Blood And Lymph Disorders

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Erythrocytes

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4-6 million

Life span- 120 days

Composed of hemoglobin which carries oxygen

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Leukocytes

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4-11,000

life span- 9 days

Fights Pathogens

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Leukopenia

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Inability to fight infection

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Thrombocytes (Platelets)

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150-400,000

Life span- 4 days

Necessary for blood clotting

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poly-

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too many

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cytosis

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too many

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penia

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too few

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pancytopenia

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decrease in all type of blood cells

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hemostasis

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5 stages

the process of blood clotting

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vessel spasm

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narrows the vessel and decreases the blood flow

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formation of the platelet plug

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platelets attach to the injured tissue

catch more platelets

stabilized by fibrin

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clot formation

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occurs as fibrin forms a meshwork

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clot retraction

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occurs after about a half hour

clot contracts and pulls opened vessel closer together

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clot dissolution

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"fibrinolysis"

removes the clot after the tissue is repaired

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How are blood types determined

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by the presence of absence of antigens

genetically determined

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Antigens

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any substance that causes your immune system to produce antibodies against it

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what is the universal recipient

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type AB-

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what is the universal donor

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type O

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When is Rh factor more of a issue

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during pregnancy

-if the mother is Rh negative, partner is positive, the child can be Rh positive; the mother will attack the baby's blood, and cause anemia, brain damage, and even death

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lymphatic system

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assists the immune system by removing foreign matter, infectious organisms and tumor cells from the lymph

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where are lymph nodes

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tonsils, spleen, and the thymus

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What are some diagnostic tests to diagnose blood or lymph disorders

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CBC, CBC with differential, bone marrow aspiration or biopsy, bleeding/coagulation studies, iron levels, sickle cell test

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what is included in a CBC

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RBC, WBC, Hgb, Hct, and platelets

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what is CBC with differential

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used to identify to which degree each of the five types of WBC are present in the blood

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What are CBC used for

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diagnoses infection vs inflammation and allergy

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Where do you remove the bone marrow from

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iliac crest or sternum

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what are you looking for in a bone marrow aspiration/biopsy

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looks at different types of cells

diagnoses hemolytic blood disorders, tumors, leukemia, and infectious disease

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what are bleeding/coagulation tests used for

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evaluates clotting and bleeding disorders (pre-op)

monitors anticoagulation therapy

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what test do you perform to monitor coumadin therapy

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PT/INR

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what test do you perform to monitor heparin therapy

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PTT

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what is the anedote for coumadin

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Vit K

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what is the anedote for heparin

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Protamine Sulfate

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Why do you monitor iron

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diagnoses iron deficiency (anemia)

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serum ferritin

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total iron stored

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serum iron

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iron in the blood

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what is the sickle cell test

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Evaluates hemolytic anemia; if the RBC sickles, it is positive for sickle cell anemia; positive for abnormal Hgb; RBC is deprived of oxygen

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anemia

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An abnormally low amount of circulating RBC. Term used when Hgb, Hct, and RBC are below normal range; can be a symptom of another disease or specific diagnosis

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What are the causes of anemia

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blood loss, impaired production (bone marrow supression), nutritional (poor intake of iron or nutrients), and hemolysis

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how is the integumentary system affected by anemia

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pallor skin & mucous, spoon shaped nails, petechiae and purpura

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how is the cardiovascular system affected by anemia

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increased heart rate (tachycardia), palpitations and angina

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how is the respiratory system affected by anemia

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fatigue, dyspnea or tachypnea

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how is the musculoskeletal system affected by anemia

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fatigue, weakness, night cramps, joint pain; bone pain is caused by the kidneys recognizing the anemia

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How is the neurological system affected by anemia

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dizziness, headaches, pica (condition where the client eats non food items; usually nutritional anemias)

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what is the Schilling test

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used to determine whether the body absorbs B12 normally

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what is sickle cell disease also called

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hemolysis

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what is a symptom of a transfusion reaction

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flank pain

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what anemia is from blood loss

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hypovolemic

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how do you treat hypovolemia

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control the bleeding; pressure dressings, apply cold, reinforce & change dressings, replace lost blood volume

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autotransfusion

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collection, filtration, and readministration of the client's own blood

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what do you always infuse blood with

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normal saline

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what is the first thing you do when a patient has a transfusion reaction

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stop the infusion and change the IV tubing

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what is necessary for the manufacture of RBC

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Vit B12

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intrinsic factor

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substance secreted by the stomach; it is necessary for the absorption of B12

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caused by a lack of B12

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pernacious anemia

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how do you diagnose pernacious anemia

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Schillings test

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what are good sources of B12

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meat, eggs, poultry, fish, shellfish, milk and cheese

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aplastic anemia

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bone marrow fails to produce RBC

no known cause

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patients with aplastic anemia usually have what?

( decreases in cell counts)

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pancytopenia

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what diagnostic test is used for aplastic anemia

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bone marrow biopsy

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allogenic

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BMT from twins or family memebers

most common

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autologous

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BMT from the client (used with chemo pts)

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Graft versus host disease (GVHD)

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donated bone marrow recognizes the recipient's body tissue as foreign

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how do you treat GVHD

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antibiotics, immunsuppressants, and stem cell transplants may be done

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what is the function of the spleen

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cleans the blood of foreign matter

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what is the most common type of anemia

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iron deficient anemia

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what is necessary for the formation of RBCs

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iron

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cracks at the corner of the mouth due to iron deficient anemia

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cheilosis

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how does a person inherit Sickle cell disease

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a person must inherit the abnormal gene from BOTH parents to have to disease

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what is the ratio of people to have sickle cell disease

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1 in 500

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what does sickle cell disease cause

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cell and tissue ischemia (pain)

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what are the treatments for sickle cell

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analgesia, oxygen, high fluids, iron, B12, folic acid

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agranulocytosis

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decrease in granulocytes (neutrophils, basophils, eosinophils)

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leukopenia

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decrease in all white blood cells

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what is the cause of agranulocytosis

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chemo or drugs that supress the bone marrow

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leukemia

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overproduction of immature WBC; no known cause

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Risk factors for leukemia

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exposure to chemicals, viruses, immune disorders, genetic factors

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myelocytic

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myeloid stem cells in the bone marrow

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lymphocytic or lymphoblastic

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lymphocytes in the bone marrow, spleen, nodes and CNS

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acute myelocytic leukemia

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strongly assoc. with toxins, genetic disorders, and treatment of other cancers

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chronic myelocytic leukemia

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early course is slow; progresses to aggressive in 3-4 years

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how do you diagnose leukemia

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CBC with differential d platelet count (every thing is low except immature WBC)

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what is the treatment leukemia

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BMT, stem cell transplant, biologic therapy

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thrombocytopenia

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platelet disorder; less than 100,000

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how do you diagnose thrombocytopenia

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CBC with platelet count, bone marrow (elevated platelet production)

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what is a group of hereditary clotting factor disorders

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hemophilia

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clotting

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vasoconstriction occurs, platelet plug forms but clotting is delayed as factors needed for clotting are missing

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Hemophilia A

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most common form; classic hemophilia; deficiency in Factor VIII (8)

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Hemophilia B

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less common; deficiency in Factor IX (9); treated with factor IX concetrate

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what gene is hemophilia carried on

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X gene; females carry the gene, but only males develop the disease

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how is hemophilia categorized

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mild, moderate, and severe

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indicators of hemophilia

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bleeding with circumcision, bruising, bleeding can be minor or severe depending on the injury or size of the blood vessels broken

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what causes Von Willebrand's disease

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caused by the deficiency in Von Willebrand's factor and sometimes also factor VIII

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what diagnostic tests do you use for Vons Willebrands

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platelet count (usually normal), coagulation studies, APTT, bleeding times & PT are delayed, clotting factor assays are used to determine which factor is missing

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what is DIC

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disseminated intravascular coagulation; complex disorder characterized by simultaneous blood clotting & hemorrhage

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what diagnostic tests do you use to diagnose DIC

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clotting studies (fibrinogen levels, low factors V & VIII)

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what is multiple myeloma

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a malignancy of the bone marrow

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what does multiple myeloma cause

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causes plasma cells (B lymphocytes) to multiply rapidly and infiltrate other tissue, particularly bone tissue

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what happens when the bone weakens in multiple myelome

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spontaneous fractures, that occur particularly in weight bearing joints like the pelvis, vertebrae, and the femur

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what are some diagnostic test done to diagnose multiple myeloma

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CBC (shows anemia), urine samples, bone marrow studies (shows excessive immature plasma cells, xrays show low densities or holes in the bone, blood calcium levels (elevated), BUN (elevatedl possible damage to kidneys)

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lymphadenopathy

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enlargement of the lymph nodes

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what are malignant lymphomas

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cancerous tumors of the lymphatic system

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what is hodgkin's disease

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Reed-sternburg cell visible; most curable; prognosis is better than for non lymphomas

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what is the most common manifestation of hodgkins disease

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enlarged, painless lymph nodes of the neck or about the clavicle; pruritus, fever, night sweats, weight loss, fatigue, malaise: seen more with men

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what is non hodgkin's disease

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most common; tends to occur more in men

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what are the diagnostic test to diagnose malignant lymphomas (hodgkins)

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chest xray, CT scan, biopsy of tissue (reed sternburg=hodgkins; no reed sternburg= non hodgkins), further testing done to stage the extent

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Stage I (malignant lymphoma)

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one lymph node & surrounding area involved

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Stage II

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2 separate regions,both above the diaphragm or both below the diaphragm

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Stage III

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nodes are both sides of the diaphragm

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Stage IV

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desseminated; metastasized