NCM112 - Intro to Hematology

Hematology

Hematology

the scientific study of the structure and functions of blood in health and in disease.

blood

circulatory fluid of the CV system which is circulating constantly through a closed circuit of tubesu

supply oxygen from the lungs and absorbed nutrients from the GIT to the cells
remove waste products from tissues to the kidneys, skin and lungs for excretion
transport hormones from their origin in the endocrine glands to other parts of the body
protect the body form dangerous microorganism
promote Hemostasis ( to stop bleeding)
regulate body temperature by heat transfer -
vasoconstriction and vasodilation

Functions of Hematology

1. Early Detection and monitoring disease progression
2. Personalized care and managing complications
3. Treatment administration
4. Patient education and advocacy
5. Hematologic emergencies
6. Comprehensive care
7. Interdisciplinary Collaboration
8. Professional development

Importance to nursing practice

Plasma (liquid portion) and solid component

2 main components of blood

Plasma

Liquid portion of blood

55% of total blood volume

Plasma makes up

Water - 90%

Plasma is primarily composed of [___] by how many percent?

45% of blood

Solid component makes up

RBC (erythrocytes), WBC (leukocytes), and platelets (thrombocytes)

Components of solid part of blood

Plasma

serves as a transport medium for various substances necessary for bodily functions.

Water, proteins, electrolytes, nutrients, waste products

Composition of plasma

90% - water

Approximately [—]% of plasma is

Acts as solvent, transporting nutrients, hormones, and waste products, helps regulate body temperature

Function of water in plasma

Albumin, globulin, fibrinogen

The three kinds of proteins

Albumin

Maintains osmotic pressure which helps keep fluid in the bloodstream and prevents edema, transports hormones

Globulins

Include antibodies (immunoglobulins) that are crucial for immune response, transports lipids, iron, and fat soluble vitamins

Fibrinogen

Essential for blood clotting

Fibrinogen is converted into FIBRIN to form A STABLE BLOOD CLOT

What happens to fibrinogen during clotting process and what is formed?

Sodium (Na+), Potassium (K+), Calcium (Ca2), Magnesium (Mg2+) Chloride (Cl-), Bicarbonate (HCO3-)

What are the six main electrolytes

Electrolytes

Maintains osmotic balance and pH; essential to nerve and muscle function

Nutrients

Provides energy and building blocks for cell growth and repair

Glucose, amino acids, lipids, vitamins

Kinda of nutrients

Waste products

Transported to the kidneys, liver, and lungs for excretion

Urea, creatinine, bilirubin, carbon dioxide

Kinds of waste products

Transport, Regulation, Protection

Three categories of PLASMA FUNCTION

Nutrients, hormones, waste products, and gases

What does plasma transport?

Nutrients

Delivers glucose, amino acids, fatty acids, and vitamins to cells

hormones

Carries [---] from endocrine glands to target organs

waste products

Removes metabolic [----] for excretion

1 - oxygen
2 - carbon dioxide

Transports (1) (bound to hemoglobin) and (2)

Temperature, pH balance, osmotic pressure

What does plasma regulate

Temperature

Distributes heat throughout the body

pH Balance

Maintains acid-base balance with buffering systems

Osmotic pressure

Regulates fluid balance between blood and tissues, preventing edema.

Immune response & Clotting

What are under protection in plasma?

Immune response

Contains antibodies and other immune proteins that protect against pathogens

Clotting

Contains clotting factors like fibrinogen essential for stopping bleeding.

Red Blood Cells (RBCs) orErythrocytes

White Blood Cells (WBCs) orLeukocytes

Platelets or Thrombocytes

Parts of the solid component

erythrocytes

Mature RBCs are also called

reticulocyte

Immature RBC is called

1 - four subunits,
2- heme portion
3 - globin chain

RBC is made up of (1) each containing a (2) attached to a (3)

transport of oxygen between the lungs and tissues

Purpose of RBC

Female: 4.2 - 5.4 million cells/mcL

Male: 4.7 - 6.1million cells/mcL

Normal values of RBC for female and male

Female : 12-16 g/dL

Male: 14-18 g/dL

Normal values of HgB for female and male

Female - 37-47%

Male - 42 - 52%

Normal values of Hct for female and male

1 - red bone marrow

2 - 120 days

3 - phagocytized, 4 - liver and spleen

5 - heme components

6 - amino acids

Life cycle of erythrocyte

1. erythrocytes form in (1)
2. erythrocytes circulate in the bloodstream for (2)
3. aged erythrocytes are (3) in the (4)
4. (5) of blood are recycled
5. erythrocyte membrane proteins and globin proteins are broken down into (6)

macrophage foreign invaders via phagocytosis

remove old or damaged cells

Stimulate the inflammatory process and present antigens to the immune system

Reticuloendothelial system function

Leukocytes

WBCs are also called

protect the body from invasion by bacteria and other foreign entities

Purpose of WBC

Granulocytes and Agranulocytes

Two general categories of WBC

Granulocytes

the presence of granules in the cytoplasm of the cell

(eosinophils , basophils,and neutrophils

Kinds of granulocytes

Agranulocytes

a single-lobed nucleus and agranule-free cytoplasm

Monocytes & lymphocytes

Kinds of agranulocytes

5000 - 10,000/mm3

Normal value of WBC

20 - 40%

Normal value of Lymphocytes

1 - 4%

Normal value of eosinophil

55-70%

Normal value of neutrophil

2-8%

Normal value of monocytes

0.5-1%

Normal value of basophils

Platelets

also called thrombocytes

control of bleeding and nurturing and maintaining the integrity of the blood vessel's endothelium when in an inactive state

Purpose of thrombocytes

7 to 10 days

Lifespan of platelets

150,000 - 400,000/mm3

Normal platelet count

Hemostasis

is the physiological process that stops bleeding at the site of an injury while maintaining blood in a fluid state within the vascular system.

1 - blood loss

2 - clot, 3 - seal

4 - excessive clotting

5 - wound healing

6 - clot

7 - healing

Role of platelet in hemostasis

Preventing (1)
Forming a (2) to (3) the wound
Preventing (4)
Facilitating wound healing
Dissolving the (6) after (7)

Plasma - obtained by separating blood treated with an anticoagulant (e.g., EDTA, heparin) to prevent clotting.

Serum - Obtained by allowing blood to clot naturally and then centrifuging to remove the clot, leaving the liquid portion.

Difference between plasma and serum ( COLLECTION )

Plasma - contains water, proteins (including clotting factors), electrolytes, nutrients, waste products, and other molecules.

Serum - similar to plasma but lacks clotting factors (especially fibrinogen)

Difference between plasma and serum (COMPOSITION )

Plasma - present including fibrinogen (necessary for blood clotting)

Serum - absent, consumed in clotting process

Difference between plasma and serum (CLOTTING FACTORS)

1. Vascular spasm (Vasoconstriction)
2. Platelet plug formation
3. Coagulation (Blood clotting)
4. Clot retraction and repair
5. Clot removal (Fibrolysis)

Phases of hemostasis

Vascular spasm (Vasoconstriction)

immediate constriction to reduce blood flow.

Platelet plug formation

Platelets adhere to exposed collagen and release chemicals that attract more platelets, forming a temporary "plug.

Coagulation (Blood clotting)

formation of fibrin, forming a stable clot

Clot retraction and repair

The clot contracts to reduce its size and bring the edges of the wound closer together, aiding in tissue repair.

Clot Removal (Fibrolysis)

Once the vessel is healed, the clot is dissolved to restore normal blood flow

Hematopoiesis

process of blood cell production, development, and maturation.

1. bone marrow
2. liver
3. spleen

Hematopoiesis occurs primarily in the (1) after birth but also in (2) and (3) during fetal development

Hematopoietic Stem Cells (HSCs

are multipotent stem cells that have the capacity to self-renew and differentiate into all types of blood cells

1 - bone marrow
2- peripheral blood
3 - umbilical cord blood

Found primarily in the (1) but also circulate in (2) and reside in (3)

Erythropoietin

is a hormone produced primarily by the kidney when it detects low levels of oxygen which then stimulates the marrow to leading to erythropoises

Red marrow & yellow marrow

Structure of bone marrow

Red marrow

1 - trabecular (spongy) bone regions

2 - pelvis, ribs, sternum, vertebrae, and proximal ends of long bones.

Active in hematopoiesis, found in the (1) such as the (2)

Yellow marrow

1 - severe blood loss.

Primarily made up of adipocytes (fat cells) and serves as a reserve that can be converted back to red marrow under certain conditions, such as (1)

1. Hematopoiesis
2. Provides a supportive microenvironment (niche) composed of stromal cells, extracellular matrix, and signaling molecules that regulate the growth and differentiation of HSCs.
3. Stores various factors and nutrients necessary for hematopoiesis.

Function of bone marrow

Biographical Data
Family History
Nutritional History
Current Medications
Onset of symptoms
Functional ability
Manifestations of distress
Coping mechanisms

Assessment of clients with hematologic disorders - HEALTH HISTORY

skin, oral cavity, lymph nodes, and spleen

Palpation as well

Assessment of clients with hematologic disorders - PHYSICAL ASSESSMENT

CBC
Peripheral blood smear
Bone marrow aspiration and biopsy

Diagnostic evaluation tests

Complete blood count (CBC)

- identifies the total number of blood cells, hemoglobin, hematocrit, and RBC indices

Peripheral blood smear

manual examination of the peripheral smear, which may be part of CBC

drop of blood is spread on a glass slide, stained, and examined under a microscope.

Process of peripheral blood smear

can determine the shape and size of the RBCs and platelets, appearance of the leukocytes

what can peripheral blood smear identify

CBC - total number

Peripheral blood smear - shape, size, and appearance

Bone marrow aspiration - how blood cells are formed

differentiate CBC, peripheral blood smear, and bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy

assess how a patient's blood cells are being formed, quantity and quality of each type of cell produced within the marrow.

Bone marrow aspiration and biopsy

Used to document infection or TUMOR within the marrow

1. splenectomy
2. therapeutic apheresis
3. hematopoietic stem cell transplantation
4. therapeutic phlebotomy
5. blood component therapy

Therapeutic approaches to hematologic disorders

Splenectomy

surgical removal of the spleen (splenectomy) is a possible treatment for some hematologic disorders

Therapeutic apheresis

blood is taken and passed through a centrifuge, where a specific component is separated from the blood and removed and the remaining blood is then returned to the patient.

Hematopoietic Stem Cell Transplantation

Hematopoietic stem cells are obtained from a donor whose cells match those of the patient. In contrast, the patient's own stem cells are harvested and then used in autologous transplant.

Therapeutic phlebotomy

is the removal of a certain amount of blood under controlled conditions