Hematopoietic System

What is included in a complete blood count?

red blood cells (RBC)

white blood cells (WBC)

platelets (PLT)

hemoglobin (Hgb)

hematocrit (Hct)

What does a CBC determine?

the number of cells per unit of blood

What does a CBC w/ differential provide?

breakdown of each subset of cell and assists in the diagnosis of specific pathologies

ABO blood groups

What determines if blood is negative or positive?

Rh factor

blood type compatibility: donor

A → A, AB

B → B, AB

AB → AB

O → A, B, AB, O

• universal donor

blood type compatibility: recipient

A ← A, O

B ← B, O

AB ← A, B, AB, O

• universal recipient

O ← O

blood transfusions: components

whole blood

packed RBCs (PRBCs)

platelets

plasma

granulocytes

lymphocytes

cryoprecipitate

blood transfusions: indications

volume replacement

hypovolemia

symptomatic anemia

hemorrhaging

specific conditions

• von Willebrand disease

• Hemophilia A, B

• factor deficiencies

acute hemolytic transfusion reaction

reaction between donor and recipient blood cells

• ABO incompatibility

diagnosis also must meet specific criteria based on lab values and other characteristics

acute hemolytic transfusion reaction onset

during or w/in 24 hrs after transfusion

acute hemolytic transfusion reaction manifestations

fevers, chills

disseminated intravascular coagulation, epistaxis

hematuria

hypotension

transfusion site pain/infiltration

acute hemolytic transfusion reactions treatment/management

STOP THE TRANSFUSION

monitor pt’s VS and status

supportive treatment (fluids/diuresis, antipyretic, analgesic, antihistamine, etc.)

report reaction to blood bank

What are the three coagulation studies?

International Normalized Ratio (INR)

Prothrombin Time (PT)

Activated Thromboplastin Time (aPTT)

international normalized ratio (INR)

ratio of pt’s PT to control PT

lab value: 1.0

uses: warfarin, alteplase

prothrombin time (PT)

measures the time it takes plasma to clot when exposed to tissue factor

• assesses intrinsic and extrinsic coagulation pathways

lab range: 10 - 13 seconds

uses: warfarin, alteplase

activated thromboplastin time (aPTT)

measures the time it takes plasma to clot in the presence of substances that activate certain clotting factors

• assesses intrinsic and extrinsic coagulation pathways

lab range: 25 - 35 seconds

uses: heparin, alteplase

warfarin labs for PT and INR

PT: 1.5 - 2.5 x control; 18 - 24 seconds

INR: 2 - 3 for treatment MI, AF, VTE, tissue heart valves

INR: 2.5 - 2.5 PE treatment

INR: 3 - 4.5 for mechanical heart valve or recurrent systemic embolism

general considerations for anticoagulants

anticoagulants and antiplatelets pose risks for bleeding

obtain baseline labs (dependent on agent)

• CBC, INR, PT, aPTT

pt teachings

• electronic razor, soft toothbrush

• monitor for bleeding: bruising, bleeding at the gums, abdominal pain, epistaxis, coffee-ground emesis, tarry stools

• avoid OTC NSAIDs, aspirin, meds w/ salicylates

proper administration techniques

• IV pump for administration

• SC injection

  • self-administration