Care of Clients with Hematologic Diseases

Blood – transports cellular requirements and

products from one part of the body to another;
composed of plasma (55%) and cellular
component (45%)
slightly alkaline (ph 7.35-7.4)
5-6 liters or 70-75 ml/kg BW (average volume)
Pulmonary circulation = 1300 cc
 arterial (400cc) + capillary (60cc) + venous (840cc)
Systemic circulation = 3000 cc
arterial (550cc) + capillary (300cc) + venous (2150cc)
re of Clients with Hematologic
seases
Hematopoiesis – blood cell production; done in
the bone marrow (red), pelvis, sternum, ribs,
epiphysis of long bones
Erythropoiesis – red blood cell production in the
liver in utero (2 to 5 months old) then in bone
marrow.
needs iron, protein, pyridoxine (B6), cyanocobalamine
(B12), folic acid, and copper
Reticuloendothilial System – mononuclear
phagocyte system or macrophage (spleen, liver,
lymphatic system, lungs)
Care of Clients with Hematologic Diseases
Nursing Assessment:
Pallor – conjunctiva
Jaundice (hemolytic) – sclera; palms of hands; soles of
feet
Signs of bleeding such as petechiae, ecchymosis,
hematoma, epistaxis
Lymph nodes enlargement
Limited joint range of motion
Splenomegaly or hepatomegaly
Care of Clients with Hematologic Diseases
Physical Assessment:
Auscultate – heart murmur, bruits
Inspect – above assessment
Palpate – lymph nodes, location, size, bone
tenderness
Percuss for ling excursion, splenomegaly,
hepatomegaly
Evaluate joint ROM asnd tenderness
Care of Clients with Hematologic Diseases
Diagnostic Assessment:
Blood
CBC with differential
a. Hemoglobin – Males13-16 gm/dl
- Females 12-14 gm/dl
b. Hematocrit – Males 42-50%
- Females 40-48%
c. RBC – N=Males 4,600,000 – 6,200,000 per cu.mm
Females 4,200,000 – 5,400,000 per cu.mm
Diagnostic Assessment
 Blood
d. WBC – N=5,000 – 10,000 cu.mm
*neutrophils – N=60-70%
*eosinophils – N=1-4%
*basophils – N=0–0.5%
*monocytes – N=2-6%
*lymphocytes – N=20-30%
e. Platelets – N=200,000-350,000 per cu.mm
 Diagnostic Assessment
Coagulation studies
PT Prothrombin time N= 11-18 secs
PTT Partial Thromboplastin Time – N =50 to
80 seconds
Clotting Time – N= 5 to 10 minutes
Bleeding Time – N=30 sec – 6 minutes
Diagnostic Assessment
Blood chemistries – patients fasts for 6 to 8 hours
 a. Blood Urea Nitrogen (BUN) – N=10-20mgs/dl
 b. Creatinine – N=0.7-1.4mgs/dl

 c. Uric acid – N= 2.5-8.0 mg/dl

 d. Cholesterol – N=150-300 mg/dl

 e. Bilirubin – Total N=0.1-1.0 mg/dl

 direct (N=0.1-0.2mg/dl)

 indirect (N=0.1-0.8mg/dl)
Diagnostic Assessment
Miscellaneous
a. ESR – N=0 to 20 mm/hr
b. Coomb’s test – indirect blood from mom, direct
blood from baby’s cord
c. Schillings test – Vit.B12 in the gastro-intestinal system
prep NPO x 8 hours
radioactive Vit.B12 given PO
Vit.B12 nonradioactive given IM
2 hours after urine collection for radioactive
Vit.B12; N = 15-40% of oral dose excreted
Diagnostic Assessment
 Urine and Stool
 Urinalysis
 Hematest
 Hemoccult – prep; -no dark colored food x 24 hours prior to test
 Radiologic
 CXR
 Scan
 Lymphangiography
 Bone Marrow aspiration and biopsy
 Preferred site – iliac crest, sternum or tibia
 Before: consent, position exposing the site
 After: pressure to site x5miuntes
Erythrocyte Disorders
Anemia – reduction below normal level in
number of erythrocytes, quantity of hemoglobin
and volume of packed RBC’s.
Basic underlying – tissue hypoxia
Signs and Symptoms – depends upon severity and
chronicity and age.
 a. Mild – hemoglobin 10-14 gms; asymptomatic; palpitations,
dyspnea and diaphoresis following strenuous exertion.
 b. Moderate – increased palpitations, dyspnea, and diaphoresis;
fatigue at rest or during activity.
 c. Severe – pale and exhausted all the time, sever palpitations,
sensitivity to cold, loss of appetite, profound weakness, angina.
 Anemia
 Iron Deficiency Anemia
Causes:
 Inadequate absorption – increased requirement
 Inadequate intake of iron rich foods
 Physiologic need – more in children and pregnant
women
 Physiologic loss – menstruation
 Blood loss – trauma, GI bleeding
Iron Deficiency Anemia
Signs and Symptoms:
Palpitations, dizziness, easy fatigability
Cold sensitivity, pallor
Brittle nails, and hair
Plummer-vinsons syndrome – soreness and
inflammation of mouth and tongue (stomatitis and
glossitis)
Iron Deficiency Anemia
Nursing management:
*Oral iron – route of choice; given after meals; liquid iron
intake with straw because it stains; mixed with 1 glass cold
H2O, best absorbed with Vitamin C; stool becomes tarry
and constipation may occur.
*Parenteral – avoid tissue staining by using separate
aspiration injection needles; Z-tract method and deep IM;
do not massage but encourage ambulation.
*Dietary – increased in iron and roughage
*Blood transfusion
Anemia
 Pernicious anemia – Vitamin B12
(cyanocobalamine) deficiency of intrinsic factor
in the gastric mucosa which is necessary for
absorption of Vit.B12.
 Signs and Symptoms:
 Hemolytic jaundice – macrolytic hypochromic
 Tingling sensations, paresthesias
 Beefy red tongue
 Deficiency or absence of hydrochloric acid in the
stomach
Pernicious anemia
Nursing management:
Drug therapy – Vit B12 injections (monthly) for life
Folic acid – reverses anemia, decreases neurological
symptoms
Transfusion therapy
Diagnostic assessment:
Schilling’s test
Gastric analysis
Anemia
 Aplastic anemia – depressed bone marrow activity
secondary to antineoplastics, radiation, insecticide,
drugs and chemical toxins.
Laboratory Assessment: pancytopenia
 Erythrocytopenia
 Leukocytopenia
 Thrombocytopenia
Aplastic anemia
Nursing management:
Blood transfusion
Prevent and treat infections
Bone marrow transplant
Drug – corticosteroids; estrogen
Identify and withdraw offending agent
Leukocyte Disorders
Leukemia – most common of childhood (3-5 y/o)
cancer; abnormal proliferation of WBC in blast form.
Predisposing factors:
Radiation
Survivors of Hiroshima
Benzol, aniline dyes
Leukemia
Types of Leukemia:
*Acute lymphocytic leukemia (ALL)
 80-85%of childhood leukemia
 95% chance of obtaining remission with diagnostic
assessment
 75% chance of surviving over 5 years

*Acute non-lymphocytic anemia (ANLL)

 granulocytic and monocytic
 60-80% will obtain remission with treatment
 30-40% cure rate
Leukemia
Signs and Symptoms:
Anemia – weakness, pallor, dyspnea
Petechiae, spontaneous bleeding
Infection, - fever, malaise
Enlarged lymph nodes, liver and spleen
Abdominal pain, weight loss, anorexia
Bone pain due to expansion of marrow
Leukemia
Nursing management:
*Supportive therapy – rest, blood transfusion, prevent
infection, promote nutrition, oral hygiene, skin care
*Drug therapy – antileukemia – oncovin, prednisone,
methotrexate (2-3 yrs.)
*Radiation
*Bone marrow transplant
Leukocyte Disorders
Lymphoma – lymphatic tissue (lymphocytes)
a. Hodgkin’s – malignant neoplasms of lymphatic tissue
originating in lymph nodes proliferating to spleen and
liver
 Signs and Symptoms – enlarged nontender nodes, Reed
Sternberg cells, pruritus Management – chemotherapy,
radiation
Lymphoma
b. NonHodgkins – tumor originating in lymphatic
tissue characterized by diffuse, undifferentiated cell;
prognosis is poorer than Hodgkin’s.
Management:
 *chemotherapy
 *radiotherapy and

 *surgery for diagnosis and staging