– Iron – saved & reused– Heme bilirubin bile

sm. intestine

Platelets

• AKA– Thrombocytes

• Function–Blood clotting

• Storage– Spleen

Hemostasis

• Blood clotting process

5 stages of hemostasis

1. Vessel spasm• Damage to blood

vessel• Vessel spasm • Vasoconstriction • i blood flow

5 stages of hemostasis

2. Formation of the platelet plug• Platelets stick to the

wall & one another

5 stages of hemostasis

3. Clot formation• Fibrin cements

components together

5 stages of hemostasis

4. Clot retraction• Platelets contract – (Pulls broken walls

closer together)• Release growth factors

tissue repair

5 stages of hemostasis

5. Clot dissolution• Fibrinolysis removes the

clot after tissue is repaired

Hemostasis• http://www.mhhe.com/biosci/esp/2002_general/Esp/folder_structure/tr/m1/s7/trm1s7_3.h

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Hematologic & Immune System

• White Blood Cells

White Blood Cell

• AKA:– Leukocytes

• Leukocytosis– h WBC count

• Leukopenia– i WBC count

Leukocytes

• Can migrate out of the blood vessel other tissue

Leukocytes: Neutrophils

• Function– Phagocytic

• Life span– 10 hours

Leukocytes: Eosinophils

• Allergic reactions

Leukocytes: Basophils

• Stress

Leukocytes: Monocytes

• Monocytes • Macrophages• Phagocytic cells

Leukocytes: Lymphocytes

• Specific immune response– B lymphocytes

• B-cells– T lymphocytes

• T-cells

B-cells

• Production of – Plasma cell

• Antibody factories– Memory cell

• Future quick response

T-cells

• T-helper cells– Activate other

components of the immune system

• T-cytotoxic cells– Directly destroy the

invader

Immune System

• BONE MARROW– Function

• WBC production

Immune System

• THYMUS– Incubator for T-cells– Not needed after

puberty

Immune System

LYMPHATIC SYSTEM• Lymph Fluid– Plasma– WBC

• Lymph nodes– Housing for T & B-cells– Filter micro-organism

Immune System

LIVER• Function– Filter blood– Stores phagocytes

Immune System

• SPLEEN– Function

• Filters blood• Stores Phagocytes

Natural immunity

• A person’s resistance to foreign substances d/t – Gender– Heredity– Age– Health status

Naturally acquired immunity

• Resistance acquired by developing the disease

Artificially acquired immunity

• Resistance develops through immunization

Physical Exam

• Skin & mucus membranes– Color

• Pallor – Anemia

• Cyanosis – i Oxygen to tissue– Hypoxia

• Jaundice– Yellow– h bilirubin

• Jaundice

Physical Exam

• Skin & mucus membranes– Color

• Erythemia– Inflammation

• Petechiae– Small red spots caused

by a minor hemorrhage– i platelet count

• Petechiae

Physical Exam

• Skin & mucus membranes– Color

• Pallor• Cyanosis• Jaundice• Erythemia• Petechiae• Bruising

– Ecchymosis

• Ecchymosis

Physical Exam

• Skin & Mucus Membranes– Temperature– Capillary refill– Edema

• Lymph nodes• Palpate abd for

tenderness

Physical Exam

• Vital signs– Temp

• h– Infection / bacterial

• i– Infection viral– Anemia

– Apical pulse– Pedal pulse

Dx Tests

Complete Blood Count (CBC)• RBC count• Hemoglobin• Hematocrit

Red Blood Cell Count: RBC count

• Men– 4.6- 6.0 million /mm3

• Women– 4.0 – 5.0 million / mm3

• Magic number– 5

RBC count

Elevated• COPD

Decreased• Hemorrhage• Anemia• Kidney disease

Hemoglobin: Hgb

• Men– 13.5 – 18 g/dL

• Women– 12-15 g /dL

• Magic Number– 15

Hemoglobin

Elevated• COPD

Decreased• Hemorrhaging• Kidney failure• Nutritional deficit

Hematocrit

• Men– 40 – 54%

• Female– 36 – 46%

• Magic Number– 45

Hematocrit

Elevated• COPD• Dehydration

Decreased• Anemia• Kidney failure• Nutritional deficiency

Prothrombin time: PT or ProtimePartial thromboplastin time: PTT

• Clotting time– h• Risk of hemorrhaging

– i• Risk of blood clots /

thrombi

Anemia

• Definition– i Red blood cells

Anemia: S&S

• i Oxygen-carrying capacity

• Respiratory– Tachypnea– Dyspnea

Anemia: S&S

• i Oxygen-carrying capacity

• C/V– Tachycardia– Palpitations– Angina

Anemia: S&S

• i Oxygen-carrying capacity

• Neurological– H/A– Fatigue– i Concentration– Dizzy

Anemia: S&S

• i Oxygen-carrying capacity

• Integumentary– pallor

Anemia: S&S

• i Oxygen-carrying capacity

• M/S– Leg cramps– Bone pain– Weakness

Anemia

• Causes–Blood loss–Nutritional–Hemolytic–Aplastic

Blood Loss Anemia

• Cause– Hemorrhaging

Nutritional Deficit Anemias

• D/T lack nutrient– Iron – Vitamin B12– Folic Acid

Iron Deficiency Anemia

• Iron is a necessary component of– Hemoglobin

• Specific S&S–Pica • Craving to eat

unusual substances

Vitamin B12 Deficiency Anemia

• AKA– Pernicious Anemia

• Specific S&S– Paresthesia

Folic Acid Deficiency Anemia

• Required for normal production and maturation of RBCs

Hemolytic Anemias

• Premature destruction of RBC

Sickle Cell

• Genetically transmitted • Abnormal hemoglobin

Anemia i O2

RBC stress

RBC SicklesSickle

cells clump

Blocks sm

vessels

Damaged RBC

Hemolysis

S&S of sickle Cell Anemia

• Pain –hands and feet

• Vision problems• Jaundice• Increased risk:–Infections–Stroke

Aplastic Anemia

• Bone marrow does not make enough RBCs

IDT Care: Anemia

• Dx Tests–CBC– Iron levels

IDT Care: Anemia

• Medications– Iron–Vitamin B12– Folic Acid

IDT Care: Anemia

• Dietary – Iron

• Meat• Beans• Green veg

– Folic Acid• Green Veg• Beans

– B12• Meat• Fish • Milk

IDT Care: Anemia

• Blood Transfusions

Leukemia

• Malignant disorders of WBC’s

In Leukemia…

• Normally the ratio of RBC:WBC – 3:1

• In leukemia the ratio changes – >WBC’s

Pathophysiology

• Stem cell mutates • Proliferation • NON-function WBC’s • Fill bone marrow • Spill into blood • Crowd out RBC’s & Platelets • Anemia, Infection & bleeding • Death

Leukemia: etiology

• Unknown

Leukemia: S&S

• Anemia• Infection• Bleeding

Leukemia: S&S

• Anemia– Pallor– Fatigue– Tachycardia– Dyspnea

Leukemia: S&S

• Infections– Fever– Skin infections– Respiratory infections– UTI– Septicemia

Leukemia: S&S

• Bleeding– Bruising

• Ecchymosis

Leukemia: S&S

• Bleeding– Bruising

• Ecchymosis– Petechiae

Leukemia: S&S

• Bleeding– Bruising

• Ecchymosis– Petechiae– Occult stool

Leukemia: S&S

• Bleeding– Bruising

• Ecchymosis– Petechiae– Occult stool– Tarry stool– Coffee ground emesis

Leukemia: Dx

• CBC• WBC w/ differential

Leukemia: Tx

• Chemotherapy– Destroy leukemic cells

• Radiation therapy– Use to shrink

• Bone Marrow Transplants

• Stem cell transplant

Clients with HIV

• Page 249-260

HIV pathophysiology

• Mode of transmission– Direct person to person

through sex– Direct injection with

contaminated blood, blood products or needles

– Mother to fetus

Manifestations of HIV

• 3 stages:– Primary infection– Asymptomatic period– AIDS & opportunistic

disorders

HIV: Primary infection

• Fever• Sore throat• General malaise/fatigue• H/A• Rash• N&V• Night sweats• Wt loss

HIV: Asymptomatic period

• Chronic– @ 10 years

HIV: AIDS & Opportunistic disorders

• Respiratory– Pneumocystis carinii

pneumonia• Gastrointestinal– wasting syndrome

• Integumentary– Kaposi's Sarcoma

Small group questions

1. Identify 3 major S&S of leukemia.2. What lab results indicate leukemia?3. How are HIV and AIDS related?4. What are the three phases of HIV infection?5. How can you protect yourself as a nurse

while caring for a client with end stage HIV infection?