HEMATOLOGICAL

RBC function

• Transports oxygen and nutrients to tissues

• Transports waste products AWAY from tissues

RBC organs

• Spleen keeps blood in balance

  • Destroys cells

  • Helps with platelet storage

What stimulates RBC production

• Stimulated by decreased oxygen

• Kidney then produces erythropoietin

RBCs live

• 90-120 days

RBC LABS

• Size (cytic)

  • MCV

    • Table 28.1 pg 1015

    • Small: microcytic

    • Normal: normocytic

    • Large: Macrolcytic

• Hemoglobin (chromic)

  • MCH

    • Table 28.1, 1015

    • Normal: normochromic

    • <26: hypochromix

    • Look at values

      • Especially for iron deficiency anemia

WBCs

• Bodys defense against infection and injury

• Table 28.1 pg 1015

• Responsible for fighting infection

Lymphocytes

• Found in bone marrow, spleen, lymph glands

• Responsible for immunity

Neutrophils

• Attack bacteria/voiruses

• Elevated in acute inflammation

Monocytes

• Macrophages

• Increased chronic inflammation

Eosinophils

• Kills parasites

• Increased in allergies

Basophils

• Elevated during healing

Platelets

• Promote hemostasis

• Produce in bone marrow, stored in spleen

• Live 8-10 days

Blood transfusion

• IV admin of

  • whole blood

  • packed RBCs

  • platelets

  • plasma

Blood transfusion nursing guidelines

• Double check blood with secondary nurse

• Monitor vital signs frequently

  • Baseline BEFORE transfusion

  • 15 min after blood transfusion has began

  • End of transfusion

• Follow facility transfusion protocol

• May need premedication

If an adverse reaction occurs during a blood transfusion

• STOP transfusion

• Run normal saline

• Obtain VS

• Notify provider

• SEND BLOOD AND TUBING BACK TO LAB

Blood transfusion adverse reactions major complications

• hemolytic

• febrile

• allergic reactions

• circulatory overload

• air emboli

• hypothermia

• electrolyte disturbances

• infection

What is iron deficiency anemia

• Body does not have enough iron to produce hemoglobin

iron deficiency anemia risk/contributing factors

• Inadequate supply of dietary iron

• inadequate iron stores

• decreased absorption

• blood loss

• excesive demands

• inability to form hemoglobin

• Increased iron or blood loss

• Impaired reabsorption

• Rapid periods of growth

• Associated with cognitive delays and behavioral changes

iron deficiency anemia risk factors: Inadequate supply of dietary iron

• Rare b4 6 months of age

  • Maternal iron stores still present

• Feeding cows milk

  • Milk impacts absorption of iron

  • Whole milk after 1 yr

    • Drinking cows before age 1, → cause deficiency

  • formula/breast milk until 1 yr

    • Make sure breast milk is not from anemic mom

• After 6 months

  • Iron Fortified Cereal

  • Veggies

  • Fruits

  • meats

iron deficiency anemia risk factors: Inadequate iron stores

• Premature

• Multiple birth

  • Twin? May not be enough iron to go around

• Anemic mother

iron deficiency anemia risk factors: decreased absorption

• Never give iron with milk

• Vitamin C enhances absorption

iron deficiency anemia risk factors: blood loss

• Hemorrhage

• Parasites

iron deficiency anemia risk factors: excessive demands

• Premature

• Pregnancy

iron deficiency anemia risk factors: Inability to from hemoglobin

• Lack of B12

• Lack of folic acid

iron deficiency anemia labs & diagnostics

• History

  • Emphasis on nutrition

• CBC

  • Low Hgb & Hct

  • Decreased MCV

  • Decreased MHC

  • Increased TIBC (total iron binding capacity)

iron deficiency anemia management

• Iron fortified

  • Green leafy vegetables

  • Yellow leafy vegetables

  • Red meat

• Limit cows milk to 24 ox/day or less

• Iron rich foods

iron deficiency anemia iron supplement teaching

• Daily oral preparation

• 2 divided doses between meals

• Can stain teeth

• Causes black tarry stools

• Begin supplementation at 406 months

what is sickle cell anemia

• Inherited hemoglobinopathies

• RBCs do not carry the normal hemoglobin

  • Carry a less effective type

• Autosomal recessive condition

• Primarily affects individuals from African descent

sickle cell anemia can be characterized by

• Production of sickle hemoglobin (HgS)

  • Stressors on cells → C shaped cells with points to scrape vessel lining and clump up → causing inflammation and issues with blood flow → pain

• Chronic hemolytic anemia

• Ischemic tissue injury

vaso occlusive crisis

• Painful episode

  • Precipitated by

    • Infection

    • Cold

    • Stress

    • Acidosis

    • Hypoxia

vaso occlusive treatment

• IVF

  • Hydration pushes out RBCs and help then UNclump and UNsickle

• Opioids

  • MORPHINE

• NSAIDs

  • Help with vessel lining inflammation

• O2

  • Comfort measure

What happens during VOC

• When PT is dehydrated → red blood cells lose water and become stiffer causing them to “sickle” and clump together → blocking blood vessels

sickle cell anemia: Acute chest syndrome

• Can be confused with pneumonia

• Decreased gas exchange

• Treatment

  • IVF

  • Opiods

  • O2

  • Transfusion

ACS evaluation

• CBC

  • Elevated reticulocyte counts

• Hemoglobin electrophoresis

• Universal screening for newborns

  • Mandatory in all 50 states

ACS prenatal diagnosis

• Chronic villi sampling at 8-10 weeks gestation

• Aminocentesis at 15 weeks gestation

ACS management

• Hydration

  • IV lfuids

• Pain management

  • MORPHINE #1 TREATMENT OF CHOICE

• Vaccinations

  • Infection is #1 reason crisis situation occurs

• Spelectomy

• Prophylactic antibiotics

  • Penicillin V

  • More susceptible to infection

• NSAIDs

• Monitor for stroke

• Monitor for infection

What is hemophelia

• Hereditary bleeding disorder caused by a dysfunction/absence of coagulation proteins

• X linked autosomal recessive disorder

• NO CURE

• 2 types

• Factor VIII, IX, and X

  • work together to create clots

  • Deficiency results in lack of coagulation

2 types of hemophelia include

• Hemophelia A (classic)

  • Deficiency of coagulation factor VIII

• Hemophelia B (Christmas)

  • Deficiency of factor IX

Hemophelia primary goal

• PRIMARY GOAL IS TO PREVENT BLEEDING

  • Provide them with primary factor that they are missing to prevent bleeding

Hemophelia manifestations

• Bruise easily

• Hemauria

• Epistaxis

  • Nose bleeds

Hemophelia bleeding can be caused by

• Loss of baby (deciduous) teeth 

• Injections

• Minor lacerations

• Recurrent bleeding to the joints (hemoarthrosis) may cause joint destruction

Hemophelia management & precaution

• Avoid activities with high potential injuries

  • Contact sports

    • Football

    • Soccer

    • Hockey

  • NO Trampolines

  • THEY CAN SWIM

• Prevent excessive bleeding and tissue damage

• Supply the body with missing or ineffective factor

  • Regularly scheduled

  • Beginning in early childhood

• AVOID ASPIRIN AND NSAIDS

Lead poisoning

• Lead applies toxic effect on bone marrow, nervous system & kidneys

• OFTEN SILENT

  • Need to SCREEN

Lead poisoning complications

• Behavioral problems

• Learning disabilities

• Seizures

• Brain damage

Lead poisoning risk assessment

• 6, 9, 12, 18, and 24 months

• 3, 4, 5, adn 6 years

• If positive risk assessment – blood level screening

Lead poisoning and levels of prevention

• Primary

  • Before it happens

• Secondary

  • Screening

  • Blood level screening

• Tertiary 

  • treatment

Lead poisoning treatment

• eliminate source of exposure