Development of Blood cells

Nursing 210
Fluid and Cells
Nursing management of patients with hematologic
dysfunction
Laurie Brown RN, MSN, MPA-HA, CCRN
Information or Knowledge?
Scotch tape by Richard Drew 3 M company
1930
The automatic answering machine- Willy Muller- inventor 1935
Blue jeans Levi Strauss
1873
Wearable eyeglasses by Salvino D’Armante of italy
1284
Development of Blood Cells
Hemoglobin and
Hematacrit
Hb: Women: 12-16
Men:
13.5-18
Hct: Women: 38-47%
Men:
40-54%
Complete Blood Count
White Blood Cells (WBC) 5,000-10,000
WBC
Differential
Neutrophil
Eosinophil
Basophil
Lymphocyte
Monocyte
50-70%
2-5%
0-2%
20-40%
4-8%
CBC
Platelet Count
150,000-400,000
Red Cells
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Mean Corpuscular Hemoglobin
(MCH)
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin
Concentration (MCHC)
Clotting
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Extrinsic
Intrinsic
Heparin
Coumadin
PTT
PT or INR
Vitamin K
Protamine
sulfate
Drugs Impairing the
Hematologic System
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Drugs causing bone marrow
suppression
Drugs causing hemolysis
Drugs that disrupt platelet action
Drugs that disrupt clotting action
ANEMIAS
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“Can Not Make”
“Lost”
“Destroyed”
ANEMIAS
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Iron Deficiency
Pernicious Anemia
Folic Acid
Deficiency
Trauma
Chronic loss
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Sickle Cell
Infectious Agents
Antibodies
Aplastic Anemia
G6PD Deficiency
Sickle Cell Anemia
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Pain Control
Sickle cell crisis
Rational for orders
Nursing orders
Pernicious Anemia
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Vitamin B 12
Intrinsic Factor
Cells mutate and become large
Development of Neurological problems
Clotting Problems
Thrombocytopenia
 Hemophilia
 Von Willebrand
 Disseminated Intravascular
Coagulation (DIC)
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DIC
“Imbalance between the process of
coagulation and anticoagulation”
Treatment
Heparin Administration
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Heparin loading dose
Initial Maintenance Infusion
Dosage calculation often by
patients weight
Transfusion
Administration
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Identification
Lab values
Drs order verify
Pt assessment
IV site assessment
Documentation
Verify with 2nd RN
Monitor VS
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Remain with the
patient
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Automatic IV infuser pump
Flow rate calculation
Blood/Blood product w/tag
150 cc NS
Blood Administration Set
Gloves
Blood Bank
Patient name and I.D. number
 Unit number and ABO/Rh type on
bag with blood bag compatibility tag
& bag unit/type
 Verify expiration date on blood bag
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Autologous Blood
Transfusions
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Preoperative autologous blood donation
Acute normovolemic hemodilution
Intraoperative autologous transfusion
Postoperative blood salvage
Characteristics of Normal Cells
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Limited Cell Division
Specific Morphology
Small Nuclear-Cytoplasmic Ratio
Perform Specific Differentiated
Functions
Adhere tightly together…
Are nonmigratory
Grow in an orderly and well
differentiated manner
Are contact inhibited
Characteristics of Malignant Cells
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Demonstrate rapid or continuous cellular
division.
Show anaplastic morphology
Have a large nuclear-cytoplasmic ratio
Lose some or all differentiated functions
Adhere loosely together
Are able to migrate
Grow by invasion
Are not contact-inhibited
Leukemia
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AML - Acute Myelogenous
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ALL - Acute Lymphocytic
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CML - Chronic Myelogenous
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CLL - Chronic Lymphocytic
FAB Leukemia Classification
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French American British
Classification
Historically
distinguishing AML from
ALL was a major clinical
problem
Chemotherapy
dependent on tissue
type
Acute Leukemia NCCN
Guidelines
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National Comprehensive Cancer
Network (NCCN) has issued guidelines
for treatment of many cancers including
Leukemia as well as other
hematological malignancies
http://www.nccn.org/index.html
Bone Marrow Aspiration
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Bone marrow biopsy
Bone marrow aspiration
Lymphoma
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Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Multiple Myeloma
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Gammopathy
“M” Protein
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called a tumor marker
History of Myeloma
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Skeletal evidence of myeloma obtained
from Egyptian mummies
First case described in 1844
1845 Dr Henry Bence Jones detected heat
properties of urinary light chains
1929 Bone marrow aspiration
1937 serum protein electrophoresis
1960 Alkeran and prednisone- first
treatment
What is Multiple Myeloma?
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A cancer of the bone marrow
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The location where cells are produced
The affected cells are plasma cells
Plasma cells produce antibodies
(proteins that fight off infection)
To Many Harmful Plasma Cells
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Abnormal Plasma Cells are called
Myeloma Cells and develop without
warning
Myeloma cells collect in bones and
cause “soft spots” where the cell is
damaged
Effects of the blood
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Normal cells are not
being produced in the
bone marrow
Bones are damaged
Bone demineralization
(soft spots)
Symptomatic Multiple Myeloma
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Calcium
Renal
Anemia
Bone

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