Hematopoietic disorders and drugs

What is Hematopoiesis?

• Hema (Haima) = blood & poiesis = to produce something

• the process of blood cell formation

What is erythropoiesis?

• formation of red blood cells (RBC) which carry oxygen

What is leukopoiesis?

• formation of white blood cells (WBC) which are responsible for infection defense

What is thrombopoiesis?

• formation of platelets which are involved in clotting

Where are RBC, WBC, and Platelets made?

Bone Marrow!

What are RBCs (erythrocytes)?

• carry oxygen to organs and lungs

• 1 erythocyte contain 300 hgb

• need vitamin and B12 and folate for production

What is the most abundant type of blood cells?

Red Blood Cells

What is RBC formation regulated by?

• the hormone erythropoietin

  • produced in kidney and liver

What are WBCs (leukocytes)?

• fight infection

• destroy abnormal cells

• types: neutrophils, monocytes, eosinophils, lymphocytes, basophils

What are neutrophils?

• kill bacteria

What are monocytes?

• clean up damaged cells

What are eosinophils?

• kill parasites, allergic response

What are lymphocytes?

• help fight viruses, make antibodies

What are basophils?

• allergic response

What are platelets (thrombocytes)?

• forms clots

• circulate for 8-10 days

What happens if RBC’s fail?

• oxygen delivery fails

• HR increases = tachycardia

• RR increases = tachypnea

• fatigue

What if WBC’s fail?

• infection kills your patient

• Low WBC + fever = emergency

What if platelets fail?

• bleeding risk

• < 50k = bleeding risk\

• < 10k =-263.15 °C spontaneous bleeding

What does your patient look like when RBC’s are low?

• fatigue, SOB, tachycardia

What are you worries about when WBC’s are low?

• fever, infection

What signs will you see when platelets are low?

• bleeding, bruising

What tells bone marrow to work harder and stimulate blood production?

• Hypoxia → increase erythropoietin

• Infection → increase WBC production

Why is smoking bad?

• Heme: can carry 1 molecule of oxygen

• 4 heme groups/Hgb protein

• Tobacoo smoke = carbon monoxide, formaldehyde, nicotine

• CO can bind to hemoglobin at the Heme sites- carboxyhemoglobin

• Reduce oxygen-carrying capacity of hemoglobin

• Reduces vit C (iron absorption), damages stomach lining (bleeding), vit B12 and folate deficiencies (RBC production)

How long do RBC’s last and why does it matter?

• 120 days

• Why it matters: anemia slow onset

What happens with RBC and blood loss?

• RBC’s can increase 5x due to blood loss

How long do WBC’s last and why does it matter?

• Hours-days

• Why it matters: infection rapid

What happens with WBC’s and infection?

• WBC’s can increase 10x due to infection

How long do platelets last and why does it matter?

• 5-9 days

• Why it matters: bleeding risk quick

What is anemia?

• Lack of oxygen-carrying capacity

• A sign of an underlying cause

• Most common: blood loss, iron deficiency

• Classified on size & color:

  • Microcytic- iron deficiency

  • Macrocytic- pernicious

What is iron deficiency anemia?

• Most common

• GI bleed (50%)

• 24 yr old female, heavy menses

• Symptoms: unexplained fatigue, lightheadedness, depression, rapid heart rate, pale skin

What is the role of iron?

• key component of hemoglobin

Where is iron stored?

• stored in organs (used as needed)

• free iron is toxic to body

What is pernicious anemia?

• Vitamin B12 and intrinsci factor deficiency

• Vitamin B12: needed for cells to grow, divide, and mature properly

  • w/o they become large and dysfunctional (macrolytic)

  • they also maintain myelin sheath (neurological)

• Intrinsic factor: needed in order for the intestine to absorb B12

• Vegans at high risk: BF infants at risk

• fatigue, numbness, tingling

S/S for Iron and B12 deficiency

• Iron: fatigue, low iron, small RBC, blood loss

• B12: neuro symptoms, no intrinsic factor, large RBC, absorption issue

What are the drug categories?

• Replacement:

  • Iron: 24-year old w/ heavy menstrual bleeding- fatigue, dizziness, pale

  • B12: 60-year-old with pernicious Anemia- fatigue, numbness/tingling

• Stimulators:

  • Epoetin: 68-year-old with chronic kidney disease- Hgb 8.2, fatigue, SOB w/ activity

  • Filgrastim: 52-year-old receiving chemo for breast cancer- WBC 1.0, temp. 101.3F

What are some neutropenic precautions?

• Protect the patient from infection

• Who: patients w/ low WBC

• Hand hygiene

• Limit exposure to germs

• No fresh plants or flowers

• No raw fruits/veggies/meats

• Mask up

• Avoid invasive procedures