DISORDERS OR WBC (CONTINUATION)  Rare symptoms of eosinophilia include weight loss, night

sweats, lymph node enlargement, skin rashes, numbness

EOSINOPHILIA or tingling sensation.
 is a higher than normal level of eosinophils.
 Eosinophils are a type of disease-fighting white blood cell. DIAGNOSTICS
 High levels of eosinophils may also occur in your body's  A simple blood test can reveal eosinophilia in the
tissues at the site of an infection or inflammation (tissue bloodstream.
eosinophilia).  In the case of tissue eosinophilia, a skin biopsy of the
relevant tissue will confirm it.
 Tissue eosinophilia may be found in samples taken
during an exploratory procedure or in samples of TREATMENT
certain fluids, such as mucus released from nasal  treatment is directed toward the underlying cause.
tissues.  However, in primary eosinophilia, or if the eosinophil count
 Blood eosinophilia may be detected with a blood test, must be lowered, corticosteroids such as prednisone may
usually as part of a complete blood count. be used. 
 A count of more than 500 eosinophils per microliter of
blood is generally considered eosinophilia in adults. NURSING CARE
 A count of more than 1,500 eosinophils per microliter of  Wash hands.
blood that lasts for several months is called  Avoid those irritants.
hypereosinophilic syndrome.  Increase intake of vitamin C.
 Eat nutritious food.
Plays 2 Roles:  Avoid those drug that can cause allergic reactions.
 Destroying foreign substances.  Early diagnostic and treatment should be emphasize.
 Regulating inflammation. 

 Eosinophils can consume foreign substances — LYMPHOCYTOSIS

particularly substances related to infection with a  A high lymphocyte count, is an increase in white blood
parasite — that have been "flagged" for destruction by cells called lymphocytes.
other components of your immune system.  They help fight off diseases, so it's normal to see a
 Eosinophils help promote inflammation, which plays a temporary rise in the number of lymphocytes after an
beneficial role in isolating and controlling a disease infection.
site.  A count significantly higher than 3,000 lymphocytes in a
microliter of blood is generally considered to be
CAUSES: lymphocytosis in adults.
 Parasitic and fungal diseases  In children, the threshold for lymphocytosis varies with
 Allergies, including to medications or food age, but may be as high as 7,000 to 9,000 lymphocytes
 Adrenal conditions per microliter.
 Skin disorders
 Toxins CAUSES/SYMPTOMS
 Autoimmune diseases  Infection (bacterial, viral, other)
 Endocrine disorders  Cancer of the blood or lymphatic system
 Tumors  An autoimmune disorder causing ongoing (chronic)
inflammation
Specific diseases and conditions that can result in blood or Specific causes of lymphocytosis include:
tissue eosinophilia include:  Acute lymphocytic leukemia
 Ascariasis (a roundworm infection)  Chronic lymphocytic leukemia
 Asthma  Cytomegalovirus (CMV) infection
 Atopic dermatitis (eczema)  HIV/AIDS
 Drug allergy  Tuberculosis
 Primary immunodeficiency  Other viral infections
 Trichinosis (a roundworm infection)
 Ulcerative colitis DIAGNOSTICS
 Blood Test
SIGNS AND SYMPTOMS
 Eosinophilia due to asthma is marked by symptoms such TREATMENT
as shortness of breath, wheezing.  treatment is directed toward the underlying cause.
 In the case of parasitic infections one might experience
severe pain in the abdomen, diarrhoea, fever, cough or NURSING CARE
rashes.  Wash hands.
 In case of an allergy due to reaction to a medicine one  Avoid those irritants.
might notice rashes, itching.  Increase intake of vitamin C.
 Eat nutritious food.
 Avoid those drug that can cause allergic reactions.
 Early diagnostic and treatment should be emphasize.
DISORDERS OF BLOOD COAGULATION
HEMOPHILIA
  rare disorder in which your blood doesn't clot normally
because it lacks sufficient blood-clotting proteins (clotting
factors).
 If you have hemophilia, you may bleed for a longer time
after an injury than you would if your blood clotted
normally.
 The greater health concern is deep bleeding inside your
body, especially in your knees, ankles and elbows.
 That internal bleeding can damage your organs and
tissues, and may be life-threatening.
 Hemophilia is an inherited (genetic) disorder.
SIGNS AND SYMPTOMS
 Unexplained and excessive bleeding from cuts or injuries,
or after surgery or dental work
 Many large or deep bruises
 Unusual bleeding after vaccinations
 Pain, swelling or tightness in your joints
 Blood in your urine or stool
 Nosebleeds without a known cause
 In infants, unexplained irritability
Emergency signs and symptoms of hemophilia include:
 Sudden pain, swelling and warmth in large joints, such as
knees, elbows, hips and shoulders, and in your arm and
leg muscles
 Bleeding from an injury, especially if you have a severe
form of hemophilia
 Painful, prolonged headache
 Repeated vomiting
 Extreme fatigue
 Neck pain
 Double vision
CAUSES
 Hemophilia occurs when you have a deficiency in one of
these clotting factors.
 Hemophilia is inherited.
TYPES OF HEMOPHILIA
 Hemophilia A, the most common type, is caused by
insufficient clotting factor VIII.
 Hemophilia B, the second most common type, is caused
by insufficient clotting factor IX.
 Hemophilia C, in which signs and symptoms are often
mild, is caused by insufficient clotting factor XI.
HEMOPHILIA INHERITANCE
 Hemophilia A or B. The gene that causes them is located
on the X chromosome, so it can't be passed from father to
son.
 Hemophilia A or B almost always occurs in boys and
is passed from mother to son through one of the
mother's genes.
 Most women with the defective gene are simply
carriers and experience no signs or symptoms of
hemophilia.
 Women can experience bleeding symptoms if their
factor VIII or IX is moderately decreased.
 Hemophilia C. This disorder can be passed on to children
by either parent. Hemophilia C can occur in girls and boys.
DIAGNOSTICS
 it's possible to determine during pregnancy if the fetus is
affected by hemophilia. However, the testing poses some
risks to the fetus.
 In children and adults, a blood test can show a clotting-
factor deficiency. 
 Hemophilia is diagnosed at an average age of 9 months
and almost always by age 2.
 Sometimes, mild hemophilia isn't diagnosed until a person
undergoes surgery and experiences excessive bleeding.
TREATMENTS
 there's no cure for haemophilia
Treatment for bleeding episodes
 Mild hemophilia A. Slow injection of the hormone
desmopressin (DDAVP) into a vein can stimulate a
release of more clotting factor to stop bleeding. 
 Moderate to severe hemophilia A or hemophilia
B.Bleeding may stop only after an infusion of recombinant
clotting factor or clotting factor derived from donated
human blood. Repeated infusions may be needed if
internal bleeding is severe.
 Hemophilia C. Clotting factor XI, the factor missing in this
type of hemophilia, is available only in Europe. In the
United States, plasma infusions are needed to stop
bleeding episodes.
ONGOING TREATMENTS
 Regular infusions of DDAVP or clotting factor. The
infusions can help prevent bleeding.
 Clot-preserving medications (antifibrinolytics). These
medications help prevent clots from breaking down.
 Fibrin sealants. These medications can be applied directly
to wound sites to promote clotting and healing. Fibrin
sealants are especially useful in dental therapy.
 Physical therapy. It can ease signs and symptoms if
internal bleeding has damaged your joints. If internal
bleeding has caused severe damage, you may need
surgery.
 First aid for minor cuts. Using pressure and a bandage.
 Vaccinations. Although blood products are screened, it's
still possible for people who rely on them to contract
diseases. If you have hemophilia, consider receiving
immunization against hepatitis A and B.
NURSING CARE
 Exercise regularly. Activities such as swimming, bicycle
riding and walking can build up muscles while protecting
joints.
 Avoid certain pain medications. Drugs that can aggravate
bleeding include aspirin and ibuprofen (Advil, Motrin,
others).
 Avoid blood-thinning medications. Medications that
prevent blood from clotting include heparin, warfarin
(Coumadin), clopidogrel (Plavix) and prasugrel (Effient).
 Practice good dental hygiene. The goal is to prevent tooth
extraction, which can lead to excessive bleeding.
 Protect your child from injuries that could cause
bleeding.Kneepads, elbow pads, helmets and safety belts
all may help prevent injuries from falls and other
accidents. Keep your home free of furniture with sharp
corners.
 Contact sports — such as football, hockey or
wrestling — are not safe for people with hemophilia.
 Instead, use acetaminophen (Tylenol, others), which
is a safe alternative for mild pain relief.
 Medications that prevent blood from clotting include
heparin, warfarin (Coumadin), clopidogrel (Plavix) and
prasugrel (Effient).
VON WILLEBRAND’S DISEASE
 a condition that can cause extended or excessive
bleeding.
 The condition is most often inherited but in rare cases may
develop later in life.
 The cause of von Willebrand disease is a deficiency in or
impairment of a protein called von Willebrand factor, an
important component in your blood-clotting process.
 In general, it takes longer for people with von Willebrand
disease to form clots and stop bleeding when they're cut.
SIGNS AND SYMPTOMS
 Abnormal bleeding is the most common sign of von
Willebrand disease
 Recurrent and prolonged nosebleeds
 Bleeding from the gums
 Increased menstrual flow
 Excessive bleeding from a cut or following a tooth
extraction or other dental procedure
 Blood in the stool or urine
 Bleeding from shaving with a razor or other similarly minor
injury
 Easy bruising
 Bruises with lumps that form underneath the skin
 Very heavy menstrual flow
CAUSES
 inherited defect in the gene that controls von Willebrand
factor, a protein that plays a key role in your blood-clotting
process. 
 When von Willebrand factor is scarce or not functioning
properly because of structural abnormalities small blood
cells called platelets cannot stick together properly, nor
can they attach themselves normally to the blood vessel
walls when an injury has occurred.
 The result is interference with the clotting process, and
uncontrolled bleeding may persist.
 Von Willebrand factor carries an additional substance,
called factor VIII, that helps stimulate clotting.
 may be an autoimmune disease, or it may be linked to a
slow thyroid gland (hypothyroidism) or to certain
medications, such as the anti-seizure medication valproic
acid (Depakene) or the antibiotic ciprofloxacin (Cipro).
RISK FACTORS
 A family history of von Willebrand disease
 A parent can pass the abnormal gene for the disease to
his or her child
 "autosomal dominant inherited" disorders, which means
you only need an abnormal gene from one parent to be
affected. 
 If you have the gene for von Willebrand disease, you have
a 50 percent chance of transmitting this gene to your
offspring.
 Most severe form of the condition (type 3) is "autosomal
recessive," which means both of your parents have to
pass an abnormal gene to you.
CLASSIFICATION OF THE DISEASE
 Type 1. In this most common form of von Willebrand
disease, levels of von Willebrand factor are low. In some
people, levels of factor VIII also are low. Signs are usually
mild.
 Type 2. In this type, which has several subtypes, the von
Willebrand factor that is present doesn't function properly.
Symptoms tend to be more significant.
 Type 3. In this rare type, von Willebrand factor is
altogether absent and levels of factor VIII are low. Signs
may be severe, such as bleeding into the joints and
muscles.
 Acquired von Willebrand disease. This type isn't inherited
from your parents. It develops later in life, possibly due to
an autoimmune disease, a thyroid condition or certain
medications.
DIAGNOSTICS
 Medical history and physical exam.
 Blood tests.
 Von Willebrand factor (vWF) antigen. This test determines
the level of von Willebrand factor in your blood by
measuring the vWF protein (antigen).
 Ristocetin cofactor activity. This analysis of your blood
demonstrates how well the von Willebrand factor works in
your clotting process.
 Ristocetin, which is an antibiotic, is used in this
laboratory testing and when added to a sample of
your blood causes a reaction in your blood that may
indicate von Willebrand disease.
 Factor VIII clotting activity. This test shows whether you
have abnormally low levels and activity of factor VIII.
 Von Willebrand factor multimers. This test evaluates the
specific structure of von Willebrand factor in your blood, its
protein complexes (multimers) and how its molecules
break down.
 This information helps identify the type of von
Willebrand disease that's present.
 Platelet function test (PFA-100). This test measures how
efficiently platelets are functioning in your blood.
TREATMENT
 Desmopressin (DDAVP). This medication is administered
by injection into a vein or, more commonly, through a
nasal spray called Stimate.
 It's a synthetic hormone, similar to the natural
hormone vasopressin, that controls bleeding by
stimulating your body to release more von Willebrand
factor already stored in the lining of your blood
vessels — thereby enhancing factor VIII levels. 
 Replacement therapies. These consist of infusions of
prepared doses of concentrated blood-clotting factors
containing von Willebrand factor and factor VIII.
 Contraceptives. These can be useful for controlling heavy
bleeding during your menstrual periods.
 The estrogen hormones present in birth control pills
can boost levels of von Willebrand factor and factor
VIII activity.  recognizes the antibodies and removes the platelets from
 Anti-fibrinolytic or clot-stabilizing medications.  your system.
 Fibrin sealants. These substances, applied like a glue
using syringes, are placed directly on a cut to curtail
bleeding.
 These medications, such as aminocaproic acid
(Amicar) and tranexamic acid (Cyklokapron; Lysteda,
others), can slow down the breakdown of clotting
factors.
NURSING CARE
 Genetic counseling
 Stay active. Keep your weight at normal levels and stay
physically active.
 avoid activities that could cause bruising (for example,
football, wrestling and hockey).
 Safe activities that can keep your muscles flexible and
joints healthy include walking, bicycling and swimming.
IMMUNE THROMBOCYTOPENIC PURPURA
 a clinical syndrome in which a decreased number of
circulating platelets (thrombocytopenia) manifests as a
bleeding tendency, easy bruising (purpura), or
extravasation of blood from capillaries into skin and
mucous membranes (petechiae).
SIGNS AND SYMPTOMS
 Widespread petechiae and ecchymoses, oozing from a
venipuncture site, gingival bleeding, and hemorrhagic
bullae indicate that the patient is at risk for a serious
bleeding complication
 If the patient's blood pressure was taken recently,
petechiae may be observed under and distal to the area
where the cuff was placed and inflated
 Suction-type electrocardiograph (ECG) leads may induce
petechiae
 Petechiae over the ankles in ambulatory patients or on the
back in bedridden ones suggest mild thrombocytopenia
and a relatively low risk for a serious bleeding
complication
Findings suggestive of intracranial hemorrhage include the
following:
 Headache, blurred vision, somnolence, or loss of
consciousness
 Hypertension and bradycardia, which may be signs of
increased intracranial pressure
 On neurologic examination, any asymmetrical finding of
recent onset
 On fundoscopic examination, blurring of the optic disc
margins or retinal hemorrhage
CAUSES
 Unknown
 the immune system malfunctions and begins attacking
platelets as if they were foreign substances.
 Antibodies produced by your immune system attach
themselves to the platelets, marking the platelets for
destruction.
 The spleen, which helps your body fight infection,
 The result of this case of mistaken identity is a lower
number of circulating platelets than is normal.
RISK FACTORS
 Your sex. Women are about twice as likely to develop ITP
as men are.
 Recent viral infection. Many children with ITP develop the
disorder after a viral illness, such as mumps, measles or a
respiratory infection.
DIAGNOSTICS
 Physical exam, including a complete medical history. Your
doctor will look for signs of bleeding under your skin, and
will ask you about previous illnesses you've had and the
types of medications and supplements that you've recently
taken.
 Complete blood count. This common blood test is used to
determine the number of white and red blood cells and
platelets in a sample of your blood.
 Blood smear. A sample of your blood is placed on a slide
and observed under a microscope. This test is often used
to confirm the number of platelets observed in a complete
blood count.
 Bone marrow examination. Another test that may help
identify the cause of a low platelet count is a bone marrow
exam. Platelets are produced in your bone marrow — soft,
spongy tissue in the center of your large bones
TREATMENT
 The goal of treating ITP is to ensure a safe platelet count
and prevent bleeding complications while minimizing
treatment side effects.
 Corticosteroids. The first line of therapy for ITP is a
corticosteroid, usually prednisone, which can help raise
your platelet count by decreasing the activity of your
immune system.
 Intravenous immune globulin (IVIG). If you have critical
bleeding or need to quickly increase your blood count
before surgery, you may receive medications, such as
immune globulin, given intravenously. 
 Thrombopoietin receptor agonists. The newest
medications approved to treat ITP are romiplostim SIGNS AND SYMPTOMS
(Nplate) and eltrombopag (Promacta).  Bleeding, possibly from many sites in the body
 These drugs help your bone marrow produce more  Blood clots
platelets, which helps prevent bruising and bleeding.   Bruising
 Biologic therapy. Rituximab (Rituxan) helps reduce the  Drop in blood pressure
immune system response. It's generally used for people
with severe ITP, and in those who corticosteroids don't DIAGNOSTICS
help.   Complete blood count with blood smear exam
 Spleenectomy  Fibrin degradation products
 Partial thromboplastin time(PTT)
NURSING CARE  Prothrombin time (PT)
 Avoid platelet-impairing medications. Over-the-counter  Serum fibrinogen
drugs, such as aspirin and ibuprofen (Advil, Motrin IB,
others), can impair platelet function. TREATMENT
 Choose low-impact physical activities. Your doctor may  The goal is to determine and treat the underlying cause of
recommend avoiding competitive sports or other activities DIC.
that might increase the risk of injury and bleeding.
 Watch for signs of infection. If you've had your spleen Supportive treatments may include:
removed, be alert for any signs of infection, including  Plasma transfusions
fever, and seek prompt treatment.  Blood thinner medicine (heparin)
 Infection in someone who's had a splenectomy may be
more severe, last longer and have more serious  to prevent blood clotting if a large amount of clotting is
implications than in someone who still has an intact occurring
spleen.
NURSING CARE
 Stay active. Keep your weight at normal levels and stay
DESSIMINATED INTRAVASCULAR COAGULATION
physically active.
 a serious disorder in which the proteins that control blood
 avoid activities that could cause bruising (for example,
clotting become over active.
football, wrestling and hockey).
 Safe activities that can keep your muscles flexible and
CAUSES
joints healthy include walking, bicycling and swimming.
 When you are injured, proteins in the blood that form
blood clots travel to the injury site to help stop bleeding.
 If you have DIC, these proteins become abnormally active HENOCH-SCHONLEIN SYNDROME
throughout the body. This may be due to inflammation,  a disorder that causes inflammation and bleeding in the
infection, or cancer.
small blood vessels in your skin, joints, intestines and
 Small blood clots form in the blood vessels. Some of these kidneys.
clots can clog the vessels and cut off blood supply to  most striking feature is purplish rash, typically on the lower
organs such as the liver, brain, or kidneys.
legs and buttocks.
 Lack of blood flow can damage the organ and it may stop
 most common in children between the ages of 2 and 6.
working properly.
 Over time, the clotting proteins in your blood are SIGNS AND SYMPTOMS
consumed or "used up."  Rash (purpura). Reddish-purple spots, which look like
 When this happens, you have a high risk of serious bruises, are the most distinctive and universal sign of
bleeding, even from a minor injury or without injury. Henoch-Schonlein purpura.
 You may also have bleeding that starts spontaneously (on  Swollen, sore joints (arthritis). 
its own).
 Gastrointestinal symptoms.
 Kidney involvement-  this shows up as protein or blood in
RISK FACTORS
the urine
 Blood transfusion reaction
 Cancer, especially certain types of leukemia CAUSES
 Inflammation of the pancreas (pancreatitis)  Nearly half the people who have Henoch-Schonlein
 Infection in the blood, especially by bacteria or fungus purpura developed the disease after an upper respiratory
 Liver disease infection, such as a cold.
 Pregnancy complications (such as placenta that is left  Infectious triggers may include chickenpox, strep throat,
behind after delivery) measles and hepatitis.
 Recent surgery or anesthesia  Other triggers may include certain medications, food,
 Severe tissue injury (as in burns and head injury) insect bites or exposure to cold weather.
 Large hemangioma (a blood vessel that is not formed
properly) RISK FACTORS
 Age. The disease affects primarily children and young
adults with the majority of cases occurring in children
between 2 and 6 years of age.
 Sex. Henoch-Schonlein purpura is slightly more common
in boys than girls.
 Race. White and Asian children are more likely to develop
Henoch-Schonlein purpura than black children are.
 Time of year. Henoch-Schonlein purpura strikes mainly in
autumn, winter and spring but rarely in summer.

DIAGNOSTICS
 Blood tests. People who have Henoch-Schonlein purpura
often have abnormal levels of a particular type of antibody
in their blood.
 Urine tests. Your urine may be tested for evidence of
blood and to determine if your kidneys are still working
properly.
 Biopsies-If there are doubts about the rash
 Imaging tests- Your doctor may recommend an ultrasound
to rule out other causes of abdominal pain and to check
for possible complications, such as a bowel obstruction.

TREATMENT
 The use of powerful corticosteroids, such as prednisone,
in treating or preventing complications of Henoch-
Schonlein purpura.
 They're most often used to treat severe
gastrointestinal symptoms.
 over-the-counter pain relievers may help.
 Surgery- If a section of the bowel has folded in upon itself
or ruptured, surgical repair will be necessary.

NURSING CARE
 Children and adults with mild Henoch-Schonlein purpura
should be kept comfortable while the disease runs its
course.
 Bed rest
 plenty of fluids
 over-the-counter pain relievers may help.