Hematology

Michele L. Miller, RN, MSN-NE

 Objectives
Student will be able to:
1. Describe the function of the bone marrow.
2. Explain the process of maturation of blood cells.
3. Explain the function of accessory organs in maintaining
hematological homeostasis.
4. Describe the role of platelets in hemostasis.
5. Compare and contrast the structure and function of platelet plugs
and fibrin clots.
6. Describe the hematological changes with aging.
7. Compare and contrast the actions and uses of anticoagulants,
antiplatelet drugs, and thrombolytic agents.
8. Discuss the assessment of a client with a suspected hematological
disorder.
9. Explain how disorders of the hematological system affect activity
tolerance.
 Objectives (con’t)
10. Compare and contrast the different types of anemias including
symptoms and medical management.
11. Explain the pattern of inheritance for Sickle Cell Disease.
12. Identify 3 common clinical manifestations of anemia.
13. Explain the mechanism of action & potential ADR of therapy with
hematological growth factors.
14. Compare and contrast the pathological mechanisms of hemolytic
anemia versus aplastic anemia.
15. Compare and contrast leukemia and lymphoma for etiology,
pathophysiology, and clinical manifestations.
16. Compare the purposes and scheduling of induction therapy and
maintenance therapy for clients with leukemia.
17. Prioritize nursing responsibilities during transfusion therapy.
18. Identify clients at risk for complications transfusion therapy
 Assessment
• Demographic data
• Family history and genetic risk
• Personal history
• Diet history
• Socioeconomic status
• Current health status
 Hematology
• This is the study of Blood.
• The blood is made of Plasma & Cells
• Plasma is found in ECF while Cells are made in the
Bone Marrow.
• Plasma in the ECF is composed of Proteins (Globulins,
Albumin, & Fibrinogen).
• Bone Marrow Cells are composed of
Immature/Uncommitted/Undifferentiated Stem Cells.
• Special Growth Factors cause the Stem Cells to Commit
and Produce RBC’S, WBC’S & PLT’s
 Also called
Bone Marrow Hematopoietic organ

Function- make blood cells

Uncommitted Stem Cells

Committed
Committedstem
stemcell
cell(also
(alsocalled
called
the precursor cell)
the precursor cell)

Myeloid
Cells

RBC’s, WBC’s, Platelets

Oxygen delivery to tissue Blood clotting (coagulation)

Inflammation and
immunity
 Hematologic Changes in the Aging
• Lower levels of Plasma protein
• Decrease blood volume
• RBC & WBC levels decrease.
• WBC’s do not increase as much in response to
infection.
• Decease in Hemoglobin levels
• Increase in amount of Fatty Marrow
• Platelet levels remain unchanged
• Small portion of remaining Marrow produces
blood.
Example of a Bullet Point Slide

Slide 002
 Example of a Bullet Point Slide
• Bullet Point
• Bullet Point
– Sub Bullet

Slide 002
 Drugs
• Anticoagulants: interfere with steps in blood
clotting. Limit or prevent extension of clots
and prevent new clots
• Fibrinolytics: selectively degrade fibrin threads
in the formed blood clot
• Platelet Inhibitors: prevent platelets from
becoming active or activated platelets from
clumping together
 Diagnostic Assessment
• Laboratory Results
• Imaging Results
– Radioisotope imaging
– Bone Marrow Aspiration & Biopsy
 RED Blood Cell Disorders
• Anemia
– Decrease in number of cells
• Polycythemia
– Increase in number of cells
 THE END

LET’S TALK
BLOOD
TRANSFUSIONS
 Transfusion Therapy
• Pretransfusion responsibilities to prevent
adverse transfusion reactions:
– Verify prescription.
– Test donor’s and recipient’s blood for
compatibility.
– Examine blood bag for identification.
– Check expiration date.
– Inspect blood for discoloration, gas bubbles, or
cloudiness.
Elsevier items and derived
items © 2006 by Elsevier Inc.
 Transfusion Responsibilities
• Provide client education.
• Assess vital signs.
• Begin transfusion slowly and stay with client
first 15 to 30 minutes.
• Ask client to report unusual sensations such as
chills, shortness of breath, hives, or itching.
• Administer blood product per protocol.

Elsevier items and derived

items © 2006 by Elsevier Inc.
 Types of Transfusions
• Red blood cell
• Platelet transfusions
• Plasma transfusions: fresh frozen plasma
• Cryoprecipitate
• Granulocyte (white cell) transfusions

Elsevier items and derived

items © 2006 by Elsevier Inc.
 Transfusion Reactions
• Clients can develop any of the following
transfusion reactions:
– Hemolytic
– Allergic
– Febrile
– Bacterial
– Circulatory overload

Elsevier items and derived

items © 2006 by Elsevier Inc.
 Autologous Blood Transfusion
• Collection and infusion of client’s own blood
• Eliminates compatibility problems; reduces
risk for transmission of bloodborne disease
• Preoperative autologous blood donation
(Continued)

Elsevier items and derived

items © 2006 by Elsevier Inc.
 Autologous Blood Transfusion
(Continued)

• Acute normovolemic hemodilution

• Intraoperative autologous transfusion
• Postoperative blood salvage

Elsevier items and derived

items © 2006 by Elsevier Inc.