NUR 203 Module 5-Hematopoietic System Alterations

Module 5: Hematopoietic System Alterations

Learning Outcomes

  • Synthesize Assessment and Lab Data: Understand hematopoietic disorders through relevant data.

  • Examine Etiologies: Investigate causes of pathophysiologic changes in the hematopoietic system.

  • Age-related Changes: Differentiate expected changes from abnormal ones based on age.

  • Normal vs. Abnormal Conditions: Distinguish between normal and common abnormal findings in assessments.

Normal Hematopoietic System Function

  • Components of Blood:

    • Plasma: Viscous fluid containing proteins, antibodies, nutrients, electrolytes, hormones, lipids, and waste.

    • Leukocytes (WBC): Involved in inflammatory response, includes neutrophils, eosinophils, basophils, lymphocytes, and monocytes.

    • Erythrocytes (RBC): Carry oxygen and CO2; contain hemoglobin.

    • Thrombocytes (Platelets): Control coagulation through clotting factors like thromboplastin and plasmin.

Hematopoiesis

  • Rate: Dependent on the body's needs; new cells produced to replace old ones.

  • Lifespan of Cells:

    • RBCs: ~120 days

    • WBCs: Hours to years

    • Platelets: 9 to 12 days

Hemostasis

  • Definition: Process to stop bleeding from injury.

    • Vasospasm: Brief constriction to prevent bleeding.

    • Platelet Plug Formation: Activation, aggregation, and adherence of platelets.

    • Coagulation: Clotting cascade activation and formation at injury site.

    • Clot Breakdown: Stabilization of injury leads to dissolution of fibrin clot by fibrinolytics (e.g., t-PA).

Diseases of White Blood Cells

  • Normal WBC Levels: 5,000-10,000 cells/mL.

    • Leukocytosis: Increased WBC levels.

    • Leukopenia: Decreased WBC levels.

    • Neutropenia: A significant decrease in neutrophils.

    • Lymphomas: Cancers that derive from lymphatic cells.

Neutropenia

  • Definition: Neutrophil count < 1500 cells/mL (normal range: 2,000-7,500 cells/mL).

    • Etiologies:

      • Decreased production due to factors like vitamin deficiencies, bone marrow suppression, cancers.

      • Increased utilization or destruction from infections or inflammation.

Clinical Manifestations of Neutropenia

  • Symptoms: Fever, malaise, chills; common sites include the respiratory tract, mouth, and GI tract.

Diagnosis and Treatment of Neutropenia

  • Diagnosis: History & physical exam, CBC with differential, bone marrow biopsy.

  • Treatment: Address underlying cause, antibiotics, and granulocyte colony-stimulating factor (e.g., filgrastim (Neupogen)).

Lymphomas

  • Definition: Cancers developing from lymphatic cells.

  • Types:

    • Hodgkin Lymphoma

    • Non-Hodgkin Lymphoma

Risk Factors for Lymphomas

  • HIV/EBV Infections

  • Non-Hodgkin: Autoimmune conditions, infections (e.g., Helicobacter pylori, HTLV-1), pesticide exposure.

Hodgkin Lymphoma

  • Characteristics: Arises in lymph nodes of the upper body; spreads through lymphatic channels.

  • Reed-Sternberg Cells: An abnormal type of B lymphocyte found in Hodgkin Lymphoma.

  • Demographics: Primarily occurs in ages 20-30 and at 70 years, slight male prevalence.

  • Prognosis: Excellent—84% 5-year survival rate; 75% cure rate.

Clinical Manifestations of Hodgkin Lymphoma

  • Swollen, painless lymph nodes (neck, mediastinal, supraclavicular).

  • Associated Symptoms: Chest pain, cough, SOB, weight loss, fever, night sweats, generalized pruritis, malaise, recurrent infections, splenomegaly.

Diagnosis and Treatment of Hodgkin Lymphoma

  • Diagnosis: History & physical, CBC, biopsy of lymph node, bone marrow biopsy, imaging (CXR, CT, MRI, PET).

  • Treatment: Chemotherapy, radiation, surgery; staging system utilized.

Non-Hodgkin Lymphoma

  • Characteristics: 90% of all lymphomas arise from B or T cells, can be aggressive or indolent.

  • Treatment Difficulty: More complex due to diffuse involvement and lack of Reed-Sternberg cells.

Clinical Manifestations of Non-Hodgkin Lymphoma

  • Symptoms: Swollen lymph nodes (anywhere in the body), weight loss, fever, night sweats, generalized pruritis, malaise, splenomegaly.

Diagnosis and Treatment of Non-Hodgkin Lymphoma

  • Diagnosis: Similar to Hodgkin Lymphoma—history, physical, laboratory testing, imaging.

  • Treatment: Staging, chemotherapy, radiation, surgery; 69% 5-year survival rate.

Diseases of Red Blood Cells

  • Erythrocytes: Most prevalent blood cells (4.2-5.9 million cells/mcL); responsible for oxygen transport and waste removal.

Anemia

  • Definition: Common condition impairs oxygen-carrying capacity.

    • Etiologies: Decrease in RBC counts, decreased hemoglobin content, abnormal hemoglobin.

  • Clinical Manifestations: Weakness/fatigue, pallor, dyspnea, tachycardia, syncope.

Iron-Deficiency Anemia

  • Characteristics: Most widespread anemia; lack of iron for hemoglobin production.

    • Symptoms: Classic signs of anemia plus specific symptoms (e.g., brittle nails, pica).

    • Sources of Iron: Animal and plant sources.

    • Diagnosis: CBC, serum ferritin, serum iron, transferrin saturation.

    • Treatment: Increase dietary iron, supplements, vitamin C.

Sickle Cell Anemia

  • Definition: Genetic hemolytic anemia due to abnormal hemoglobin S altering erythrocyte shape.

  • Clinical Manifestations: Fever, swelling in extremities during infancy; reflects hypoxia and ischemic tissue damage.

  • Triggers: Dehydration, stress, altitude, fever, temperature extremes.

Symptoms of Sickle Cell Disease

  • General Symptoms: Pain (abdominal/bone), frequent infections, delayed growth, jaundice, fatigue.

Diagnosis and Treatment of Sickle Cell Anemia

  • Diagnosis: CBC, sickle cell test, hemoglobin electrophoresis, bilirubin levels.

  • Treatment: Avoid triggers, pain management, proper hydration, possible blood transfusions, hydroxyurea, bone marrow transplant, vaccinations.

Diseases of the Platelets

  • Importance: Vital for coagulation; normal platelet count: 150,000-350,000 cells/mL.

    • Thrombocytosis: Elevated levels increase thrombus risk.

    • Thrombocytopenia: Decreased levels increase bleeding risk.

Disseminated Intravascular Coagulation (DIC)

  • Definition: Life-threatening condition of inappropriate clotting and bleeding.

  • Etiologies: Endothelial injury, tissue destruction, severe infection, certain medical procedures, and complications.

Diagnosis and Treatment of DIC

  • Diagnosis: CBC, fibrinogen levels, PT, PTT, D-dimer.

  • Treatment: Address underlying cause, supportive care, control bleeding/clotting.

Immune Thrombocytopenic Purpura (ITP)

  • Definition: Autoimmune destruction of platelets, acute (children) or chronic (adults).

  • Clinical Manifestations: Abnormal bleeding (e.g., petechiae, purpura).

Diagnosis and Treatment of ITP

  • Diagnosis: Laboratory tests; including CBC and CT.

  • Treatment: Glucocorticoids, immunoglobulin infusions, potential splenectomy.