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‫‪Republic of Yemen‬‬ ‫الجمهوريـــة اليمنــــية‬

‫‪Ministry of Higher Education& Scientific‬‬
‫‪Research‬‬
‫وزارة التعليـم العـالــي والبحث‬
‫‪Al-Razi University‬‬ ‫العلمي‬
‫‪College of Medical Sciences‬‬ ‫جامعة الرازي‬
‫‪Applied of Medical Sciences‬‬
‫كلية العلوم الطبية‬
‫الدارسات العلياء‬

‫‪Hematologic Emergency‬‬

‫اعدد الطالب ‪/‬‬

‫وحيد ابكر الشمري‬
‫تحت راشاف الدكتور ‪/‬‬
‫مرزوق عوضة‬
‫‪1‬‬
 Hematological Emergencies

❖ Outline Of Lecturer

1. Abnormalities of haemostasis

2. Disseminated intravascular coagulation

3. Disseminated Intravascular Coagulation (DIC)

4. Immune Thrombocytopenic Purpura

5. Acute Leukemia

6. Thrombotic Thrombocytopenic Purpura (TTP)

7. Acute Hemolytic Anemia

8. Chronic Hemolytic Anemia

9. Sickle cell anemia

10.Nursing Management oh Hematological Emergency

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 Haemostasis
This is the process of clot formation in the walls of damaged blood vessels to prevent
blood loss, whilst, at the same time, maintaining blood in a fluid state within the
vascular system.
 Blood disorders occur when there is an imbalance in haemostasis.
1. If blood becomes too thin, it loses the ability to form the blood clots that stop
bleeding.
2. If blood becomes too thick, the risk of blood clots developing within the blood
vessels I, creating a potentially life-threatening condition such as Disseminated
intravascular coagulation DIC
Abnormalities of haemostasis

▪ People with bleeding disorders bleed easily and may lose excessive amounts of blood as a
result of injuries, surgery, or dental surgery.
▪ Severe bleeding disorders may even cause spontaneous bleeding without any injury.
▪ Injury to a blood vessel initiates a series of events that result in the formation of a clot
(hemostasis).
Pathophysiology of Abnormalities of haemostasis
▪ Abnormalities of hemostasis disrupt the body's ability to regulate blood clotting.
▪ Defects in platelets, coagulation factors, or blood vessels can contribute to these
abnormalities.
Types of Abnormalities
1. Bleeding Disorders:
✓ Hemophilia: Inherited deficiency of clotting factors, leading to prolonged bleeding.
✓ von Willebrand disease: Deficiency or dysfunction of von Willebrand factor, affecting
platelet function and clotting.
2. Clotting Disorders:
1. Deep Vein Thrombosis (DVT): Formation of blood clots in deep veins, commonly in
the legs.
2. Pulmonary Embolism (PE): Blockage of pulmonary arteries by blood clots originating
from DVT or other sources.

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 3. Disseminated Intravascular Coagulation (DIC): Widespread activation of clotting
factors, causing excessive clotting and subsequent bleeding.
Clinical Features Abnormalities of haemostasis
✓ Bleeding Disorders: Easy bruising, prolonged bleeding after injury or surgery, excessive
bleeding from minor cuts, nosebleeds, heavy menstrual bleeding.
✓ Clotting Disorders: Pain, swelling, redness in the affected area (DVT), sudden shortness
of breath, chest pain, coughing up blood (PE), signs of organ dysfunction (DIC).
Diagnosis Abnormalities of haemostasis
1. Obtain medical history and conduct a physical examination.
2. Perform laboratory tests like Complete Blood Count (CBC), coagulation profile (PT,
aPTT, INR), von Willebrand factor assay, specific factor assays, D-dimer test, etc.
3. Utilize imaging studies such as ultrasound, CT scan, or MRI to diagnose DVT or PE.
Prognosis Abnormalities of haemostasis
 Prognosis varies based on the specific disorder and its severity.
 With proper management, many patients can lead relatively normal lives, while severe
cases may require ongoing medical intervention and monitoring.
Management Abnormalities of haemostasis
1. Bleeding Disorders:Hemophilia:
1. Replacement therapy with deficient clotting factors, such as factor VIII for Hemophilia A
or factor IX for Hemophilia B.
2. Regular prophylactic infusions of clotting factors to prevent bleeding episodes.
3. von Willebrand disease:
4. Desmopressin (DDAVP) administration to release stored von Willebrand factor and
improve platelet function.
5. Replacement therapy with von Willebrand factor concentrates if desmopressin is
ineffective.
2. Clotting Disorders:
- Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE):
✓ Anticoagulant therapy with medications such as heparin or low molecular weight
heparin initially, followed by oral anticoagulants like warfarin or direct oral
anticoagulants (DOACs).
✓ Thrombolytic therapy may be considered in severe cases.
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- Disseminated Intravascular Coagulation (DIC):
✓ Address and treat the underlying cause.
✓ Transfusion of blood products (platelets, fresh frozen plasma, cryoprecipitate) to correct
coagulation abnormalities.
✓ Supportive care for organ dysfunction and bleeding complications.- Surgical
Management:
✓ Surgical interventions may be necessary, such as removing blood clots or repairing
damaged blood vessels.
- Nursing Management:
1. Assessment:
✓ Perform a comprehensive assessment to identify the specific bleeding or clotting
disorder, its severity, and any associated symptoms or complications.
✓ Monitor vital signs, including blood pressure, heart rate, and respiratory rate.
✓ Assess for signs of bleeding, such as petechiae, purpura, ecchymosis, or excessive
bleeding from wounds or mucous membranes.
✓ Assess for signs of clotting, such as swelling, redness, warmth, or pain in the affected
area.
2. Medication Administration:
✓ Administer prescribed medications as ordered, such as clotting factor replacements,
anticoagulants, or thrombolytics.
✓ Monitor the effectiveness of medications and document any adverse reactions or
complications.
✓ Educate the patient and their family about the purpose, dosage, and potential side effects
of prescribed medications.
3. Monitoring and Interventions:
✓ Monitor laboratory values, including coagulation profiles (PT, aPTT, INR), platelet
counts, and fibrinogen levels.
✓ Assess and document the patient's response to treatment, including any improvement or
worsening of symptoms.
✓ Implement measures to prevent bleeding or injury, such as providing a safe environment,
using gentle handling techniques, and ensuring the patient receives appropriate protective
equipment.
✓ Apply pressure or use appropriate measures to control bleeding if necessary.

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 ✓ Monitor for signs of complications, such as excessive bleeding, hematoma formation, or
signs of thrombosis.
4. Education and Support:
✓ Provide patient and family education on the specific bleeding or clotting disorder,
including its causes, treatment options, and potential complications.
✓ Teach the patient about self-care measures, such as managing bleeding episodes,
administering medications, and recognizing signs of bleeding or clotting.
✓ Promote adherence to the treatment plan, including regular follow-up visits and
laboratory monitoring.
✓ Offer emotional support and counseling to help the patient cope with the challenges of
living with a bleeding or clotting disorder.

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 Disseminated Intravascular Coagulation (DIC)
DIC is a condition where the coagulation and fibrinolytic systems are activated, leading to clot
formation and breakdown. It can be caused by infections, malignancies, trauma, liver disease,
or environmental factors. DIC can be acute and life-threatening or chronic and compensated.

▪ Causes Disseminated Intravascular Coagulation (DIC):

Common causes of DIC include:
1. Severe injury or trauma from car accidents or sports-related accidents.
2. Severe inflammation associated with acute infections or sepsis.
3. Severe burns.
4. Blood cancers.
5. Inherited blood clotting disorders.
▪ Signs and Symptoms:
The signs and symptoms associated with DIC can vary and may include:
1) Multiple severe bleeding in different parts of the body, such as gums, nose, gastrointestinal
tract, and urinary tract.
2) Appearance of petechiae or bruises on the skin.
3) Swelling or pain in the extremities.
4) Shortness of breath or chest pain.
5) Changes in organ functions such as the liver, kidneys, and lungs.
▪ Risk Factors: Risk factors for DIC include diseases and conditions such as:
1. Blood cancers.
2. Severe inflammation associated with infections.
3. Severe burns.
4. Complicated pregnancy.
5. Major surgeries.
6. Acute injuries.
Diagnostic Methods diagnosis of DIC involves the following tests and examinations:
1. Blood tests to measure platelet levels, clotting factors, and the prothrombin time.
2. Examination of the clotting blood under a microscope.
3. Radiographic imaging to evaluate the functions of different organs.
4. FDP and D-dimer may help differentiate DIC from other causes of prolonged coagulation
times and low platelets; the D-dimer may be more specific than FDP in diagnosing DIC.
5. Additional laboratory findings include increased LDH, decreased haptoglobin
levels, and a peripheral smear with schistocytes.

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Differential Diagnosis DIC:
Differential diagnosis aims to exclude other conditions that may cause similar symptoms, such
as hypovolemic shock, decreased platelet count, and clotting disorder-related skin diseases.
Treatment for DIC usually involves several aspects, including:
1. Addressing the underlying cause or triggering factor, such as treating infections or
managing complications.
2. Replacing clotting factors and platelets through transfusions.
3. Administering anticoagulant medications to prevent further clot formation.
4. Supportive care measures, such as maintaining fluid and electrolyte balance and
managing organ dysfunction.
DIC can cause serious complications, including:
1. Organ failure: Different organs in the body may be affected due to the formation of
blood clots in the blood vessels.
2. Severe bleeding: Excessive bleeding may occur in the body due to the depletion of
clotting factors in the blood.
3. Blood clots: Blood clots may form in small and large blood vessels in the body.
DIC Prevention
It is difficult to completely prevent DIC, but some measures can be taken to reduce the
risk, such as:
1. Maintaining good health by avoiding infections and following a healthy lifestyle.
2. Avoiding severe injuries and exposure to extreme trauma.
3. Taking medications cautiously according to medical guidance.
DIC Follow-up:
After treatment and improvement of DIC, regular medical follow-up may be necessary to
ensure the patient's stability and recovery.
Nursing diagnosis and intervention for DIC may involve:
1. Impaired Tissue Perfusion related to microvascular thrombosis:
▪ Monitor vital signs frequently and assess tissue perfusion.
▪ Administer prescribed blood products, such as fresh frozen plasma, platelets, or
cryoprecipitate, to support clotting factor levels.
▪ Position the patient to promote optimal tissue perfusion.
▪ Monitor for signs of bleeding and promptly report any changes.

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2. Risk for Bleeding related to consumption of clotting factors and platelets:
▪ Implement bleeding precautions, such as using a soft-bristle toothbrush and avoiding
invasive procedures if not necessary.
▪ Monitor laboratory values, including platelet count, fibrinogen levels, and coagulation
profile, to detect any changes.
▪ Administer prescribed anticoagulant therapy carefully, considering the balance
between preventing clotting and avoiding bleeding complications.
▪ Educate the patient and family about signs and symptoms of bleeding, emphasizing
the importance of reporting any unusual bleeding or bruising.
3. Acute Pain related to tissue ischemia and microvascular thrombosis:
▪ Assess pain level regularly using a pain scale and document the findings.
▪ Administer prescribed pain medications, such as analgesics or anticoagulants, as
appropriate.
▪ Provide comfort measures, such as positioning, warm compresses, or relaxation
techniques, to alleviate pain.
▪ Educate the patient about pain management strategies and encourage the use of non-
pharmacological pain relief methods.
4. Risk for Infection related to invasive procedures and immunosuppression:
▪ Implement strict infection control measures, such as hand hygiene, proper use of personal
protective equipment, and aseptic techniques during procedures.
▪ Monitor for signs and symptoms of infection, such as fever, increased white blood cell
count, or localized redness and swelling.
▪ Administer prescribed prophylactic antibiotics as ordered.
▪ Educate the patient and family about the importance of infection prevention strategies
and the need for prompt reporting of any signs of infection.
5. Impaired Gas Exchange related to microvascular thrombosis and tissue ischemia:
▪ Monitor respiratory status closely, including oxygen saturation levels and
respiratory rate.
▪ Administer supplemental oxygen as prescribed to maintain adequate oxygenation.
▪ Encourage deep breathing exercises and frequent position changes to optimize lung
function.
▪ Provide emotional support and reassurance to reduce anxiety, which can affect
respiratory function.

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 Immune Thrombocytopenic Purpura
Immune Thrombocytopenic Purpura (ITP): ITP is an autoimmune disorder where the immune
system mistakenly destroys platelets, leading to a decrease in their count. This can cause
excessive bleeding and bruising.

Causes of Immune Thrombocytopenic Purpura

1. ITP is an autoimmune disorder where the immune system mistakenly attacks and
destroys platelets, leading to a low platelet count.
2. The exact cause of ITP is unknown, but it can be triggered by viral infections, certain
medications, or other underlying autoimmune conditions.
Pathophysiology of Immune Thrombocytopenic Purpura
✓ Antibodies, produced by the immune system, attach to platelets and mark them for
destruction by the spleen and liver.
✓ This destruction leads to a decreased platelet count, resulting in abnormal bleeding or
bruising.

Types of Immune Thrombocytopenic Purpura

ITP can be classified into two types: acute and chronic.
1. Acute ITP usually occurs in children after a viral infection and resolves within six
months.
2. Chronic ITP lasts longer than six months and can affect both children and adults.
Clinical Features of Immune Thrombocytopenic Purpura
1. Common symptoms include petechiae (small red or purple spots on the skin), easy
bruising, nosebleeds, and excessive bleeding after minor injuries or surgeries.
2. Severe cases may present with spontaneous bleeding, such as gastrointestinal or
intracranial bleeding.
Diagnosis Immune Thrombocytopenic Purpura
1. Diagnosis is based on a thorough medical history, physical examination, and blood
tests to assess platelet count and function.
2. Additional tests, such as bone marrow examination or imaging studies, may be
required to rule out other causes of thrombocytopenia.
Prognosis Immune Thrombocytopenic Purpura
1. The prognosis for ITP varies depending on the type and individual response to
treatment.
2. Acute ITP in children often resolves spontaneously, while chronic ITP may require long-
term management.
Medical Management Immune Thrombocytopenic Purpura
1. Treatment options include corticosteroids, immunosuppressive drugs, intravenous
immunoglobulin (IVIG), and thrombopoietin receptor agonists.
2. The goal is to increase platelet count and prevent bleeding while minimizing side
effects.
Surgical Management of Immune Thrombocytopenic Purpura
 Surgery is rarely indicated in ITP. It may be considered in life-threatening situations,
such as uncontrollable bleeding, where splenectomy (removal of the spleen) may be
performed.
Nursing Management of Immune Thrombocytopenic Purpura
✓ Nursing care focuses on monitoring for signs of bleeding, providing emotional support to
patients and their families, and educating them about the condition and treatment options.
✓ Nurses also play a crucial role in ensuring medication adherence and managing potential
side effects.

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 Acute Leukemia

Acute Leukemia: Acute leukemia is a type of cancer that affects the blood and bone marrow. It
leads to the rapid production of abnormal white blood cells, inhibiting the production of healthy
blood cells.
Pathophysiology of Acute Leukemia:
▪ Acute leukemia is a type of cancer that affects the blood and bone marrow, causing
abnormal production of immature white blood cells.
▪ It results from genetic mutations in the stem cells of the bone marrow, leading to
uncontrolled growth and accumulation of immature cells (blasts).
▪ These abnormal cells interfere with the production of healthy blood cells, leading
to symptoms and complications.
Types of Acute Leukemia:
1. Acute lymphoblastic leukemia (ALL): Most common in children, characterized by the
overproduction of immature lymphoid cells.
2. Acute myeloid leukemia (AML): More common in adults, characterized by the
overproduction of immature myeloid cells.

Clinical Features of Acute Leukemia:

1. Fatigue, weakness, and pallor due to anemia.
2. Increased susceptibility to infections due to decreased normal white blood cells.
3. Easy bruising, bleeding gums, and petechiae due to low platelet count.
4. Bone pain, joint swelling, and enlarged lymph nodes.
5. Fever, weight loss, and night sweats.
Diagnosis of Acute Leukemia:
1. Blood tests: Complete blood count (CBC) to assess abnormal cell counts and
morphology.
2. Bone marrow aspiration and biopsy: Obtaining a sample of bone marrow to examine
the presence of abnormal cells.
3. Cytogenetic analysis: Studying the genetic abnormalities in leukemia cells.
4. Immunophenotyping: Identifying specific markers on the leukemia cells to determine
the type and subtype.
Prognosis of Acute Leukemia:
1. Prognosis varies depending on factors such as age, subtype of leukemia, genetic
abnormalities, and response to treatment.
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 2. Prompt diagnosis and initiation of appropriate treatment improve prognosis.
Management of Acute Leukemia:
1. Medical management involves chemotherapy, targeted therapy, and stem cell
transplant, depending on the subtype and patient characteristics.
2. Surgical management may include procedures like central venous catheter placement
for chemotherapy administration.
3. Nursing management includes monitoring vital signs, managing side effects of
treatment, providing emotional support, and educating patients and their families.
Medical Management of Acute Leukemia:
1. Chemotherapy: The mainstay of treatment for acute leukemia. It involves the use of
powerful drugs to kill cancer cells and induce remission.
2. Targeted therapy: In certain cases, targeted drugs may be used to specifically target
genetic mutations or abnormal proteins in leukemia cells.
3. Stem cell transplant: Also known as a bone marrow transplant, it involves replacing the
diseased bone marrow with healthy stem cells from a donor.

Surgical Management of Acute Leukemia:

1. Central venous catheter placement: A catheter is inserted into a large vein to facilitate
the administration of chemotherapy drugs and other medications.
2. Surgical procedures may be required to manage complications such as infections or
bleeding.
Nursing Management of Acute Leukemia:
1. Monitoring vital signs: Regular monitoring of temperature, blood pressure, heart rate,
and respiratory rate.
2. Managing treatment side effects: Assisting with symptom management, such as
nausea, vomiting, hair loss, and fatigue.
3. Infection control: Implementing strict infection prevention measures to minimize the
risk of infections.
4. Emotional support: Providing psychological support to patients and their families,
addressing fears and concerns.
5. Patient education: Educating patients and families about the disease, treatment options,
and self-care measures.

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 Thrombotic Thrombocytopenic Purpura (TTP)
Thrombotic Thrombocytopenic Purpura (TTP): TTP is a rare blood disorder characterized by
the formation of blood clots in small blood vessels throughout the body. This can lead to organ
damage and low platelet counts.
Pathophysiology Thrombotic Thrombocytopenic Purpura (TTP)
1. TTP is a rare disorder characterized by the formation of blood clots in small blood
vessels, leading to tissue damage.
2. It often occurs due to a deficiency in the ADAMTS13 protein, which helps break down
excessive von Willebrand factor (vWF) in the blood.
Types Thrombotic Thrombocytopenic Purpura (TTP)
- TTP can be divided into two main types:
1. Hereditary TTP
2. Acquired TTP.
Clinical features Thrombotic Thrombocytopenic Purpura (TTP)
▪ Common signs and symptoms of TTP include low platelet count
(thrombocytopenia), low red blood cell count (anemia), and enlarged spleen
(splenomegaly).
▪ Evidence of microvascular clotting can appear throughout the body, including the
skin (purpura) and internal organs such as the kidneys and brain.
Diagnosis Thrombotic Thrombocytopenic Purpura (TTP)
- Diagnosis involves blood tests to determine platelet count, kidney function, and other
evaluations of body functions. A detailed diagnosis usually requires a skin biopsy and
examination.

Prognosis Thrombotic Thrombocytopenic Purpura (TTP)

- Without prompt treatment, TTP can be fatal.
- With appropriate treatment, high survival rates can be achieved.

Management Thrombotic Thrombocytopenic Purpura (TTP)

✓ The main treatment is plasma exchange, where part of the infected plasma is replaced
with healthy plasma.
✓ Plasma exchange sessions are carried out several times during the treatment period.
✓ Immunosuppressive medications such as corticosteroids and acyclovir may be used to
help reduce the immune system's response to an excess.
Prevention of TTP:
▪ There is no direct or specific prevention of TTP.
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 ▪ In the case of a family history of the disease, genetic tests and tests are
recommended for the early detection of genetic defects associated with the disease.
▪ In case of symptoms similar to TTP, a doctor should be consulted immediately to
assess the condition and begin appropriate treatment
Nursing management
1. Monitoring and assessment:
✓ Monitor vital signs, including blood pressure, heart rate, and oxygen saturation.
✓ Assess the patient's neurological status, including level of consciousness and signs of
confusion or seizures.
✓ Monitor urine output and assess for signs of kidney dysfunction.
✓ Keep a close eye on laboratory values, including platelet count, hemoglobin, and renal
function tests.
2. Fluid and electrolyte balance:
✓ Maintain fluid balance by monitoring intake and output closely.
✓ Administer intravenous fluids, as prescribed, to maintain hydration and support kidney
function.
✓ Monitor electrolyte levels and administer appropriate electrolyte replacement, if
necessary.
3. Medication administration:
✓ Administer prescribed medications, such as immunosuppressive drugs or
corticosteroids, as directed by the healthcare team.
✓ Monitor for adverse reactions and report any concerns promptly.
✓ Educate the patient and their family about the purpose, dosage, and potential side
effects of medications.
4. Plasma exchange support:
✓ Collaborate with the interdisciplinary team to ensure the patient's readiness for plasma
exchange procedures.
✓ Provide emotional support and education to the patient and their family about the
procedure and its expected outcomes.
✓ Monitor the patient during and after the procedure, assessing for any adverse reactions.
5. Education and discharge planning:
✓ Educate the patient and their family about TTP, including its causes, symptoms,
and the importance of adherence to treatment.
✓ Provide information on the signs and symptoms that should prompt immediate
medical attention.

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✓ Coordinate with the healthcare team to develop a discharge plan that includes
follow-up appointments, medication management, and ongoing support.

14
 Acute Hemolytic Anemia
▪ This condition involves the rapid destruction of red blood cells, leading to a sudden
drop in hemoglobin levels. It can be caused by various factors, such as incompatible
blood transfusions or autoimmune reactions
▪ Anemia is a condition that causes a rapid decrease in the hemoglobin levels in the
blood.
▪ Anemia can result from factors such as iron deficiency, hemoglobin disorders, or folate
deficiency.
▪ It can lead to the destruction of red blood cells due to inadequate nutrition or immune
reactions.0
▪ Severe cases of anemia can result in frequent blood transfusions.
▪ Anemia should be diagnosed and treated by specialized medical professionals.
Normal Red Blood Cell (RBC) Values for Adults. A
Measure Male Female
RBC count (million/μL) 4.5–6.0 4.0–5.5
Hemoglobin (g/dL) 14–17 12–15
Hematocrit (%) 42–52 36–48
Mean corpuscular volume (FL) 78–100 78–102
Mean cellular hemoglobin (pg./cell) 25–35 25–35
Mean corpuscular hemoglobin concentration (g/dL) 32–36 32–36
Red cell distribution width (%) 11.5–14.5 11.5–14.5
Reticulocyte count (%) 0.5–2.5 0.5–2.5
Classification of Anemias.
Mean Mean Corpuscular
Type Corpuscular Hemoglobin Cause Other Hematologic Findings
Volume (fL) Concentration (g/dL)
Low reticulocytes, low serum ferritin and iron,
<80 <32 Iron deficiency high total iron-binding capacity

Variable, but usually Elevated reticulocytes, target cells, normal or

Microcytic <80 Thalassemias elevated serum ferritin and iron
<32
Chronic lead Basophilic red blood cell stippling
<80 <32
poisoning
Variable, but usually Sideroblastic Elevated serum iron; ring sideroblasts in bone
<80 marrow
<32 anemia

Normocytic 80–100 32–36 Acute blood loss Elevated platelets00

Hemolytic Elevated reticulocytes, low haptoglobin, elevated

80–100 32–36 LDH, and indirect bilirubin
anemia
Low reticulocytes; low serum iron and total
80–100 32–36 Chronic disease ironbinding capacity

Macrocytic >101 (usually Vitamin B12 or Macro elliptocytes, hyper segmented neutrophils
>36
>130) folate deficiency
>101–120 >36 Liver disease Decreased platelets

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 Acute Hemolytic Anemia
Acute Hemolytic Anemia is a condition characterized by the rapid destruction of red
blood cells, leading to a sudden decrease in overall blood count. This occurs due to an
immune reaction between antibodies and red blood cells, resulting in their breakdown
and destruction.

Types of Acute Hemolytic Anemia:

1. Immune Hemolytic Anemia:- This occurs when the immune system of the recipient
recognizes transfused red blood cells as foreign and targets them for destruction.
2. Drug-induced Hemolytic Anemia: -Certain medications can cause immune reactions
that lead to the destruction of red blood cells.
3. Genetic Factors: Some inherited genetic conditions can result in enzyme deficiencies in
red blood cells, making them more susceptible to hemolytic destruction.

Risk Factors of Acute Hemolytic Anemia

1. Family history of Hemolytic Anemia.

2. Use of specific medications known to cause immune reactions.
3. Presence of known genetic conditions that increase the risk of hemolytic destruction.

Signs and Symptoms of Acute Hemolytic Anemia

- Sudden loss of blood.

- Anemia.
- Changes in skin and mucous membrane color.
- Dark-colored urine.
- Jaundice (yellowing of the skin and eyes).
- Increased heart rate.
- Shortness of breath.
- Swollen lymph nodes.

Diagnostic Methods of Acute Hemolytic Anemia

1. Complete Blood Count (CBC) to evaluate red blood cell count, white blood cells, and
platelets.
2. Urine analysis to detect abnormal color changes.
3. Advanced blood tests (electrophoresis, genetic analysis) to diagnose genetic hemolytic
anemias.
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 4. Eye examination (retinal examination) to identify changes in blood vessels.

Treatment Options Acute Hemolytic Anemia

- Treating the underlying cause of Acute Hemolytic Anemia.

- Transfusion of packed red blood cells in cases of severe anemia.
- Use of medications that suppress the immune response.

Nursing Interventions:
- Monitor vital signs regularly.
- Assess and document the patient's symptoms and response to treatment.
- Administer prescribed medications and transfusions.
- Provide emotional support and education to the patient and their family.
- Monitor for potential complications and report any abnormalities to the healthcare
team.
~Waheed Abkr, [8/31/2023 1:05 AM]
2. Abnormalities of haemostasis Pathophysiology, types, Clinical

Acute hemolytic anemia is a condition characterized by the rapid destruction of red blood
cells (hemolysis), leading to a decrease in the number of circulating red blood cells.
Here's a breakdown of the key points related to the topic:

Causes and Pathophysiology:

✓ Acute hemolytic anemia can be caused by various factors, including autoimmune

disorders, transfusion reactions, infections, medications, toxins, or inherited
conditions such as sickle cell disease or glucose-6-phosphate dehydrogenase
(G6PD) deficiency.
✓ The destruction of red blood cells can occur in the bloodstream (intravascular
hemolysis) or within the reticuloendothelial system (extravascular hemolysis).
✓ Hemolysis leads to the release of hemoglobin, which can result in the formation of
bilirubin and subsequent jaundice.

Types and Clinical Features:

✓ Acute hemolytic anemia can be classified based on the underlying cause and the
specific type of hemolysis (intravascular or extravascular).

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 ✓ Clinical features may include symptoms of anemia, such as fatigue, weakness,
pallor, and shortness of breath.
✓ Other possible signs and symptoms include jaundice, dark urine (due to increased
bilirubin), enlarged spleen, and, in severe cases, signs of organ dysfunction or
failure.

Diagnosis Acute Hemolytic Anemia

✓ Diagnosis involves a thorough medical history, physical examination, and laboratory

tests.
✓ Blood tests may include a complete blood count (CBC), reticulocyte count,
peripheral blood smear, and direct and indirect Coombs tests to detect antibodies or
complement proteins on red blood cells.
✓ Additional tests may be ordered to identify the underlying cause, such as specific
genetic tests or infectious disease screening.

Prognosis Acute Hemolytic Anemia

a. The prognosis of acute hemolytic anemia depends on the underlying cause,

severity of hemolysis, and timely management.
b. Prompt identification and treatment can lead to favorable outcomes in many
cases, but severe or untreated hemolysis can result in life-threatening
complications.

Management:

a. Medical Management:
✓ Treatment aims to address the underlying cause, stop hemolysis, and manage
symptoms.
✓ Specific interventions may include discontinuing medications or addressing
infections, autoimmune disorders, or transfusion reactions.
✓ In severe cases, blood transfusions or the administration of immunosuppressive
medications may be required.
b. Surgical Management:
✓ Surgery is typically not the primary treatment for acute hemolytic anemia unless it is
necessary to address an underlying cause, such as removing an enlarged spleen in
certain cases.

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c. Nursing Management Acute Hemolytic Anemia
✓ Monitor vital signs, oxygen saturation, and assess for signs of worsening anemia or
organ dysfunction.
✓ Administer prescribed medications, including immunosuppressive agents or iron
supplementation.
✓ Implement appropriate infection control measures if the cause is infectious.
✓ Educate the patient and their family about the condition, treatment plan, signs
of

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 Chronic Hemolytic Anemia
Chronic Hemolytic Anemia is a blood disorder characterized by the continuous
destruction of red blood cells, either due to their premature breakdown or faster
destruction in the bloodstream than their replacement.

Causes of Chronic Hemolytic Anemia:

1. Genetic factors: The most c0ommon cause is a genetic mutation that affects the blood's
hemoglobin.
2. Immune disorders: Immune disorders can lead to the destruction of red blood cells.
3. Splenic disorders: The spleen can cause the destruction of red blood cells due to
excessive sequestration.

Risk factors:

a. Family history of Chronic Hemolytic Anemia.

b. Other immune or genetic disorders.
c. Exposure to environmental factors that increase immune reactions and red
blood cell destruction.

Signs and symptoms:

- Loss of appetite, fatigue, and general weakness.

- Decreased hemoglobin levels in the blood.
- Elevated bilirubin levels in the blood.
- Dark-colored urine.
- Skin and mucous membrane jaundice.

Diagnosis:

- Interrogation and medical examination for initial assessment.

- Blood tests to measure the level of hemoglobin, red blood cells and other indicators.
- Hemoglobin electrolysis test to detect abnormal deviations.
- Coombs test for hemolytic immune anemia.
- Bone marrow examination in some cases.
Calculation:
- Projections for chronic hemolytic anemia depend on the underlying cause, its severity
and treatment response.
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 Some forms of chronic hemolytic anemia can significantly affect quality of life and
require long-term management.

Management:

Medical Administration:
1. Blood transfusion: In cases of severe anemia, blood transfusions may be needed
to increase red blood cell count and relieve symptoms.
2. Medications: A variety of medications may be prescribed depending on the
underlying cause of symptom management or targeting the erythrolysin
mechanism (e.g. corticosteroids, immunosuppressive drugs).
3. Folic acid supplements: Folic acid supplements may be recommended to support
red blood cell production.
a. Hydroxyurea: This drug is commonly used to manage diabolic anemia by
reducing the frequency and severity of pain crises.
b. Fat treatment: For people with chronic anemia who need frequent blood
transfusions, grease therapy can be used to reduce iron buildup.

Surgical Management:

 Splenectomy: In some cases, surgical removal of the spleen may be recommended to

reduce the breakdown of red blood cells. However, this step is not suitable for all types of
chronic hemolytic anemia..
Nursing Administration (Follow-up):
▪ Regular monitoring: You need to regularly monitor your hemoglobin and red
blood cell levels to assess your response to treatment and ensure the condition is
stabilizing.
▪ Healthy nutrition: Eating a diet rich in iron, vitamins and minerals can help
support red blood cell production.
▪ Symptom management: Analgesic medications may be used to relieve pain and
other symptoms associated with chronic hemolytic anemia.
▪ Psychological care and support
▪ Chronic hemolytic anemia can be a psychological and emotional burden.
▪ Seek psychological support and guidance from friends and family or through
counseling sessions.
- Kidney or gallbladder stone formation.
- Blood vessel blockage.

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 - Respiratory failure.
- Liver fibrosis.

Nursing interventions include:

- Providing psychological and emotional support to patients and their families.

- Monitoring and assessing signs and symptoms.
- Administering medications as prescribed.
- Educating patients and families about the condition, treatment, and potential
complications.
- Collaborating with the healthcare team to ensure comprehensive care.

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 Sickle cell anemia
Sickle cell anemia is a genetic blood disorder that affects the shape and function of red
blood cells. It is caused by a mutation in the gene responsible for producing hemoglobin,
a protein that carries oxygen in the blood. This mutation leads to the production of
abnormal hemoglobin called hemoglobin S, which causes red blood cells to become rigid
and take on a sickle shape

Causes:
Sickle cell anemia is an inherited disorder caused by a mutation in the gene responsible for
hemoglobin production. This mutation leads to the production of abnormal hemoglobin called
hemoglobin S. When oxygen levels decrease or there is increased stress on the red blood cells,
hemoglobin S causes the red blood cells to become rigid and assume a sickle shape.
Pathophysiology:
The sickle-shaped red blood cells are prone to getting trapped in small blood vessels, leading to
vaso-occlusive crises. This can cause tissue ischemia, pain, and organ damage. Additionally, the
lifespan of sickle cells is shorter than normal red blood cells, leading to chronic anemia.
Types:
There are different types of sickle cell disease, including sickle cell anemia (HbSS), sickle cell
trait (HbAS), and various other genotypes such as HbSC and HbS beta thalassemia. Sickle cell
anemia (HbSS) is the most severe form.
Clinical Features:
Clinical features of sickle cell anemia include:
1. Anemia-related symptoms: Fatigue, weakness, and pallor.
2. Vaso-occlusive crises: Severe pain, usually in the bones, joints, and abdomen.
3. Acute chest syndrome: Chest pain, cough, and difficulty breathing due to pulmonary
complications.
4. Splenic sequestration crisis: Sudden enlargement of the spleen, leading to abdominal pain
and anemia.
5. Stroke: Due to the occlusion of blood vessels in the brain.
6. Gallstones: Caused by the breakdown of red blood cells.
7. Delayed growth and development in children.
8. Leg ulcers: Chronic non-healing ulcers on the lower legs.
9. Priapism: Prolonged and painful erections in males.
Diagnosis:
Diagnosis of sickle cell anemia involves:
a. Hemoglobin electrophoresis: Determines the presence of abnormal hemoglobin S.
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 b. Complete blood count (CBC): Reveals anemia and other blood abnormalities.
c. Sickle cell solubility test: Detects the presence of sickle hemoglobin.
d. Genetic testing: Confirms the presence of the sickle cell gene.
Prognosis:
The prognosis of sickle cell anemia varies. While some individuals experience frequent
complications and have a shortened lifespan, others may have milder symptoms and lead
relatively normal lives. Early diagnosis, regular medical care, and proper management can
improve outcomes.
Management:
The management of sickle cell anemia includes:
1. Medical Management:
- Pain management: Analgesics and, in severe cases, opioids.
- Hydroxyurea: Reduces the frequency of painful crises.
- Blood transfusions: To manage severe anemia and prevent complications.
- Antibiotics and vaccinations: To prevent infections.
2. Surgical Management:
- Splenectomy: In some cases of recurrent splenic sequestration crises.
- Cholecystectomy: For gallstone-related complications.
3. Nursing Management:
- Pain assessment and management.
- Hydration and electrolyte balance.
- Monitoring for complications and providing supportive care.
- Education on self-care, disease management, and genetic counseling.
- Psychosocial support for patients and families.

Nursing Management oh Hematological Emergency

1. Rapid assessment:
✓ Perform a thorough assessment of the patient's vital signs, level of consciousness, and
overall clinical status.
✓ Pay close attention to signs of hypoxia, bleeding, or organ dysfunction.
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2. Airway management:
✓ Ensure a patent airway and provide supplemental oxygen as needed.
✓ Monitor oxygen saturation levels and respiratory status closely.

3. Bleeding management
✓ Apply direct pressure to the bleeding site, elevate the affected limb if applicable, and
consider the use of hemostatic agents or tourniquets if necessary.
✓ Administer blood products (such as packed red blood cells, platelets, or fresh frozen
plasma) as ordered by the healthcare provider.

4. Fluid resuscitation:
✓ Administer intravenous fluids as prescribed to maintain adequate circulating volume and
prevent hypovolemia.
✓ Monitor fluid balance closely and assess for signs of fluid overload.
5. Pain management: Hematological emergencies, such as sickle cell crisis or acute leukemia,
can be associated with severe pain.
✓ Administer appropriate analgesics as ordered and reassess pain levels regularly.
✓ Provide comfort measures, such as positioning, heat packs, or distraction techniques, to
help alleviate pain.
1. Monitoring and laboratory tests:
✓ Continuously monitor the patient's vital signs, oxygen saturation, and level of
consciousness.
✓ Perform frequent laboratory tests, including complete blood counts, coagulation profiles,
and other relevant tests, to assess the patient's hematological status and response to
treatment.
2. Psychosocial support: Hematological emergencies can be emotionally and psychologically
challenging for patients and their families.
✓ Provide emotional support, education, and clear communication to help alleviate
anxiety and promote coping strategies.

3. Collaboration with the healthcare team:

✓ Maintain open communication and collaborate closely with the healthcare team,
including physicians, hematologists, pharmacists, and other specialists involved in the
patient's care. Participate in care planning, interdisciplinary rounds, and discussions to
ensure coordinated and comprehensive care.
.
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