Chapter 15: The Hematologic System

Relate at least five different kinds of information that can be obtained from a complete blood count (CBC).
Illustrate ways to accomplish hemostasis.
Apply the nursing process to patients with hematologic system disorders.

Explain the procedure and care for a patient receiving bone marrow aspiration.
Perform a focused assessment in a patient with a problem of the hematologic system.
Identify appropriate nursing interventions for patients with problems of the hematologic system.

Transportation:
- Water
- Oxygen
- Nutrients
- Hormones
- Enzymes
- Medications to the cells
Transportation of waste products:
- Carbon dioxide and other waste products away from the cells
Regulation of body functions:
- Fluid volume and electrolyte distribution
- pH and acid-base balance with its buffering ability
- Body temperature
Clotting Factors: Provides clotting factors for hemostasis.

Blood Composition:
- Blood is composed of formed elements and plasma.
Formed Elements:
- Erythrocytes (Red blood cells)
- Leukocytes (White blood cells): Includes neutrophils, lymphocytes, monocytes, eosinophils, and basophils.
- Thrombocytes (Platelets)
Plasma Contents:
- Proteins, water, salts, dissolved gases (e.g., CO2), bicarbonate (HCO3−), hormones, glucose, and metabolic wastes.
- Plasma Proteins: First type includes albumin, globulins, and fibrinogen.

Source: From Patton KT, Thibodeau GA: The human body in health and disease, ed. 7, St. Louis, 2018, Elsevier.

Development of Blood Cells: Initiated from hemocytoblast, which differentiates into various blast cells such as:
- Proerythroblast
- Myeloblast
- Lymphoblast
- Monoblast
- Megakaryoblast
Final Cellular Forms:
- Erythrocytes
- Granulocytes (Basophil, Eosinophil, Neutrophil)
- Agranulocytes (Lymphocyte, Monocyte)
- Thrombocytes (Platelets)

Albumin: Raises osmotic pressure at the capillary membrane, helping to prevent fluid from leaking into tissue spaces.
Globulins:
- Alpha and Beta Globulins: Act as carriers for drugs and lipids, transporting them throughout the body.
- Gamma Globulins: Function as antibodies.
Fibrinogen: Key to blood clot formation.

Origin: Blood cells develop from stem cells in the bone marrow, a process known as erythropoiesis.
Regulation: Erythropoietin produced primarily in the kidneys stimulates erythrocyte production.
Nutritional Requirements: Erythropoiesis requires:
- Iron
- Vitamins B12, C, E
- Folic acid
- Amino acids, primarily obtained from dietary proteins.

Hemoglobin: Carries oxygen to body cells and partakes in transporting carbon dioxide back.
Blood Type: Determined by antigens present on the surface of RBCs; types include A, B, AB, or O.
RBC Lifespan: Approximately 120 days, after which they're removed by the spleen and liver.

Defense: First line of defense against microbial agents.
Laboratory Range: Normal adult range is 4500 to 11,000/mm³, with a lifespan of about 13 to 20 days.
Maturation and Function:
- Leukocytes migrate from bone marrow to tissues and are transported via bloodstream.
- Classified into two categories: granulocytes and agranulocytes.

Thrombocytes: Fragments of megakaryocytes produced in the bone marrow.
Primary Role: Initial protection against bleeding, promoting clotting at damaged blood vessels.
Hemostasis Maintenance: Balancing factors involved in clotting and dissolution.
Clot Formation: Fibrin strands from fibrinogen attach to aggregated platelets to stabilize the clot.

Lymphatic Role: Collects fluid and proteins from interstitial spaces, returning them to circulation.
Lymph Nodes: Filter leukocytes and debris from infections/inflammations before returning lymph to the bloodstream.

Plasma Volume: Decreases after age 60, leading to diminished blood volume.
Bone Marrow Function: Reduced efficiency limits blood cell production, affecting immune response.
Cell Production: Slower, causing longer correction times for anemia.
Vaccine Responses: Decreased antibody response.
Risk Factors: Increased susceptibility to hypovolemia and shock from blood loss; heightened coagulation tendency.

Clinical Findings Associated with Aging: (Select all that apply.)
- Decreased hematocrit
- Decreased red blood cells
- Prolonged protime
- Increased neutrophils
- Increased platelets

Categories:
- Anemia
- Blood loss and hemorrhage
- Hemolysis
- Hemophilia
- Sickle cell disease
- Thalassemia

Sickle Cell Disease: Highest incidence in African Americans.
Pernicious Anemia: More prevalent among Scandinavians and African Americans.
Thalassemia: Higher predisposition in people of Middle Eastern descent.
Leukemia: Increased incidence among Caucasians.

Anemia Risk: Significant blood loss leads to anemia.
Menstrual Blood Loss: Targeted assessment due to potential excessive blood loss.
Postoperative Care: Vigilance in assessing bleeding post-surgery or childbirth.

Public Awareness: Caution against ionizing radiation and harmful chemicals.
Genetic Counseling: Suggested for adults with genetic blood disorders.
Medication Awareness: Patients should be aware of medications that can cause blood disorders and signs of bruising or bleeding.
Routine Assessments: Periodic checks of CBC recommended.

Symptoms and Complications:
- Excessive bleeding
- Excessive clotting
- Fatigue
- Anorexia
- Pain
- Infection
- Bone marrow failure