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Hematologic & Lymphatic System
Chapter 19-20
Hematologic
• BONE MARROW– Location
• Spongy center of bones– Function
• RBCs production• WBC production• Platelets production
Hematologic
• LIVER– Function:• Manufactures
clotting factors • Filter old & damaged
RBC’s from circulation
Hematologic
• SPLEEN– Function• Works with the liver
removes old RBC’s from circulation• Stores platelets
Hematologic
• BLOOD
Blood
• Function– Transport• Oxygen• Nutrients • Essential
substances
• Waste products
To cells/tissue
Away from cells / tissue
Blood composition
• Plasma• Red blood cells– Erythrocytes
• White blood cells– Leukocytes
• Platelets– Thrombocytes
Plasma
• Color–Clear yellow
• Contains–Protein • Formed in the– LIVER
Red Blood Cells
• AKA:– Erythrocytes
• Function– Carry O2 to body tissues
• Formed – Bone marrow– Erythropoiesis
Erythropoiesis
• The process of red blood cell formation Tissue
hypoxia
Kidney
erythropoietinBone marrow
h RBC production
3-5 days
Hemoglobin
• Function– Carry oxygen
• Main ingredient– Iron
Hemolysis
• Hemo = –Blood
• Lysis– -breakdown
• Breakdown of RBC
•Death of a RBC
Hemolysis
• Life span of RBC– @120 days
• Old / damaged cells– Liver filters blood– Iron – saved & reused– Heme bilirubin bile
sm. intestine
Platelets
• AKA– Thrombocytes
• Function–Blood clotting
• Storage– Spleen
Hemostasis
• Blood clotting process
5 stages of hemostasis
1. Vessel spasm• Damage to blood
vessel• Vessel spasm • Vasoconstriction • i blood flow
5 stages of hemostasis
2. Formation of the platelet plug• Platelets stick to the
wall & one another
5 stages of hemostasis
3. Clot formation• Fibrin cements
components together
5 stages of hemostasis
4. Clot retraction• Platelets contract – (Pulls broken walls
closer together)• Release growth factors
tissue repair
5 stages of hemostasis
5. Clot dissolution• Fibrinolysis removes the
clot after tissue is repaired
Hemostasis• http://www.mhhe.com/biosci/esp/2002_general/Esp/folder_structure/tr/m1/s7/trm1s7_3.h
tm
Hematologic & Immune System
• White Blood Cells
White Blood Cell
• AKA:– Leukocytes
• Leukocytosis– h WBC count
• Leukopenia– i WBC count
Leukocytes
• Can migrate out of the blood vessel other tissue
Leukocytes: Neutrophils
• Function– Phagocytic
• Life span– 10 hours
Leukocytes: Eosinophils
• Allergic reactions
Leukocytes: Basophils
• Stress
Leukocytes: Monocytes
• Monocytes • Macrophages• Phagocytic cells
Leukocytes: Lymphocytes
• Specific immune response– B lymphocytes
• B-cells– T lymphocytes
• T-cells
B-cells
• Production of – Plasma cell
• Antibody factories– Memory cell
• Future quick response
T-cells
• T-helper cells– Activate other
components of the immune system
• T-cytotoxic cells– Directly destroy the
invader
Immune System
• BONE MARROW– Function
• WBC production
Immune System
• THYMUS– Incubator for T-cells– Not needed after
puberty
Immune System
LYMPHATIC SYSTEM• Lymph Fluid– Plasma– WBC
• Lymph nodes– Housing for T & B-cells– Filter micro-organism
Immune System
LIVER• Function– Filter blood– Stores phagocytes
Immune System
• SPLEEN– Function
• Filters blood• Stores Phagocytes
Natural immunity
• A person’s resistance to foreign substances d/t – Gender– Heredity– Age– Health status
Naturally acquired immunity
• Resistance acquired by developing the disease
Artificially acquired immunity
• Resistance develops through immunization
Physical Exam
• Skin & mucus membranes– Color
• Pallor – Anemia
• Cyanosis – i Oxygen to tissue– Hypoxia
• Jaundice– Yellow– h bilirubin
• Jaundice
Physical Exam
• Skin & mucus membranes– Color
• Erythemia– Inflammation
• Petechiae– Small red spots caused
by a minor hemorrhage– i platelet count
• Petechiae
Physical Exam
• Skin & mucus membranes– Color
• Pallor• Cyanosis• Jaundice• Erythemia• Petechiae• Bruising
– Ecchymosis
• Ecchymosis
Physical Exam
• Skin & Mucus Membranes– Temperature– Capillary refill– Edema
• Lymph nodes• Palpate abd for
tenderness
Physical Exam
• Vital signs– Temp
• h– Infection / bacterial
• i– Infection viral– Anemia
– Apical pulse– Pedal pulse
Dx Tests
Complete Blood Count (CBC)• RBC count• Hemoglobin• Hematocrit
Red Blood Cell Count: RBC count
• Men– 4.6- 6.0 million /mm3
• Women– 4.0 – 5.0 million / mm3
• Magic number– 5
RBC count
Elevated• COPD
Decreased• Hemorrhage• Anemia• Kidney disease
Hemoglobin: Hgb
• Men– 13.5 – 18 g/dL
• Women– 12-15 g /dL
• Magic Number– 15
Hemoglobin
Elevated• COPD
Decreased• Hemorrhaging• Kidney failure• Nutritional deficit
Hematocrit
• Men– 40 – 54%
• Female– 36 – 46%
• Magic Number– 45
Hematocrit
Elevated• COPD• Dehydration
Decreased• Anemia• Kidney failure• Nutritional deficiency
Prothrombin time: PT or ProtimePartial thromboplastin time: PTT
• Clotting time– h• Risk of hemorrhaging
– i• Risk of blood clots /
thrombi
Anemia
• Definition– i Red blood cells
Anemia: S&S
• i Oxygen-carrying capacity
• Respiratory– Tachypnea– Dyspnea
Anemia: S&S
• i Oxygen-carrying capacity
• C/V– Tachycardia– Palpitations– Angina
Anemia: S&S
• i Oxygen-carrying capacity
• Neurological– H/A– Fatigue– i Concentration– Dizzy
Anemia: S&S
• i Oxygen-carrying capacity
• Integumentary– pallor
Anemia: S&S
• i Oxygen-carrying capacity
• M/S– Leg cramps– Bone pain– Weakness
Anemia
• Causes–Blood loss–Nutritional–Hemolytic–Aplastic
Blood Loss Anemia
• Cause– Hemorrhaging
Nutritional Deficit Anemias
• D/T lack nutrient– Iron – Vitamin B12– Folic Acid
Iron Deficiency Anemia
• Iron is a necessary component of– Hemoglobin
• Specific S&S–Pica • Craving to eat
unusual substances
Vitamin B12 Deficiency Anemia
• AKA– Pernicious Anemia
• Specific S&S– Paresthesia
Folic Acid Deficiency Anemia
• Required for normal production and maturation of RBCs
Hemolytic Anemias
• Premature destruction of RBC
Sickle Cell
• Genetically transmitted • Abnormal hemoglobin
Anemia i O2
RBC stress
RBC SicklesSickle
cells clump
Blocks sm
vessels
Damaged RBC
Hemolysis
S&S of sickle Cell Anemia
• Pain –hands and feet
• Vision problems• Jaundice• Increased risk:–Infections–Stroke
Aplastic Anemia
• Bone marrow does not make enough RBCs
IDT Care: Anemia
• Dx Tests–CBC– Iron levels
IDT Care: Anemia
• Medications– Iron–Vitamin B12– Folic Acid
IDT Care: Anemia
• Dietary – Iron
• Meat• Beans• Green veg
– Folic Acid• Green Veg• Beans
– B12• Meat• Fish • Milk
IDT Care: Anemia
• Blood Transfusions
Leukemia
• Malignant disorders of WBC’s
In Leukemia…
• Normally the ratio of RBC:WBC – 3:1
• In leukemia the ratio changes – >WBC’s
Pathophysiology
• Stem cell mutates • Proliferation • NON-function WBC’s • Fill bone marrow • Spill into blood • Crowd out RBC’s & Platelets • Anemia, Infection & bleeding • Death
Leukemia: etiology
• Unknown
Leukemia: S&S
• Anemia• Infection• Bleeding
Leukemia: S&S
• Anemia– Pallor– Fatigue– Tachycardia– Dyspnea
Leukemia: S&S
• Infections– Fever– Skin infections– Respiratory infections– UTI– Septicemia
Leukemia: S&S
• Bleeding– Bruising
• Ecchymosis
Leukemia: S&S
• Bleeding– Bruising
• Ecchymosis– Petechiae
Leukemia: S&S
• Bleeding– Bruising
• Ecchymosis– Petechiae– Occult stool
Leukemia: S&S
• Bleeding– Bruising
• Ecchymosis– Petechiae– Occult stool– Tarry stool– Coffee ground emesis
Leukemia: Dx
• CBC• WBC w/ differential
Leukemia: Tx
• Chemotherapy– Destroy leukemic cells
• Radiation therapy– Use to shrink
• Bone Marrow Transplants
• Stem cell transplant
Clients with HIV
• Page 249-260
HIV pathophysiology
• Mode of transmission– Direct person to person
through sex– Direct injection with
contaminated blood, blood products or needles
– Mother to fetus
Manifestations of HIV
• 3 stages:– Primary infection– Asymptomatic period– AIDS & opportunistic
disorders
HIV: Primary infection
• Fever• Sore throat• General malaise/fatigue• H/A• Rash• N&V• Night sweats• Wt loss
HIV: Asymptomatic period
• Chronic– @ 10 years
HIV: AIDS & Opportunistic disorders
• Respiratory– Pneumocystis carinii
pneumonia• Gastrointestinal– wasting syndrome
• Integumentary– Kaposi's Sarcoma
Small group questions
1. Identify 3 major S&S of leukemia.2. What lab results indicate leukemia?3. How are HIV and AIDS related?4. What are the three phases of HIV infection?5. How can you protect yourself as a nurse
while caring for a client with end stage HIV infection?