NURS 3366: ALTERATIONS IN HEMATOLOGIC SYSTEM

Leukemia

uncontrolled proliferation of leukocytes, causing over-crowding of bmw & decreased production of normal hematopoietic cells

Leukemia S&S

1. leukocytosis
2. thrombocytopenia → easy bleeding & bruising
3. anemia
4. ease of infection

Multiple Myeloma

a type of cancer that is idiopathic etiologically, but can have a genetic component (plasma cells)

Pathogenesis of multiple myeloma

plasma cells → malignant → over-production of Ig → increase osteoclastic activity → hypercalcemia & weak bones

Multiple Myeloma S&S

* osteoporosis → pathological fractures
* hypercalcemia

Multiple Myeloma tx

chemotherapy, radiation, bmw transplantation

Anemia

TOO FEW; dz due to pathologically *decreased* number of RBCs

anemia etiology

1. decrease in erythropoiesis: due to bmw dysfunction, leukemias, or hypersplenism
2. loss of RBCs via hemorrhage &/or pathologic hemolysis

severe anemia S&S

hypoxemia → tissue hypoxia →


1. weakness & fatigue, muscle, cramps
2. SOB
3. CNS effects: __syncope__, lethargy, dizziness, slowed mentation
4. __pallor__

RBC count

4 to 6 million

microcytic anemia range

MCV < 80

microcytic anemia definition

sometimes called “iron deficiency anemia”

microcytic anemia EX

1. women w/ heavy menses
2. occult GI bleeding

microcytic anemia S&S

common anemia S&S

* low MCV & low Hgb

microcytic anemia tx

stop blood loss if possible & give Fe supplements

normocytic anemia range

MCV 80-95

normocytic anemia patho

1. rapid blood loss (no time for compensation) → traumatic hemorrhage
2. chronic dz: slow-down RBC production; ex: lupus, AIDS, chronic renal failure

normocytic anemia S&S

normal MCV & anemia S&S

normocytic anemia tx

1. __acute blood loss__ → stop blood loss and give units of blood
2. __chronic dz__ → give erythropoietin (GH) to stimulate bmw to make more RBCs

macrocytic anemia range

MCV >95

macrocytic anemia patho

certain dz process cause faulty DNA coding of RBC size → RBCs are larger than normal (but don’t function right!)

macrocytic anemia common EX

pernicious anemia due to lack of intrinsic factor

pernicious anemia

seen inelderly, pts with GI absorption disorders, and inadequate nutrition (eg, alcoholics)

intrinsic factor

if diminished, vitamin B12 cannot be adequately absorbed from digested food

* without vitamin B12, DNA malfunctions & makes coding error in RBC creation→ too few RBCs

made AND they are larger than normal (but don’t function right!).

macrocytic anemia S&S

anemia S&S, **glossitis** (beefy red, smooth painful tongue), neuropathies (**paresthesia**)

macrocytic anemia tx

B12 injection

Hgb normal

14-18 gm/L

Hct normal

42-52%

polycythemia

increased # of RBCs

primary polycythemia

polycythemia vera - slow development of hyperproliferation of bmw stem cells

polycythemia vera tx

removal of 300 to 500 ml of blood 3 to 4 times per month

secondary polycythemia

__*compensatory*__  increase in RBCs *in response to hypoxic conditions*

* higher altitudes, smoking, chronic low-O2 conditions (Chronic obstructive pulmonary disease - COPD)

secondary polycythemia MOC

low O2 → body increases erythropoietin secretion → more RBCs

polycythemia CBC

RBCs **> 6 million** & ==Hct== **> 52%**

polycythemia S&S

linked with patho:


1. ischemic pain → “sludge-like”, thick blood
2. formation of blood clots → stasis
3. heart & lung failure → coagulated blood causes extra workload

__**frank**__ bleeding

obvious or easily visible

*petechiae*

pinpoint red spots that don’t blanche

*purpura*

larger areas that look purplish

*ecchymosis*

general term for collection of blood under skin greater than\~1cm

GI bleeding

stools can be bloody or black and __**tarry**__

mucous membranes bleeding

Nose bleed

two subcategories of clotting deficiency

platelets and clotting factors

__thrombocytopenia__

platelets (thrombocytes) deficient in number

__thrombocytopenia__ etiology

1. congenital problems (rare)
2. nutritional
3. certain drugs & chronic dzs
4. autoimmune:


1. IgG attacks platelets, diminishing their effectiveness


1. __**idiopathic thrombocytopenia purpura –ITP**__

__thrombocytopenia__ S&S

platelet count on CBC is less than __100,000__ & bleeding

__hemophilia__

several possible different hereditary deficiencies of coagulation factors, usually X-linked recessive problem

__hemophilia S&S__

spontaneous bleeding or bleeding that is out of proportion to amount of trauma

__hemophilia tx__

(1) __transfuse plasma__—plasma has clotting factors

(2) __transfuse concentrates__ of whichever clotting factor is deficient.

__von Willebrand Factor__ (vWD)

found in blood and tissue; inherited disorder & it is the most common clotting disease

vWF

released by injured tissue; “calls”& binds to platelets and fibrinogen to promote clotting—a “platelet plug”

vWD S&S

1. very mild clotting deficiency with mild incidences of “easy bleeding.”
* ex—some women manifest very heavy periods due to a type of vWD.

vWD tx

usually none needed, or symptomatic; certain more severe forms    receive transfusions of vWF.

__liver disease__ (cirrhosis)

liver disease→ DECREASED coagulation factors→ decreased ability to clot →easy bleeding.

Disorders of  “overactive clotting”

__thrombocytosis, thromboembolic ds (thrombus & embolus)__

__thrombocytosis__

platelet count > __400,000;__ causes __hypercoagulation__ →manifest as __*thrombotic*__ disorder--proliferation of blood clot formation

__thromboembolic ds__

any combination of thrombocytosis and clotting factor overactivity.

__thrombus__

an arterial or venous clot attached to vessel wall

__embolus__

an arterial or venous thrombus that has broken loose and travels in the circulatory system

__Splenomegaly__

enlargement of spleen

__Splenomegaly hematologic__

any time there is __increased hemolysis__ of RBC’s, the spleen can enlarge because it has more RBC “debris” to process

* __ABO__ blood type incompatibility
* Rh blood type incompatibility (erythroblastosis fetalis)
* hemolytic problems
* drug reactions and autoimmune diseases, infections in which RBCs are attacked

splenomegaly S&S

1. palpably large spleen (normally you can’t palpate it)
2. may have pain
3. may have __hypersplenism.__

__Hypersplenism__

*caused by splenomegaly → enlarged spleen* RBCs, WBCs, and thrombocytes being sequestered

__Hypersplenism sequela__

spleen becomes even more engorged & enlarged

__pancytopenia__

low numbers of all cells in blood (__Hypersplenism sequela)__

hypersplenism S&S

anemia, increased risk of infection, “easy bleeding.”