Hematology Jan Bazner-Chandler CPNP, CNS, MSN, RNSlide 2
Blood is the liquid of life Blood is made out of: Plasma RBC WBC PlateletsSlide 3
Plasma comprises of: 90% water. 10 % solutes: egg whites, electrolytes and proteins. Proteins comprise of coagulating elements, globulins, flowing antibodies and fibrinogen.Slide 4
Red Blood Cells RBC\'s go through the body conveying oxygen and evacuating waste. RBC\'s are red since they contain a protein compound called hemoglobin which is splendid red in shading. Hemoglobin contains press, making it an astounding vehicle for transporting oxygen and carbon dioxide.Slide 5
Average life cycle is 120 days. The bones are persistently delivering new cells. RBC\'sSlide 6
White Blood Cells The fighting platelets. The white platelets are constantly watchful for indications of ailment. At the point when a germ shows up the WBC will: Produce defensive antibodies. Encompass it and eat up the microscopic organisms. .:tslidesep\'s.: WBC life traverse is from a couple days to half a month. WBC\'s will increment when battling contamination.Slide 7
Platelets are unpredictably formed, dry bodies that are available in blood. Their sticky surface gives them a chance to shape clumps to quit dying. PlateletsSlide 8
Blood Values CBC with differential and platelet tally. Hgb: Normal levels are 11 to 16 g/dl Panic levels are: Less than 5 g/dl More than 20 g/dlSlide 9
Hematocrit Normal hematocrit levels are 35 to 44%. Freeze levels: Hmct under 15 % Hmct more noteworthy than 60%Slide 10
Hemoglobin and Hematocrit Can be utilized as a straightforward blood test to screen for sickliness. The CBC with differential would be utilized to help analyze a particular issue. A bone marrow yearning would be the most indisputable in deciding reason for sickliness – aplastic/leukemia.Slide 11
Bone Marrow Bone marrow is the light substance found in the focal point of the bones. It makes bone marrow immature microorganisms, which thusly create platelets. Red platelets – convey oxygen to tissue Platelets – help blood to clump White platelets – battle diseaseSlide 12
Bone Marrow Transplant Donor is set under anesthesia. Marrow is suctioned out of the iliac peak. Marrow is separated and treated to evacuate bits of bone and other undesirable cells and flotsam and jetsam, exchanged to a blood pack, and is injected into the patient\'s blood quite recently like at transfusion.Slide 13
Bone Marrow AspirationSlide 14
Treatment Modalities Transfusion: Packed red platelets – pallor Platelets – platelet brokenness Fresh solidified plasma – coagulation variablesSlide 15
Blood Transfusions 3 sorts of transfusion responses Hemolytic Allergic FebrileSlide 16
Hemolytic Reaction Refers to an insusceptible reaction against transfused platelets. Antigens, on the surface of red platelets, are perceived as "remote proteins" and can invigorate B lymphocytes to create antibodies to the red platelet antigens.Slide 17
Hemolytic response Flank torment Fever Chills Bloody pee Rash Low pulse Dizziness/swooningSlide 18
Nursing Management Stop the blood transfusion. Begin ordinary saline mixture. Bring indispensable signs with circulatory strain Call the MD Obtain blood test and pee example. Return blood to blood donation center. RecordSlide 19
Febrile Reaction Often happens after various blood transfusions. Symptoms:fever, chills, and diaphoresis. Mediations: Slow transfusion and regulate antipyretic. Regulate antipyretic preceding organization.Slide 20
Allergic Reaction Symptoms: rash, urticaria, respiratory trouble, or hypersensitivity. Mediations: regulate antihistamine before transfusion Physician may arrange washed rbc\'sSlide 21
Hematologic ConditionsSlide 22
Alteration in Hematologic Status Disorders of hemostasis or thickening variables Structural or quantitative irregularities in the hemoglobin. Anemias Aplastic AnemiaSlide 23
Genetic Implications The accompanying have a hereditary connection: suggestions for hereditary screening and fetal conclusion Sickle cell weakness Thalassemia HemophiliaSlide 24
Bleeding Disorders Three sorts Hemophilia: guys just Type A most basic – calculate VIII inadequacy Type B - absence of element IX (Christmas Disease) Type C – absence of element XI Von Willebrand Disease – 1% of populace – men or ladies – delayed draining timeSlide 25
Hemophilia Type A Hemophilia sort An is the insufficiency of thickening variable VIII. A genuine blood issue Affects 1 in 10,000 guys in the US Autoimmune confusion with brought down level of coagulating component All races and financial gatherings influenced similarlySlide 26
Hemophilia is a sex-connected inherited draining issue Transmitted on the X chromosome Female is the bearer Women don\'t experience the ill effects of the ailment itselfSlide 27
Historical Perspective First recorded case in Talmud Jewish content by an Arab doctor – documentation of two siblings with seeping after circumcision. Ruler Victoria is transporter and spread the illness through the male English eminence.Slide 28
Goals of Care Goals of care: Provide consider VIII (IX) to help blood in thickening. To abatement transmission of irresistible operators in blood items; hepatitis & AIDS. Future: quality treatment to build creation of coagulating element.Slide 29
Symptoms Circumcision may deliver delayed dying. As tyke develops and turns out to be more dynamic the rate of seeping because of injury incrementsSlide 30
Symptoms May be gentle, direct or extreme Bleeding into joint spaces, hemarthrosis Most risky drain would be intracranial.Slide 31
Diagnosis Presenting side effects Prolonged actuated aPTT and diminished levels of component VIII or IX. Hereditary testing to distinguish transportersSlide 32
Treatment Products used to treat hemophilia are: Fresh solidified plasma and cryoprecipitate which are from single blood givers and require unique solidifying. Second era of element VIII are made with creature or human proteins.Slide 33
Nursing Diagnoses Risk for damage Pain with drain particularly into a joint Impaired physical portability Knowledge deficiency in regards to sickness and administration of maladySlide 34
Nursing mediations No rectal temps. Supplant the component as requested by doctor. Oversee torment using analgesics as requested. Keeping up joint uprightness amid intense stage: immobilization, height, ice. Non-intrusive treatment to avert flexion compression and to fortify muscles and joints. Give chances to ordinary development and advancement.Slide 35
Teaching Avoid ibuprofen which draws out draining time in individuals with typical levels of variable VIII. A crisp draining scene can begin if the coagulation gets to be removed. Characteristic responses in the body cause the coagulation that is no longer expected to "separate. This procedure happens 5 days after the underlying coagulation is framed.Slide 36
Family Education Medic-Alert arm jewelery Injury avoidance fitting for age Signs and side effects of interior draining or hemarthrosis Dental checkups Medication organizationSlide 37
Long Term Complications 20% create killing antibodies that make substitution items less successful. Quality treatment giving consistent creation of the insufficient coagulating element could be the following real progress in hemophilia treatment.Slide 38
Disseminated Intravascular Coagulation or DIC is a procured coagulopathy that is described by both thrombosis and drain. DIC is not an essential issue but rather happens therefore of an assortment of modifications in wellbeing.Slide 39
Assessment The most evident clinical element of DIC is dying. Renal association = hematuria, oliguria, and anuria. Pneumonic inclusion = hemoptysis, tachypnea, dyspnea and trunk torment. Cutaneous association = petechiae, ecchymosis, jaundice, acrocyanosis and gangrene.Slide 40
Management of DIC Treatment of the encouraging issue. Steady care with organization of platelet fixation and new solidified plasma and coagulation variables. Organization of heparin (questionable in kids). Heparin overlords against thrombin III which represses thrombin and further advancement of thrombosis.Slide 41
Nursing Diagnoses Altered tissue perfusion Risk for harm AnxietySlide 42
Nursing Interventions Rigorous progressing appraisal of all body frameworks Monitor draining No rectal temps Avoid injury to fragile tissue territories All infusions destinations and IV locales should be dealt with like a blood vessel stick.Slide 43
Prognosis Depends on the basic issue and the seriousness of the DIC.Slide 44
ITP Idiopathic thrombocytopenic purpura Idiopathic = cause is obscure Thrombocytopenic = blood does not have enough platelets Purpura = over the top draining/woundingSlide 45
Immune Thrombocytopenic Purpura Antibodies obliterate platelets Antibodies consider platelets to be microorganisms and work to dispense with them ITP is gone before by a viral illness URI Varicella/measles immunization Mononucleosis FluSlide 46
Symptoms Random purpura Epistaxis, hematuria, hematemesis, and menorrhagia Petechiae and hemorrhagic bullae in mouthSlide 47
Diagnostic Tests Low platelet number Peripheral blood spread Antiplatelet antibodies Normal platelet check: 150,000 to 400,000Slide 48
Management IV gamma globulin to piece counter acting agent creation, lessen immune system issue Corticosteroids to decrease fiery process IV hostile to D to invigorate platelet generationSlide 49
Sickle Cell Anemia Autosomal latent issue Defect in hemoglobin atom Cells get to be sickle molded and unbending Lose capacity to adjust shape to environment. Sickling might be activated by fever and enthusiastic or physical anxietySlide 50
Pathophysiology When presented to decreased levels of oxygen, the hemoglobin in the RBC builds up a sickle or bow shape; the cells are unbending and deter hairlike blood stream, prompting to blockage and tissue hypoxia; clini
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