Case Study ON: Blood Dyscrasia

University of Saint Louis
Tuguegarao City, Cagayan 3500

SCHOOL OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING – LEVEL IV
CASE STUDY
ON
BLOOD DYSCRASIA
PRESENTED BY:
JHOANNA MAE ROMIAS
BSN IV GROUP A
INTRODUCTION
Blood dyscrasias are conditions that affect the blood, bone marrow, or lymph
tissue. They may be common or uncommon, cancerous or benign. They can range
from very mild or asymptomatic conditions to those that are life-threatening.
The term “blood dyscrasia” is a non-specific term that can refer to any
blood-related disease. That said, it tends to be used when a diagnosis is
uncertain or in certain situations.
Blood dyscrasias may involve:
 Blood cells, such as red blood cells, white blood cells, and platelets
 Proteins in the blood responsible for clotting and bleeding
 Lymph tissue such as the lymph nodes and spleen
 The bone marrow
 Blood vessels
Causes of Blood Dyscrasias
The causes of blood dyscrasias are not always known. When this is the case,
healthcare providers often use the term idiopathic. This means the cause is
uncertain or even totally unknown at the time.
Causes and risk factors can fall into several categories, which sometimes
overlap.
 Cancers: Blood dyscrasias include certain cancers, such

as leukemias, lymphomas, and multiple myeloma. These cancers are
characterized by the out-of-control growth of one of the types of white
blood cells. This can lead to problems related to the specific type of
cell. It may also affect other blood cells. For example, leukemic cells
may crowd the bone marrow resulting in lower production of other types
of blood cells.

 Medication: Medication is a very common cause of blood dyscrasias. Both
prescription and illicit drugs may cause them, and so can vitamin and
nutritional supplements.

 Environmental exposures: There are a number of exposures in the
environment that may result in blood dyscrasias. Examples include
certain chemicals and radiation.

 Infections: Blood cells are not only important in fighting infections
but may also be damaged by infections.
 Vitamin and mineral deficiencies: A nutrient deficiency may interfere
with the formation of blood cells. This includes blood dyscrasias like
anemias caused by iron, vitamin B12, or folate deficiencies.

 Autoimmune: With certain autoimmune conditions, antibodies may
mistakenly attack blood cells.

 Genetics: Genetics can play a role in blood dyscrasias. This can happen
through specific gene mutations like sickle cell disease. It may also
happen because of a hereditary predisposition, such as with some cases
of B12 deficiency anemia.

 Combination: A combination of the above causes may result in a single
type of blood dyscrasia. For example, aplastic anemia may be caused by a
viral infection, medication, exposure to chemicals or radiation, and
more.
Types and Classification
There are a number of different blood dyscrasia types. Some conditions affect
only one type of blood cell. Commonly, these conditions will cause either an
increase or decrease in this blood cell type
If all major types of blood cells are affected, the condition is called
a pancytopenia.
Terminology for an Increase or Decrease in Blood Cells
Cell type Excess Deficiency
Red blood Erythrocytosis or

Anemia
cells polycythemia
White blood
Leukocytosis Leukopenia
cells
Platelets Thrombocytosis Thrombocytopenia
Red Blood Cell and Hemoglobin Disorders
Red blood cells may be abnormal in a number of different ways. When there are
too few of them, it’s called anemia. It is also possible to have too many
red blood cells, cells with abnormal structure, or cells that contain abnormal
hemoglobins.
Some red blood cell disorders include:
 Nutritional deficiencies: These include iron deficiency anemia or

macrocytic (large cell) anemias caused by vitamin B12 or folate
deficiency.

 Aplastic anemia: In some cases, damage to bone marrow results in the
production of very few red blood cells. The term aplastic means
“absence of.”
 Hemolytic anemias: In these conditions, red blood cells are broken
down. Cold agglutinin disease is an example of this type of condition.

 Red cell membrane diseases (leading to abnormal shapes): These can be
inherited or they may develop later in life. They include conditions
such as hereditary spherocytosis and elliptocytosis.

 Red blood cell enzyme deficiencies: These include glucose-6-phosphate
dehydrogenase deficiency and pyruvate kinase deficiency.

 Hemoglobinopathies: Hemoglobin is a protein found in red blood cells.

Some hemoglobin disorders like sickle cell
disease and thalassemia are hereditary.Others, like acquired
sideroblastic anemia, can develop later in life.
 Polycythemia: An excess number of red blood cells may be hereditary, but
sometimes it can occur as a response to other factors, such as lung
disease, heart disease, or high altitude. This happens because the body
makes more red blood cells to compensate for a lack of oxygen. An
example is polycythemia vera.
White Blood Cell Disorders
In white blood cell disorders, there may be too much or too little of all or
one type of white blood cell. There could also be a normal number of
abnormally functioning cells. Some white blood cell disorders include:
 Proliferative disorders: Leukemias are cancers in which abnormal white

blood cells are found primarily in the blood and bone marrow. Lymphomas
involve the same cells, but they are found primarily in lymphoid tissue
such as the lymph nodes.Leukemias may be acute, which means they grow
quickly, or chronic, which means they grow more slowly. They may involve
cells at any point in development. Myeloma and other plasma cell
neoplasms involve producing too much of a type of white blood cell.
 Leukocytosis: An elevated white blood cell count is common with many
types of infections. One type of white blood cell, eosinophils, is often
elevated when there is a parasitic infection.
 Leukopenia: A deficiency of white blood cells may occur for many
reasons. Some examples include chemotherapy, other medications that
cause the destruction of white blood cells, and some infections,
especially after the acute period of infection.
 Other: A few noncancerous conditions that affect white blood cells are
uncommon. These conditions are often caused by a single gene mutation.
Examples include myeloperoxidase (MPO) deficiency, leukocyte adhesion
deficiency (LAD), hyperimmunoglobulin E syndrome (“Job syndrome”),
and chronic granulomatous disease.
Platelet Disorders
Platelet disorders may be caused by too many (thrombocytosis) or too few

(thrombocytopenia) platelets. They can also be caused by a normal number of
platelets that function abnormally. They can be genetic or they may develop
later in life.
Platelets are an essential part of the clotting process, so there is some

overlap with bleeding disorders and clotting disorders.
Thrombocytopenia (a low platelet count) may be caused by:
 Decreased production of platelets. Examples include bone marrow

disorders, some medications such as chemotherapy, certain viral
infections, etc.
 Increased destruction of platelets. This can be caused by immune
disorders such as immune thrombocytopenia (also called idiopathic
thrombocytopenic purpura).
 Blood loss such as from bleeding.
Thrombocytosis (thrombocythemia) is an elevated platelet count. It can be

seen with some cancers and inflammatory conditions, such as essential
thrombocythemia.
Platelet disorders that affect normal functioning can be caused by liver or

kidney disease.They can also be caused by inherited conditions such as
Wiskott-Aldrich syndrome. These conditions may affect the ability of platelets
to come together or stick together.
Bleeding Disorders
Bleeding disorders can be broken down into four major categories:
 Platelet disorders: (discussed above).

 Coagulation factor deficiencies: Coagulation factor deficiencies such
as hemophilia are inherited conditions. They are caused by a
deficiency of substances in the blood called clotting factors. Clotting
factors are needed in order for blood to clot normally. These conditions
may be rare or common and can be mild or life-threatening. Coagulation
factor issues that develop later in life include liver disease, vitamin
K deficiency, and conditions caused by blood thinners.
 Fibrinolytic defects: Even when a clot forms properly, it may be broken

down prematurely. This happens with the medication streptokinase, a drug
sometimes used with strokes or heart attacks.
 Vascular defects: Vascular defects involve bleeding from inflammation
or damage to the blood vessels. These may be seen with autoimmune
conditions. They may also be seen with angiogenesis inhibitors, which
are cancer drugs that interfere with the growth and repair of blood
vessels.
Clotting Disorders (Thrombosis)
Some types of blood dyscrasias cause the blood to clot too easily. Some of
these conditions are hereditary, such as:
 Factor V Leiden mutation

 Prothrombin gene mutation
 Protein C deficiency
 Protein S deficiency
 Antithrombin deficiency
 Hyperhomocysteinemia
Others are related to conditions like:
 Cancer
 Kidney disease
 Autoimmune conditions
 Antiphospholipid syndrome
Medications like estrogen can also cause this type of blood dyscrasia.
Bone Marrow Disorders
Diseases related to the bone marrow are another important cause of blood
dyscrasias.
In some cases, the bone marrow is infiltrated with abnormal cells. This limits
the production of normal blood cells and often leads to a deficiency of all
blood cell types. It may be seen with:
 Blood-related cancers in the bone marrow such as leukemia and

myelodysplastic syndromes
 Solid tumors, such as breast cancer, that spread to the bone marrow
 Myelofibrosis, when the bone marrow is replaced with fibrous/scar tissue
 Some connective tissue diseases
Failure of the bone marrow can occur for other reasons, too, such as:
 Medications
 Environmental exposures
 Severe infections
 Aplastic anemia
Symptoms
Many of the symptoms of blood dyscrasias are related to having too much or too
little of the different types of blood cells. Symptoms can also be caused by
the build-up of these cells within the lymph nodes or spleen.
Red Blood Cells
Anemia can cause a number of symptoms, including:
 Lightheadedness or fainting
 Fatigue
 Palpitations or a rapid heart rate
 Shortness of breath
 Pale skin3
When red blood cells are the wrong shape, such as in sickle cell anemia, they
may get “stuck” in blood vessels in various tissues. This can cause cell
death and pain that is often severe.
An increase of red blood cells can result in a red facial complexion and
headaches.
White Blood Cells

When white blood cells levels are low, infections may develop. Symptoms are
usually related to the site of infection, such as:
 Lungs: Cough or coughing up blood, shortness of breath

 Upper respiratory tract: Sore throat, difficulty swallowing, sinus pain,
nasal drainage
 Urinary tract: Pain with urination, frequency of urination
 Abdomen: Nausea, vomiting, or diarrhea, abdominal pain
 Central nervous system: Headaches, neck stiffness, confusion
Platelets
Depending on the severity, a low level of platelets can also cause symptoms.
These may include:
 Bruising
 Red dots on the skin that don’t blanch with pressure (petechiae)
 Nosebleeds
 Heavy menstrual periods
 Bleeding from the bladder or with bowel movements
Bleeding Disorders
The symptoms of bleeding disorders overlap with platelet conditions. Specific

symptoms often depend on the severity of the disease. If the condition is
mild, you may notice increased bleeding after surgery or dental procedures.
With more serious disorders you may have spontaneous bleedings.
Clotting Disorders
Risk factors for blood clots include bed rest, recent surgery, cancer,

travel, and more. Sometimes blood clots occur without these risk factors in
someone who is otherwise healthy and has not been sedentary. When this
happens, your healthcare provider will consider the possibility of a clotting
disorder.
Bone Marrow Disorders and Malignancies

Bone marrow disorders may affect all types of blood cells. Symptoms of these
conditions can be similar to those of blood cell disorders. Blood-related
cancers may produce symptoms such as:
 Enlarged lymph nodes

 Night sweats
 Fever of unknown origin
 An enlarged spleen and/or liver
 Unintentional weight loss
Other Symptoms
A wide range of symptoms may be seen with different blood dyscrasias. Many of
these are not obvious. A few examples include:
 Pica: Pica means to “eat dirt.” Children who have iron deficiency
anemia indeed sometimes eat dirt, presumably because of an instinctual
craving for iron.
 Pagophagia: Pagophagia is a craving for ice. This is a more common
symptom of iron deficiency than pica.
 Neurological symptoms: When you have vitamin B12 deficiency, you may
develop anemia and symptoms that are similar to those of multiple
sclerosis.
Tests to Evaluate Blood Dyscrasias
 Complete blood count (CBC): This test will provide the number of red

blood cells, white blood cells, and platelets present. A differential
will show the proportion of different types of white blood cells in the
blood. A larger than normal number of immature white blood cells may
suggest a serious infection or blood-related cancer.
 Blood cell indices: This test can be very helpful for learning more
about blood cells. For example, small red blood cells tend to be seen
with iron deficiency anemia whereas red blood cells tend to be large
with anemia related to vitamin B12 deficiency.
 Reticulocyte count: A reticulocyte count is used to find the cause of
anemia. For example, it can help the healthcare provider determine
whether the patient’s anemia is caused by decreased production of red
blood cells or increased breakdown of cells.
 Peripheral blood smear for morphology: This is an extremely important

test that may note abnormal findings in any of the types of blood cells.
It can also detect the presence of cells not ordinarily found in the
bloodstream.
Supplemental Tests
Based on CBC results, other tests may be recommended:
 Hemoglobin electrophoresis, to look for thalassemias

 Iron studies, such as serum iron, iron binding capacity, or serum
ferritin
 Vitamin B12 and folic acid levels
Evaluation of Bone Marrow
A bone marrow biopsy and aspiration can provide a lot of information about

the health of the bone marrow. This test is essential in diagnosing some types
of leukemia. When cancer is suspected, further tests such as biomarker testing
will be done on the cells.
Coagulation Studies
History and physical exam may provide clues as to whether a person have a
platelet disorder or another type of bleeding disorder.
Tests to evaluate platelet function may include:
 Bleeding time
 Platelet function assay
 Platelet aggregation testing
Coagulation studies may include a prothrombin time (and INR) and partial
thromboplastin time. If a clotting factor abnormality is suspected, specific
testing will be done.
If healthcare provider suspects a patient’s blood clots more easily than

usual, it may be referred for tests such as:
 Antiphospholipid antibodies
 Protein C activity
 Homocysteine levels
Treatment
The treatment of blood dycrasias depends on the cause. Sometimes it’s enough
to just treat the underlying condition. Other times, a deficiency in blood
cells or absence of clotting factors will need to be treated directly.
For severe anemia, a blood transfusion may be needed until the underlying
cause can be addressed. If platelet count is very low, platelet transfusions
may be needed to stop or prevent bleeding.
A very low white blood cell count, may be prescribed a medication that
stimulates the production of white blood cells. Since the most important
complications related to a low white count are infections, it’s also
important to take steps to reduce infections.
Clotting disorders require treatments that help reduce the risk of clotting.
Bleeding disorders require treatments that help the blood clot. Fresh frozen
plasma and/or replacement of missing clotting factors are also often needed.
PATIENT’S PROFILE
Name: Patient R.L.T
Age: 21
Gender: Male
Birth Date: February 23, 2001
Place of Birth: Ifugao
Address: Tabuk City, Kalinga
Occupation: Farmer
Civil Status: Single
Weight: 75kg (165.347 lbs)
Height: 5’9ft (175.26 cm)
BMI: 24.4 (Normal)
Nationality: Filipino
Language/s Used: Tagalog
Religion: Born Again Christian
Admission’s Date/Time: July 1,2022 (11:30 pm)
Chief Complaint: Easy Fatigability
Admitting Diagnosis: Blood Dyscrasia probably Thalassemia, Severe Anemia
Secondary
Attending Physician: Dr. Odessa Peka
History of Present Illness

Last July 01 2022, patient R.L.T experience dizziness and easy fatigability
upon going home from their farm. They immediately went to KD Clinic for check-
up.The doctor whom they consulted made a referral to PMD since he noticed that
the patient’s blood profile has decreased from its normal value, was then
immidiately transferred to Cagayan Valley Medical Center and was admitted
there.Laboratory tests were ordered on admission. The result of his blood exam
is still low so his mother decided to have him admitted at the Emergency room
for observation.
History of Past Illness

The patient R.L.T received two doses of the Sinovac COVID vaccine in addition
to receiving a full course of vaccinations. He had never been in an accident
before and had never had surgery. Patient R.L.T has a history of blood
transfusion due to severe anemia in the year 2019, aside from his admission he
was always able to handle colds and fevers by getting lots of rest and taking
over-the-counter drugs. Patient R.L.T has no allergies.
FAMILY HISTORY
Mother Father
Age: Unknown Age: Unknown
No Known Disease No known Disease
1st Child (Patient) 2nd Child

Age: 21 Age: 18 3rd Child
Blood Dyscrasia No Known Disease Age: 16
No Known Disease
LEGENDS
- Female
- Male
- Patient (Male)
GORDON’S 11 FUNCTIONAL HEALTH PATTERNS
Health Pattern Before Hospitalization During Hospitalization
Health Perception-Health Patient R.L.T. defined The patient defined his
Management health as “Kapag health as “Mahina nag
malakas magtrabaho” and katawan ko kasi konting
believes to the galaw lang napapagod na

statement that health is agad ako”. The patient
wealth. According to the stated that he can no
patient he always felt longer do his usual
tired in just small activities due to his
amount of work before condition and rated is
hospitalization and health as 6 out of 10.
rates his health as 8
out of 10. He takes Vit.
C to protect his
immunity and buys OTC
drugs such as
paracetamol and bioflu
when he gets mild fever
or headache. He was
vaccinated with 1st and
2nd dose of COVID-19
vaccines without
booster.
Nutritional-Metabolic Patient R.L.T eats three Patient R.L.T eats three
Pattern meals a day—breakfast, times a day (breakfast,
lunch, and dinner—plus lunch, and dinner) with
snacks. He eats snacks in between.
breakfast at six in the “kapag nagugutom ako sa
morning before going to gabi, nagpapakuha ako
farm, lunch at twelve in kay mama ng biscuit yun
the afternoon, and yung kinakain ko” as
dinner at 6pm. in verbalized by the
regular basis. Each day, patient. He eats
the patient drinks 1-2 breakfast at 7a.m.,
liter of water. He lunch at 12p.m., and
typically eats 3-5 cups dinner at 7p.m. The
of rice with meat or patient’s dietician has
fish, vegetables, and ordered diet as
rice. The patient said, tolerated (DAT) for him.
"Madalas gulay at isda The patient’s diet
ang ulam minsan lang mag consists of 1 cup of
ulam ng karne kasi mahal rice with meat or fish,
ang presyo ng karne vegetables, and fruits.
ngayon " The patient When served with
stated that he likes to chicken, he chose not to

eat fish like tilapia. eat it. He does not have
He doesn't have any any difficulty in
issues swallowing or chewing or swallowing
eating his food. He does food.
not smoke, and he does
not consume alcoholic
beverages.
Weight: 75kg (165.347
lbs)
Height: 5’9ft (175.26
cm)
BMI: 24.4 (Normal)
Elimination Pattern Patient R.L.T usually The patient voids 3x a
voids 3 times a day, day once in the morning
once in the morning, and twice at noon. He
once in noon, and once describes his urine as
at night, with an amount yellowish in color and
of urine that is about his urination was
3-5 glasses. He stated painless. The patient
that his urination was defacates once a day in
painless and is clear hospital. He described
white in color. Patient his stool as brown in
R.L.T defecates twice a color and formed.
day and has no
difficulty in
defecating. He described
his stool as brown and
slightly formed.
Activity-Exercise Patient R.L.T stated Patient R.L.T stated
Pattern that he exercises that his only excercise
atleast twice a week. He in the hospital is
jogs from their house to walking from the
their farm as his restroom to his bed.
exercise. He also walks Patient stated that,
from their house to “Naka upo o nakahiga
their church. “ lang naman ginagawa ko
Pumupunta ako lagi sa dito siguro yung
church namin naglalakad paglalakad ko nalang

pero netong nakaraang papuntang cr exercise
buwan hindi na ko.” The patient said
akomasyadong lumalabas that his condition
kasi konting galaw lang prevents him from moving
napapagod na ako” as extensively and that he
stated by the patient. spends much of his time
on his phone.
Sexuality-Reproduction When he was in fourth The patient does not
Pattern grade, the patient have any sexual
underwent circumcision. activities nor any
When he was in grade 9, experiences.
he became aware of the
puberty-related changes.
He observed that the
hair on his face,
genital region, and
armpits had grown. He
has never engaged in
sexual activity or had
any sexual encounters.
Sleep-Rest Pattern According to the patient During hospitalization,
R.L.T., he typically Patient R.L.T. stated
goes to bed at 12 am and that he sleeps for 8
gets up at 7 am. He said hours. He takes a nap
he takes two-hour naps for an hour and feels
around 1 or 2 o'clock in irritated when he wakes
the afternoon and that up due to his condition.
they leave him feeling “Naiinis ako minsan
sluggish. He doesn't kasi sumasakit ulo ko
have any trouble falling kapag nagigising ako
asleep and doesn't take bigla nabbibitin tulog
any sleep aids. ko” as verbalized by
the patient.
Cognitive-Perceptual Patient R.L.T. is Patient R.L.T. is
Pattern oriented to people, time oriented and alert. He
and place, responses to responds to questions
stimuli verbally and that are asked and
physically. He can
understand and speak cooperates well.

Tagalog fluently.
Role-Relationship Patient R.L.T. belongs Patient R.L.T. stated

Pattern to a family of 5 which that he is getting his
includes himself, his 2 strength from his
siblings, and his family, and they have
parents. He has a good always supported him and
relationship with is showed their love for
family and he stated him by giving him foods
that they always support and calling through
each other especially phone. “Inaalagaan ako
through hard times. When nilang mabuti lalo na si
family problem occurs, mama kasi siya
he chooses to be quiet. nagbabantay sakin
His role in the family dito.” as verbalized by
is to help his father in the patient.
the farm. “Pumupunta
ako lagi sa bukid
sinasamahan si papa nong
di pa ako nagkasakit.”
as verbalized by the
patient.
They go to church and
eat at a restaurant as a
form of their family
bonding. The one who
decides in the family is
their mother. The
patient stated that he
has a lot of friends
“tumutugtog kami ng mga
barkada ko sa church
namin. Gabi gabi kaming
nagpapractice sa church
namin” as their bond.
Self-perception – Self- Patient R.L.T stated Patient R.L.T. stated
concept pattern that he perceived that he is still hopeful
himself as a healthy he would get better. He

person. He described his stated that he is
positive trait as God currently not satisfied
fearing person and he with his body because of
also stated that he is his illness. The patient
satisfied by his self- stated that he wants to
body image. go home immediately and
helps with the chores in
their house. “Gusto ko
na umuwi kasi
nakakabagot na dito,
sana nga gumaling na ako
para makapagtrabaho na
ulit ako” as stated by
the patient.
Coping-Stress Tolerance Patient R.L.T. Patient R.L.T said that
Pattern verbalized that the he is currently stressed
major cause of his about his condition. He
stress is his work. His copes up with his
way of relieving stress current stress by
is through cellphone or watching videos using
hanging out with friends his cellphone and
and jamming with them. praying.
Value-Belief Pattern Patient R.L.T. is a Born Patient R.L.T. always
Again Christian and he prays that he will get
stated that he always better soon. He believes
prays. He goes with his that his faith will help
family to their church him recover from his
every Sunday. Patient condition. “Nag dadasal
does not believe in any po ako na sana gumaling
superstitious beliefs. ako kaagad.” as
verbalized by the
patient. He always
listens every time there
is a mass in the
hospital.
ANATOMY AND PHYSIOLOGY
Blood is a specialized bodily

fluid that delivers necessary
substances to the body's
cells – such as nutrients
and oxygen – and transports
waste products away from
those same cells. In
vertebrates, it is composed
of blood cells suspended in a
liquid called blood plasma.
Plasma, which comprises 55%
of blood fluid, is mostly
water (90% by volume), and
contains dissolved proteins,
glucose, mineral ions,
hormones, carbon dioxide
(plasma being the main medium for excretory product transportation), platelets
and blood cells themselves. The blood cells present in blood are mainly red
blood cells (also called RBCs or erythrocytes) and white blood cells,
including leukocytes and platelets. The most abundant cells in vertebrate
blood are red blood cells. These contain hemoglobin, an iron-containing
protein, which facilitates transportation of oxygen by reversibly binding to
this respiratory gas and greatly increasing its solubility in blood.
Function of the blood
Transports:
• Dissolved gases (e.g. oxygen, carbon dioxide);
• Waste products of metabolism (e.g. water, urea);
• Hormones;
• Enzymes;
• Nutrients (such as glucose, amino acids, micro-nutrients (vitamins &
minerals), fatty
acids, glycerol);
• Plasma proteins (associated with defense, such as blood-clotting and anti-

bodies);
• Blood cells (incl. white blood cells 'leucocytes', and red blood cells
'erythrocytes').
Maintains Body Temperature

Controls pH
• The pH of blood must remain in the range 6.8 to 7.4, otherwise it begins to
damage cells.
Removes toxins from the body
• The kidneys filter all of the blood in the body (approx. 8 pints), 36 times
every 24 hours. Toxins removed from the blood by the kidneys leave the body in
the urine. (Toxins also leave the body in the form of sweat.)
Regulation of Body Fluid Electrolytes18
• Excess salt is removed from the body in urine, which may contain around 10g
salt per day (such as in the cases of people on western diets containing more
salt than the body requires).
Composition of the Blood

1. RED BLOOD CELLS
Red blood cells are the most common cells found in blood. There are about 5
million red blood cells in each cubic millimeter of blood or approximately 250
million red blood cells in every drop of blood. This number varies with
individuals in accordance to heredity, gender and state of health. These cells
are produced by the bone marrow and have a lifespan of 3-4 months. When they
die, they are destroyed by macrophages in the liver and spleen. This process
releases iron to be stored in the liver and bile pigments to be excreted.
Functions:
Red blood cells are important in the process of respiration. Gases involved in
respiration are carried around the body through these cells. Oxygen readily
combines with hemoglobin to form oxy-hemoglobin in the lungs where there is
high concentration of oxygen. However, oxy-hemoglobin is an unstable compound
and will break down to release oxygen when there is low concentration of
oxygen in the surroundings. Hence there will be an even distribution of oxygen
to all parts of the body. Red blood cells also carry part of the carbon
dioxide waste from the cells through most is transmitted through plasma as
soluble carbonates.
2. PLASMA
Plasma is a pale yellowish fluid with a total volume of 2-3 liters in a normal
adult.
3. WHITE BLOOD CELLS
White blood cells are responsible for the defense system in the body. There
are approximately 6,000 white blood cells per millimeter of blood or ½ a
million white blood cells in every drop of human blood. White blood cells
fight infections and protect our body from foreign particles, which includes
harmful germs and bacteria. White blood cells, the red blood cells are formed
from the stem cell of the bone marrow. It has a life-span of a couple of days.
When they die, they are destroyed by surrounding white blood cells and
replaced with new ones.
Types of WBC
Neutrophils make up 55%-70% of the total white blood count in the bloodstream.
They have a segmented nucleus and it is said to be ‘C’ shaped. Neutrophils
can be most commonly found near sites of infection or injury where they will
stick to the walls of the blood vessels and engulf any foreign particles that
try to enter the bloodstream. They can also be found in the pus of wounds.
Eosinophils make up 2%-5% of the total blood count and mainly attacks
parasites and any antigen complexes. These cells are also responsible for
allergic response within the blood.
Basophils make up less than 1% of the total white blood count. They secrete
anti-coagulant and antibodies, which mediate hypersensitivity reactions within
the blood. They are known to have phagocytory features though they are more
often related to immediate immune reaction against external germs and
diseases.
Monocytes, though having only 5%-8% in the total white blood count, are the
largest of the 5 types of white blood cells. They act as tissue macrophages
and remove foreign particles and prevent the invasion of germs which cannot be
effectively dealt with by the neutrophils. They have been known to have
phagocytic functions.
Lymphocytes produce anti-bodies against toxins secreted by bacteria and
infecting germs. These antibodies will be excreted into the plasma to kill
bacteria in the blood as well as act as anti-toxins. These anti-bodies will
cause the foreign particles to cluster together, rendering them easily
engulfed by the phagocytes. However, the nature of lymphocytes is highly
specific and they can only recognize certain antigens.
4. PLATELET18
Platelets are granular non-nucleated fragments of cytoplasm in the form of
oval discs. A platelet consists of two parts, a clear outer ground substance
occupying the greater part of the platelet and a central part that contains
granules.
Function:
They secrete a hormone called serotonin which constricts torn blood vessels.
They also have a major role in accumulating at sites of injury sticking
together to plug gaps in broken blood vessels. They are rich in a certain
activator that activates some proteins found in plasma. These proteins are
thrown out in the form of fibers as a network. This network traps the escaping
RBCs and forms a clot that will seal the cut blood vessels and so bleeding is
stopped.
DRUG STUDY
Ferrous Sulfate
Classification Brand- Indication Mechanism of Contraindicatio Adverse Nursing
Generic Action n Reaction Responsibilities
Name
Pharmacological Generic Indicated for Elevates serum Allergy to any Gastrointestina Assessment and Drug
class: Name: the treatment iron ingredient; l disorders: Effects
of iron- concentration, sulphite
Iron supplement Ferrous and is then allergy; Gastrointestina
deficiency
Sulfate converted to hemochromatosis l irritation,
anemia  Assess nutritional
Hgb or trapped , hemolytic nausea,
status and dietary
Therapeutic in the anemia vomiting,
history to
class: Brand Name: reticuloendoth epigastric determine possible
elial cells pain, diarrhea,
Antianemics Fersulfate cause of anemia
for storage constipation, and need for
and eventual tooth patient teaching.
conversion to discoloration,  Monitor bowel
a usable form abdominal movements as
of iron
Dosage/Route/ discomfort constipation is a
Frequency: common adverse
effect.
325mg/ tab/ PO/ Immune system
TID disorders: Hyp Patient and Family
ersensitivity Teaching
 Educate the client

for changes in
stool color to
green as a side
effect of the
drug.
Instruct client
that consuming citrus
fruit or tomato juice
with iron preparation
(except the elixir)
may increase its
absorption.
Albendazole
Classification Brand- Indication Mechanism of Contraindicatio Adverse Reaction Nursing
Generic Action n Responsibilities
Name
Drug Generic For the Albendazole Albendazole is Blood and  Monitor patient
Classification: Name: treatment of causes contraindicated lymphatic system response to
Antihelmintics Albendazole parenchymal degenerative in patients disorders: Leuk therapy.
neurocysticerc alterations in with a history openia,
Dosage and osis due to the tegument of neutropenia.  Monitor for
Route: Brand Name: active lesions and intestinal hypersensitivit adverse effects
Albenza
caused by cells of the y to (e.g. orientation
400mg/Oral Eye
larval forms worm by albendazole, and affect,
disorders: Blur
of the pork diminishing benzimidazoles, nutritional
red vision.
tapeworm, Tae its energy or any state, skin color
nia production, component of and lesions,

solium and ultimately the Gastrointestinal hepatic function,
for the leading to formulation. disorders: Abdo and reports of
treatment of immobilization minal pain, abdominal
cystic hydatid and death of nausea, discomfort and
disease of the the parasite. vomiting, pain, etc).
liver, lung, It works by diarrhoea.
and binding to the
 Assess for the
peritoneum, colchicine-
General mentioned
caused by the sensitive site
disorders and cautions and
larval form of of tubulin,
administration contraindications
the dog thus
site (e.g. known
tapeworm, Ech inhibiting its
conditions: Fev allergies,
inococcus polymerization
er, asthenia. hepatorenal
granulosus. or assembly
dysfunction,
into
pregnancy and
microtubules. Hepatobiliary
lactation, etc.)
As cytoplasmic disorders: Mild
to prevent any
microtubules to moderate
untoward
are critical hepatic enzyme
complications.
in promoting elevation,
glucose uptake hepatitis, acute
 Perform a
in larval and liver failure.
thorough physical
adult stages
assessment (other
of the
Musculoskeletal medications
susceptible
and connective taken, reflexes
parasites, the
tissue and muscle
glycogen
disorders: Rhab strength, skin
stores of the domyolysis. color,

parasites are temperature,
depleted. texture, etc.) to
Nervous system
Degenerative establish
disorders: Head
changes in the baseline data
ache, dizziness,
endoplasmic before drug
somnolence,
reticulum, the therapy begins,
convulsion.
mitochondria to determine
of the effectiveness of
germinal Renal and therapy, and to
layer, and the urinary evaluate for
subsequent disorders: Acut occurrence of any
release of e renal failure. adverse effects
lysosomes associated with
result in drug therapy.
decreased Skin and
production of subcutaneous  Assess the
adenosine tissue patient’s liver
triphosphate disorders: Itch function,
(ATP), which iness, rash, including liver
is the energy alopecia, function tests to
required for erythema determine
the survival multiforme, appropriateness
of the Stevens-Johnson of therapy and to
helminth. syndrome. monitor for
toxicity.
Potentially
Fatal: Hypersen  Obtain a culture
sitivity of stool for
reactions e.g. ova and parasites
rash, pruritus, to determine the
urticaria; bone infecting worm
marrow and establish
suppression, appropriate
granulocytopenia treatment.
, pancytopenia,
aplastic  Assess the
anaemia, abdomen to
agranulocytosis. evaluate for any
changes from
baseline related
to the infection,
identify possible
adverse effects,
and monitor for
improvement.
Mebendazole
Classification Brand-Generic Indication Mechanism of Contraindicatio Adverse Reaction Nursing
Name Action n Responsibilities
Drug Class: Generic Name: For the Mebendazole Mebendazole is Significant: Bo  Monitor patient
Antihelmintic Mebendazole treatment causes contraindicated ne marrow vital sign.

of Enterobi degenerative in patients suppression e.g.
Dosage: us alterations in with known agranulocytosis,  Monitor patient
500 mg vermicularis the tegument hypersensitivit neutropenia. response to
Brand Name: (pinworm), and intestinal y to therapy.
Vermox Trichuris cells of the benzimidazole
Gastrointestinal
trichiura ( worm by class of  Monitor for
disorders: Diar
whipworm), binding to the compounds, in adverse effects
rhoea,
Ascaris colchicine- pregnancy, and (e.g. orientation
flatulence,
lumbricoides sensitive site in children <2 and affect,
abdominal pain,
(common of tubulin, years of age. nutritional
anorexia.
roundworm), thus state, skin color
Ancylostoma inhibiting its and lesions,
duodenale ( polymerization Hepatobiliary hepatic function,
common or assembly disorders: Hepa and reports of
hookworm), into titis, abnormal abdominal
Necator microtubules. liver tests. discomfort and
americanus The loss of pain, etc).
(American the
hookworm) in cytoplasmic Nervous system
disorder: Convu  Assess for the
single or microtubules
lsion, headache, mentioned
mixed leads to
dizziness. cautions and
infections. impaired
contraindications
uptake of
(e.g. known
glucose by the Skin and allergies,
larval and subcutaneous hepatorenal
adult stages tissue dysfunction,
of the disorders: Exan pregnancy and
susceptible thema, lactation, etc.)

parasites, and angioedema, to prevent any
depletes their urticaria, untoward
glycogen alopecia, rash. complications.
stores.
Degenerative  Perform a
Potentially
changes in the thorough physical
Fatal: Toxic
endoplasmic assessment (other
epidermal
reticulum, the medications
necrolysis,
mitochondria taken, reflexes
Stevens-Johnson
of the and muscle
syndrome.
germinal strength, skin
layer, and the color,
subsequent temperature,
release of texture, etc.) to
lysosomes establish
result in baseline data
decreased before drug
production of therapy begins,
adenosine to determine
triphosphate effectiveness of
(ATP), which therapy, and to
is the energy evaluate for
required for occurrence of any
the survival adverse effects
of the associated with
helminth. Due drug therapy.
to diminished
energy  Assess the

production, patient’s liver
the parasite function,
is immobilized including liver
and eventually function tests to
dies. determine
appropriateness
of therapy and to
monitor for
toxicity.
 Obtain a culture
of stool for
ova and parasites
to determine the
infecting worm
and establish
appropriate
treatment.
 Assess the
abdomen to
evaluate for any
changes from
baseline related
to the infection,
identify possible
adverse effects,
and monitor for

improvement.
Ferusemide
Classification Brand- Indication Mechanism of Action Contraindication Adverse Nursing
Generic Reaction Responsibilities
Name
Therapeutic Generic Furosemide Furosemide promotes Contraindicated  Assess fluid
CNS: vertigo,
class: Name: is diuresis by blocking in patients status. Monitor
Antihypertensiv Furosemide indicated tubular reabsorption hypersensitive headache, daily weight,
e for the of sodium and to drug and in dizziness, intake and output
treatment chloride in the those with ratios, amount and
of edema proximal and distal paresthesia, location of edema,
anuria.
Brand Name: associated tubules, as well as weakness, lung sounds, skin
Pharmacologic
Lasix with in the thick turgor, and mucous
class: Loop congestive ascending loop of restlessness, membranes. Notify
diuretics heart Henle. This diuretic Premature health care
fever.
failure, effect is achieved infants may be professional if
cirrhosis through the at increased CV: thirst, dry mouth,
of the competitive risk for lethargy,
liver, and inhibition of persistent orthostatic weakness,
renal sodium-potassium- patent ductus hypotension, hypotension, or
disease, chloride arteriosus with oliguria occurs.
including cotransporters thrombophlebi
furosemide
the (NKCC2) expressed treatment during tis with lV  Monitor BP and
nephrotic along these tubules first weeks of pulse before and

administratio
syndrome, in the nephron, life. during
in adults preventing the n. administration.
and transport of sodium Monitor frequency
pediatric ions from the ENT: blurred of prescription
patients.9 lumenal side into or yellowed refills to
the basolateral side determine
Oral for reabsorption. vision, compliance in
furosemide This inhibition transient patients treated
is results in increased for hypertension.
indicated excretion of water deafness,
alone for along with sodium, tinnitus.  Assess patient for
the chloride, magnesium, skin rash
management calcium, hydrogen, Gl: Abdominal frequently during
of mild to and potassium therapy.
moderate ions.10 As with discomfort Discontinue
hypertensio other loop and pain, furosemide at
n or severe diuretics, first sign of
hypertensio furosemide decreases diarrhea, rash; may be life-
n in the excretion of anorexia,naus threatening.
combination uric acid.8 Stevens-Johnson
with other ea, vomiting, syndrome, toxic
antihyperte Furosemide exerts constipation, epidermal
nsive direct vasodilatory necrolysis, or
pancreatitis.
medications effects, which erythema
.12 results in its multiforme may
GU: azotemia, develop. Treat
therapeutic
Intravenous effectiveness in the nocturia, symptomatically;
furosemide treatment of acute may recur once
polyuria,
is pulmonary edema. treatment is
frequent
indicated Vasodilation leads stopped.

urination,
as to reduced
adjunctive responsiveness to oliguria.  Instruct patient
therapy in vasoconstrictors, to take furosemide
acute such as angiotensin Hematologic as directed. Take
pulmonary II and agranulocytos missed doses as
edema when noradrenaline, and soon as possible;
a rapid decreased production is, aplastic do not double
onset of of endogenous anemia, doses.
diuresis is natriuretic hormones
desired with leukopenia,  Caution patient to
vasoconstricting anemia. change positions
properties. It also slowly to minimize
leads to increased Hepatic: orthostatic
production of hypotension.
prostaglandins with Hepatic
vasodilating dysfunction,j  Caution patient
properties. that the use of
Furosemide may also aundice, alcohol, exercise
open potassium increased during hot
channels in weather, or
resistance liver enzyme standing for long
arteries.8 The main levels. periods during
mechanism of action therapy may
of furosemide is Metabolic: enhance
independent of its orthostatic
inhibitory effect on volume hypotension.
carbonic anhydrase depletion and
and aldosterone.9
dehydration,
asymptomatic
hyperuricemia
, impaired
glucose
tolerance,
hypokalemia,
hypochloremic
alkalosis,
hyperglycemia
.
NURSING CARE PLAN

Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Activity After 8 hours of Independent: Independent

intolerance nursing
“Nanghihina ako related to intervention the  Assess patient  Influences
di ko matapos imbalance client will; ability to choice of
tapos mg gawain between oxygen perform normal intervention
ko” as supply and task or or needed
verbalized by demand as activities of assisstance.
the patient.  Report daily living.
evidenced of increase of  May indicate
client’s activity  Note changes neurological
complain of intolerance in balance, changes
Objective: feeling weak including and muscle associated
 Fatigue activities weakness. with vitamin
of daily B12
 Dizziness living deficiency.
Vital Signs;  Demonstrate  Recommend a  Enhanced rest
a decrease quiet to lower body
BP: 110/60 atmosphere and
in oxygen
Temp: 36.6C physiologica bed rest. requirements
l signs of and reduced
RR: 20
tolerance strain on the
PR: 74 heart and
lungs.
O2 Sat: 99%
 Elevate the  enhances lung
head as expansion to
tolorated. maximize
oxygen for
cellular
uptake.
 Self-esteem
is enhanced
when patient
 Provide does some
assistance of things for
daily living his self.
or ambulation
as necessary.
COLLABORATIVE: COLLABORATIVE:
1. Monitor 1. Identifies
laboratory deficiency in
studies, RBC
hemoglobin,Hct components
and RBC count, affecting
arterial blood oxygen
gases (ABGs) transport and
treatment
needs.
REFERENCES
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1053245/pdf/brjvendis00199-0134.pdf
https://www.webmd.com/heart/anatomy-picture-of-blood
https://www.verywellhealth.com/blood-dyscrasias-4788341#toc-definition-and-basics
https://medlineplus.gov/druginfo/meds/a610019.html
https://www.mims.com/philippines/drug/info/furosemide?mtype=generic
https://go.drugbank.com/drugs/DB00695
https://www.webmd.com/drugs/2/drug-6261/albendazole-oral/details
https://nurseslabs.com/anthelmintics/
https://www.osmosis.org/learn/Anthelmintics:_Nursing_Pharmacology
https://nursing.com/lesson/drug-furosemide-lasix/
https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51345/all/furosemide
https://nursing.com/lesson/drug-furosemide-lasix/

Case Study ON: Blood Dyscrasia

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Case Study ON: Blood Dyscrasia

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University of Saint Louis

Tuguegarao City, Cagayan 3500

Blood dyscrasias may involve:

Causes of Blood Dyscrasias

 Cancers: Blood dyscrasias include certain cancers, such

Types and Classification

Terminology for an Increase or Decrease in Blood Cells

Cell type Excess Deficiency

Red blood Erythrocytosis or

Platelets Thrombocytosis Thrombocytopenia

Red Blood Cell and Hemoglobin Disorders

Some red blood cell disorders include:

 Nutritional deficiencies: These include iron deficiency anemia or

 Hemoglobinopathies: Hemoglobin is a protein found in red blood cells.

White Blood Cell Disorders

 Proliferative disorders: Leukemias are cancers in which abnormal white

Platelet disorders may be caused by too many (thrombocytosis) or too few

Platelets are an essential part of the clotting process, so there is some

Thrombocytopenia (a low platelet count) may be caused by:

 Decreased production of platelets. Examples include bone marrow

Thrombocytosis (thrombocythemia) is an elevated platelet count. It can be

Platelet disorders that affect normal functioning can be caused by liver or

Bleeding disorders can be broken down into four major categories:

 Platelet disorders: (discussed above).

 Fibrinolytic defects: Even when a clot forms properly, it may be broken

Clotting Disorders (Thrombosis)

 Factor V Leiden mutation

Others are related to conditions like:

Bone Marrow Disorders

 Blood-related cancers in the bone marrow such as leukemia and

Red Blood Cells

Anemia can cause a number of symptoms, including:

White Blood Cells

 Lungs: Cough or coughing up blood, shortness of breath

The symptoms of bleeding disorders overlap with platelet conditions. Specific

Risk factors for blood clots include bed rest, recent surgery, cancer,

Bone Marrow Disorders and Malignancies

 Enlarged lymph nodes

Tests to Evaluate Blood Dyscrasias

 Complete blood count (CBC): This test will provide the number of red

 Peripheral blood smear for morphology: This is an extremely important

Based on CBC results, other tests may be recommended:

 Hemoglobin electrophoresis, to look for thalassemias

Evaluation of Bone Marrow

A bone marrow biopsy and aspiration can provide a lot of information about

Tests to evaluate platelet function may include:

If healthcare provider suspects a patient’s blood clots more easily than

History of Present Illness

History of Past Illness

1st Child (Patient) 2nd Child

believes to the galaw lang napapagod na

stated that he likes to chicken, he chose not to

church namin naglalakad paglalakad ko nalang

understand and speak cooperates well.

Role-Relationship Patient R.L.T. belongs Patient R.L.T. stated

himself as a healthy he would get better. He

ANATOMY AND PHYSIOLOGY

Blood is a specialized bodily

• Plasma proteins (associated with defense, such as blood-clotting and anti-

Maintains Body Temperature

Composition of the Blood

 Educate the client