HEMATOLOGY

NURSING
__________
EDNA U. ROBLES, RN MAN
St. Luke’s College of Nursing
 NCM 112
• 8 units LECTURE
• 1 unit = 18 hrs
– Hematology
– Oncology
– Renal
– Fluids
– OR
– Communicable Diseases
– Cardiology
– Respiratory
05

06
 REVIEW OF BLOOD
ANATOMY & PHYSIOLOGY
 OBJECTIVES
• At the end of the lecture the students
– Recall anatomy and physiology of blood
– Identify importance of basic CBC components
– Identify causes of anemia
– Enhance clinical eye on the assessment of anemia
– Formulate plan of care for patient with anemia
REVIEW OF BLOOD FORMATION
REVIEW OF BLOOD FORMATION
REVIEW OF BLOOD FORMATION
T CELL MATURATION
B CELL TO PLASMA CELL
RETICULO ENDOTHELIAL SYSTEM
 BLOOD

• Overview
• Functions of blood
• Plasma
• Erythrocytes
• Leukocytes
• Platelets
 COMPOSITION OF BLOOD
• Blood is a fluid connective tissue composed
of:
– Plasma
– Formed elements
• Erythrocytes
• Leukocytes
• Platelets
 FUNCTIONS OF BLOOD
• Transport
– O2, CO2, nutrients, wastes, hormones, etc
• Protection
– WBC, antibodies, platelets, compliment CHON
• Regulation
– Fluid and temperature, regulation and buffering
– 37 degrees
– pH – 7.35 – 7.45.
 BLOOD VOLUME
• Adults have 4-6 L of blood (7-10%)
• Plasma, a clear extracellular fluid
• Formed elements (blood cells and platelets)
 PLASMA
• Plasma – liquid portion of blood
– Serum remains after plasma clots
• 3 major categories of plasma proteins
– Albumin
– Globulin
– Fibrinogen
OTHER COMPONENTS OF PLASMA
• Nitrogenous by-products of metabolism
– Lactic acid, urea, crea, CHON etc
• Nutrients – glucose, carbohydrates, amino
acids
• Electrolytes – Na, K, Cl, HCO3
• Repiratory gases – O2 and CO2
• Hormones.
 ERYTHROCYTES
OVERVIEW
• Biconcave disc, anucleated, essentially no organelles
• 7-8 microns
• 5-7days
• Have a flexible cytoskeleton that allows them to move
through narrow spaces
• Cytoplasm is filled with hemoglobin for gas transport
• Are the major factor contribution to blood viscosity
• 175B/day
• 1-2% reticulocytes
• 5M/microliter (mm3)
• 120 days.
ERYTHROCYTE IMAGE
 ERYTHROCYTE FUNCTIONS
• Gas transport – major function
– Due to loss of organelles during maturation
– Increase surface area/volume ratio
• 26-33% of cytoplasm is hemoglobin
– O2 delivery to tissue and CO2 transport to lungs
• Important role in gas transport and pH
balance
HEMOGLOBIN STRUCTURE OVERVIEW
• Protein globin: 2 alpha chain and 2 beta chain
– Heme pigment centrally bonded to each globin
• Iron atom in each heme can bind to 1 O2
molecule
• Each Hb molecule can transport 4 O2
molecule
• Men 14-16g/dl
• Women 12-14g/dl
HEMOGLOBIN STRUCTURE
 HEMATOCRIT
• RBC count and hemoglobin concentration
indicate an O2 carrying capacity of blood
• Hematocrit (packed cell volume) - % of blood
composed of cells
• Men 42-52%
• Women 37-48%
 ERYHTROCYTE DISORDERS

• Increased – Eryhtrocytosis/Polycythemia
• Decreased – Anemia
 LEUKOCYTES
• 5,000 - 10, 000 WBC/microliter
• Conspicous nucleus
• Travel in blood before migrating to connective
tissue and lymphatic tissues tissue
• Protects against pathogens
• Less than RBC
• Stored in RBM
• RES
 LEUKOCYTE CLASSES
• Granulocytes
– Neutrophils 50 - 70%
– Eosinophils 2 - 4%
– Basophils 0.5-1%
• Agranulocytes
– Lymphocytes 25 - 45%
– Monocytes 3-8%
LEUKOCYTE FUNCTIONS
1st responder, bacterial
Neutrophils
infections

Basophils allergic rxn

Eosinophils parasitic & allergic rxn

Monocytes chronic infections

viral infections &

Lymphocytes
chronic infection
NEUTROPHILS

• 9-12microns
• 50-70%
• 3-5 lobes
• 1-2days/6 hours
• Blue & pink granules
BASOPHILS

• 9-12 microns
• 0.5-1%
• Few hrs-few days
• Blue stain
EOSINOPHILS

• 10-14microns
• 2-4%
• 5days
• 2 lobes
• Bright red
LYMPHOCYTE

• 5-10/10-18microns
• 25-45%
MONOCYTE

• Kidney shaped
• 16-25microns
• 3-8%
• Months - years
 LEUKOCYTE DISORDERS
1. Leukopenia – low WBC count – damaged RBM
Causes: radiation, poisons
2. Leukocytosis: high WBC count
Causes: infection, allergy and disease
3. Leukemoid reaction –
Uncontrolled WBC reaction/overproduction
4. Leukemia ???
 PLATELETS
• Small fragments of megakaryocytes cytoplasm
• Sticky, circulate in clumps
• 150,000 - 400,000/ml
• 2-3 µm, contain granules
• Secrete clotting factor and growth factors for
vessel repair
• Initiate formation of clot (HEMOSTASIS)
PLATELETS
PROPERLY ID WHAT YOU SEE
 ERYTHROPOIESIS
• Production of erythrocytes
• Regulated by:
– Balance in erythrocytes production and
destruction
– Blood oxygen levels
– Hormonally controlled (EPO and testosterone)
**blood doping**
• Excessive effects: blood viscosity
• Decreased effects: O2 carrying capacity
HEMATOPOEISIS
ERYTHROPOIESIS
 LEUKOPOEISIS
• Chemically regulated by other WBC’s and
other physiologic functions
• Colony Forming Units (CFU) stimulate
production of specific leukocytes
LEUKOPOEISIS
THROMBOPOIESIS
 NUTRITIONAL REQUIREMENTS
• Adequate protein intake
• Adequate iron intake
• Adequate vitamin intake
 CELLS SIZE/µm NUCLEUS LIFESPAN COLOR NORMAL VALUES/µL

RBC 7 to 8 anucleated 120 days red 4to 5M /mm3

Hb/Hgb 12-16mg/dl

Hct 40-50%

WBC 4,000 – 11,000/mm3

6h/1-2
Neutrophils 9 to 12 2 to 5 days pink to violet 1800 -7300 50-70%

Eosinophils 10 to 14 bilobed 5 days bright red 0-700 2-4%

few
Basophils 9 to 12 bilobed hrs/days deep blue 0-150 0.5-1%

Lymphocytes 5 to 10 large hrs/yrs 1500-4000 25-45%

10 to 18

Monocytes 16 to 25 K shaped mos to yrs pale blue 200-950 3-8%

5 to 10
Platelets 2 to 3 fragments days deep purple 150,000-400,000 <1%
COMPLETE BLOOD COUNT
 BASIC TERMINOLOGIES
1. Hematocrit (Hct) Vol in a given blood occpd by RBC when packed

2. RBC count Number of RBC in a given volume of blood

3. Hemoglobin (Hb/Hgb) concentration Total amount of Hb in a given volume of RBC .

4. Mean Corpuscular Volume (MCV) Average volume of RBC

5. Mean Corpuscular Hb (MCH) Average amount of Hb in RBC

6. Mean Corpuscular Hb Concentratiion (MCHC) Concentration of Hb in a given volume of RBC

7. Normocytic cells Normal sized cell

8. Microcytic cells Small sized cell

9. Macrocytic cells Large sized cells

10. Normochromic cells Normal color or normal degree of hemoglobinization

11. Hypochromic cells Less degree of hemoglobinization

12. Hyperchromic cells High degree of hemoglobinization

13. Red cell Distributive Width Variations in the size of the cells
 ANEMIA INDICATORS
Packed Cell Vol in a given blood occupiedd by
Volume (PCV) / Hct RBC when packed

In 1L of blood = _______L Hct and ______ L Plasma

In 100 ml of blood = _______ml Hct and ______ml Plasma
In 10 ml of blood = _______ml Hct and ______ml Plasma
In 1 ml of blood = _______ml Hct and ______ml Plasma
 ANEMIA INDICATORS
Red Blood Cell
Number of RBC in a given volume of blood
or RBC Count

In 1 ml of blood = 0.45 ml Hct and 0.55 ml Plasma

In 1 ml of blood there is 5million RBC
 ANEMIA INDICATORS
Hb/Hgb Total amount of Hb in a given volume
concentration of RBC

In 1 microL of blood = 0.45 microL Hct and 0.55 microl Plasma

In 1 microl of blood there is 5million RBC
In 1microl of blood = 0.45microl Hct, 1/3 is Hgb = 0.15 g/microL
In 100ml of blood = 45ml hct, 1/3 is Hgb = 15 g/dL
 ANEMIA INDICATORS
Mean Corpuscular
Volume (MCV) Average volume of RBC

It can be calculated by using this formula:

 ANEMIA INDICATORS
Mean Corpuscular
Hb (MCH) Average amount of Hb in RBC

It can be calculated by using this formula:

 ANEMIA INDICATORS
Mean Corpuscular
Hb Concentratiion
Concentration of Hb in a given
(MCHC) volume of RBC
It can be calculated by using this formula:
 MCV 90fl
MCH 30pg
MCHC 33%

MCV <80fl MCV 80-100fl MCV >100fl

MCV 60fl MCV 90fl MCV 120fl
MCH 20pg MCH 30pg MCH 40pg
MCHC 33% MCHC 33% MCHC 33%
MICROCYTIC, NORMOCHROMIC NORMOCYTIC, NORMOCHROMIC MACROCYTIC, NORMOCHROMIC

MCV 60fl MCV 90fl MCV 120fl

MCH 15pg MCH 20pg MCH 30pg
MCHC 25% MCHC 22% MCHC 25%
MICROCYTIC, HYPOCHROMIC NORMOCYTIC, HYPOCHROMIC MACROCYTIC, HYPOCHROMIC

MCV 60fl MCV 90fl

MCH 30pg MCV 120fl
MCH 45pg MCH 60pg
MCHC 50% MCHC 50% MCHC 50%
MICROCYTIC, HYPERCHROMIC NORMOCYTIC, HYPERCHROMIC
MACROCYTIC, HYPERCHROMIC
 ANEMIA INDICATORS
Red cell
Distributive Width Variations in the size of the cells
ANEMIA
 ANEMIA ACCDG TO WHO
Population Normal Hb Mild Anemia Moderate Severe Anemia
Anemia
6 – 59 months > 11.0 10.0 – 10.9 7.0 – 9.9 < 7.0

5 – 11 years old > 11.5 11.0 – 11.4 8.0 – 10.9 < 8.0

12 – 14 years old > 12.0 11.0 – 11.9 8.0 – 10.9 < 8.0

Non Pregnant > 12.0 11.0 – 11.9 8.0 – 10.9 < 8.0
> 15 years old
Pregnant > 11.0 10.0 – 10.9 7.0 – 9.9 < 7.0

Men > 13.0 11.0 – 12.9 8.0 – 10.9 < 8.0

> 15 years old
DIFFERENT TYPES OF ANEMIA
Decreased Red
cell production

Increased Red
ANEMIA
cell destruction

Blood loss
 NURSING DIAGNOSIS
1. Activity Intolerance related to imbalance between oxygen supply
(delivery) and demand
2. Ineffective tissue perfusion
3. Decreased cardiac output
4. Disturbed sensory perception
5. Impaired oral mucous membrane
6. Imbalance Nutrition: Less than body requirement
7. Constipation
8. Deficient knowledge
9. Low self esteem
10. Fatigue
11. Fear
12. Risk for infection
13. Risk for injury
Thank You!