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DISTURBANCES IN OXYGENATION
CARRYING MECHANISM AND TRANSPORTATION
FACILITIESJefferson C. Ramos, RMT RN
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BLOOD
Circulatory fluid of the the Cardiovasclar system that is circulating constantly through a closed circuit of tubes.
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PARTS OF THE BLOOD Liquid Portion
Plasma - a pale, straw colored fluid that remains if coagulation is prevented
Serum - fluid part that remains after separation of the clot
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PARTS OF THE BLOOD Solid Portion
Red Blood Cells/Erythrocytes
White Blood Cells/Leukocytes
Platelets/Thrombocytes
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CHARACTERISTICS OF BLOOD
Volume 5 - 6 liters or 7 - 8% of
the body weight
Color Venous blood - dark
red Arterial blood - bright
scarlet red
Viscosity Thick and sticky (5x
that of water)
Specific Gravity Between 1.055 - 1.065
Reaction Range of 7.35 - 7.45
(avg. of 7.4)
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FUNCTIONS OF BLOOD Metabolic Functions
Respiration
Nutrition
Excretion
Regulation of water balance
Regulation of body temperature
Transportation of hormones
Maintenance of normal acid-base balance in the body
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FUNCTIONS OF BLOOD Defensive Functions
Production of immune globulins
Functions as phagocytes
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ERYTHROCYTESBiconcave discs resembling a soft
ball compressed between 2 fingersGases can easily diffuse across it
due to its very thin membraneContains HEMOGLOBIN
From matured erythrocytes; with Iron
Makes up 95% of blood massEnables the RBCs to perform its
principal function
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RBC DESTRUCTION
120 days Removed by the reticuloendothelial cells in
the liver and spleen Hemoglobin is recycled
Bilirubin New hgb molecules in the bone marrow Sterco- and urobilinogen
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KINDS OF WBCS
Granulocytes
Neutrophils
Eosinophils
Basophils
• Agranulocytes
• Lymphocytes
• Monocytes
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NEUTROPHILS
Most abundant type of phagocyte, 50 - 60%
Responsible for neutralizing bacterial infections
They engulf pathogens coated with antibodies
Does not return to the blood
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EOSINOPHILS
1 - 3%
They play a crucial part in killing parasites
Neutralize histamine
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BASOPHILS
0 - 1% of the differential count
Appears in inflammatory reactions esp. those that cause allergic reations
Contains heparin & histamine
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LYPMHOCYTES
About 25 - 33% of the differential
Usually abnormal results in diseases caused by viruses
Has three kinds: Natural Killer Cells T Cells B Cells
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MONOCYTES
About 3 - 7%
Functions to replenish resident macrophages and dendrictic cells under noramal states
Also responds to inflammation signals
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THROMBOCYTES
100,000 - 450,000 in value
Derived from the fragmentation of precursor megakaryocytes
Plays a key role in hemostasis
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ASSESSMENT AND DIAGNOSTIC FINDNIGS
Hematologic StudiesComplete blood
countPeripheral blood
smearHemoglobinHematocritRBC indices
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ASSESSMENT AND DIAGNOSTIC FINDNIGSBone marrow aspiration
and biopsyBone marrow
aspirationBone marrow biopsy
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MANAGEMENT OF HEMATOLOGIC DISORDERS
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ANEMIA
A condition in which Hemoglobin (Hgb) concentration is lower than normalHgb = 75 – 175 μg/dL or 13.5-17.5 g/dL (M)
= 65 to 165 μg/dL or 11.5-15.5 g/dL (F)
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ANEMIA: CAUSESAcute or chronic blood lossInadequate dietary intake of vitamins
and mineralsIncreased demands of vitamins and
minerals for RBC productionDecreased RBC production by bone
marrowIncreased RBC destruction
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ANEMIA
Hemolytic
Hypo-proliferativ
eBleeding
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ANEMIA: SIGNS AND SYMPTOMS
PallorEasy
fatigabilityWeaknessWeight lossHeadacheTachycardia
SyncopeBrittle hairParesthesiaCold
sensitivityAnorexiaAmenorrhea
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IRON DEFICIENCY ANEMIA Laboratory findings1. CBC- Low levels of
Hct, Hgb and RBC count
2. Low serum iron, low ferritin
3. Bone marrow aspiration- MOST definitive
Assessment1. Pallor2. Weakness &
fatigue3. Smooth & sore
tongue4. Koilonychia5. Vinson Plummer
syndrome
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MEGALOBLASTIC ANEMIAS: VIT. B12 DEFICIENCY
Inadequate dietary intake
Pernicious AnemiaDue to the absence of intrinsic factor
secreted by the parietal cells Intrinsic factor binds with Vit. B12 to
promote absorption
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MEGALOBLASTIC ANEMIAS: VIT. B12 DEFICIENCY
Causative factors1.Strict vegetarian diet2.Gastrointestinal malabsorption
3.Crohn's disease4.Gastrectomy
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MEGALOBLASTIC ANEMIAS: MANIFIESTATIONS
1. Weakness2. Fatigue3. Listless4. Neurologic manifestations (only in
Vit. B12 deficiency)5. Jaundice – due to poor
erythropoiesis6. Red beefy tongue 7. Mild diarrhea8. Extreme pallor9. Paresthesias in the extremities
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MEGALOBLASTIC ANEMIAS: LAB DATA
1. Peripheral blood smear- shows giant RBCs, WBCs with giant hypersegmented nuclei
2. Very high MCV3. Schilling’s test – determines
the cause of Vit B12 deficiency4. Intrinsic factor antibody test
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MEGALOBLASTIC ANEMIAS
1. Vitamin supplementation Folic acid 1 mg daily
2. Diet supplementation Vegetarians should have
vitamin intake or fortified soy milk
3. Lifetime monthly injection of IM Vit. B12 – 1000µg (if intrinsic factor is absent)
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MEGALOBLASTIC ANEMIAS
1. Monitor patient (neurologic assessment)
2. Provide assistance in ambulation
3. Oral care for sore tongue4. Explain the need for
lifetime IM injection of Vit. B12
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POLYCYTHEMIA
Refers to an INCREASE volume of RBCs
The hematocrit (Hct) is ELEVATED to more than 55%
Classified as Primary or Secondary
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POLYCYTHEMIA: PRIMARY
POLYCYTHEMIA VERAA proliferative disorder in which the myeloid stem cells become uncontrolled
Causative factor: unknown
Co
llee
n C
. Flo
res, R
N
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POLYCYTHEMIA: PRIMARY Uncontrollable stem cell growth
Hypercellular bone marrow
Increase in number of blood cells
Hematopoiesis in spleen
Fibrotic bone marrow
Increased RBC, WBC, platelets
Splenomegaly
Increased blood viscosity
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POLYCYTHEMIA: PRIMARY
1. Ruddy skin2. Splenomegaly3. Headache4. Tinnitus5. Fatigue6. Paresthesia7. Blurred vision
1.Angina2.Claudication3.Dyspnea4.Thrombo-
phlebitis5.Pruritus6.Erythromelalgi
a
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POLYCYTHEMIA: PRIMARY Laboratory findings
1. CBC- shows elevated RBC mass
2. Elevated WBC and platelets
3. Elevated hematocrit4. Normal oxygen
saturation
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POLYCYTHEMIA: PRIMARY
Complications1. Increased risk for
thrombophlebitis, CVA and MI
2. Bleeding due to dysfunctional platelets
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POLYCYTHEMIA: PRIMARY 1. To reduce the high blood
cell mass (goal) PHLEBOTOMY
2. Allopurinol (Zyloprim) – if uric acid is increased
3. Dipyridamole (Persantine)4. Chemotherapy to
suppress bone marrow (hydroxyurea)
Co
llee
n C
. Flo
res, R
N
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POLYCYTHEMIA: PRIMARY
Patient education: Client instructions on:
1. Avoiding Iron supplements
2. Bathing with cool water (cocoa-butter based lotion and bath products)
3. Minimize bleeding Avoid Aspirin (if with bleeding
history) Minimize alcohol intake
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POLYCYTHEMIA: SECONDARY
Caused by: Excessive production of
erythropoietin (hypoxic stimulus)
Hemoglobinopathies Neoplasms (renal cell
carcinoma) Treat primary problem
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BLEEDING DISORDERS
Platelets
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THROMBOCYTOPENIA
Low platelet level due to:1. Decreased platelet production by
bone marrow2. Increased platelet destruction (ITP)3. Increased platelet consumption
(DIC)Manifestation: bleeding and petichiae
(<20,000mm3)
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IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)
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ITP Goal: safe platelet count (>30,000mm3) Immunosuppressants - block the binding
receptors on macrophages so that the platelets are not destroyed1. Prednisone2. Cyclophosphamide (Cytoxan)3. Azathioprine (Imuran)4. Dexamethasone (Decadron)
IVIG Spleenectomy Chemotherapy – Vincristine (Oncovin)
Colleen C. Flores, RN
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ITP
Determine bleeding risksClient education regarding
Medication and treatmentLifestyleRefrain from vigorous
sexual intercourse (< 10,000/mm3)
Avoid client constipation
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HEMOPHILIA Inherited (x-linked) bleeding disorder Deficient or defective factor VIII (A) Deficient or defective factor IX (B) Hemorrhage after minimal trauma
(joints)
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HEMOPHILIA: INHERITANCE
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VON WILLEBRAND’S DISEASE
Inherited (autosomal dominant) bleeding disorder; deficiency of the vWF
Common manifestationsNosebleedsHeavy menses
Lab data = normal platelet count but prolonged PTT
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VON WILLEBRAND’S DISEASE: MANAGEMENT
Cryoprecipitate or FFP
Desmopressin (DDAVP) – can be used to prevent bleeding with dental/surgical procedures or manage mild post-op bleeding
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DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
A potentially life-threatening sign of an underlying condition
Triggered by sepsis, trauma, cancer, abruptio placenta, transfusion reactions (hemolysis)
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DIC: MANIFESTATIONSMinimal occult internal bleeding to profuse hemorrhage
Lab data:Fibrin degradation products – high
PTT - highPlatelet count - lowPT - highSerum fibrinogen - low
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DIC: MANAGEMENTTreat underlying disorderCorrect secondary effects of tissue ischemia
Cryoprecipitate or FFPHeparin infusion* – to interrupt thrombosis
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