HEMATOLOGY : SHORT NOTES FOR NURSES

HAEMATOLOGY


Hematology is the study of blood anatomy and physiology of blood

Blood 

  • plasma( 55%)
  • Cellular component 45%                            

Plasma     :-       Albumin,  Globulin,  Clotting factor

Albumin:-     Maintain osmotic pressure

Globulin

  • Alfa Globulin ———–Transport Of Iron, Bilirubin, And Steroid
  • Beta Globulin————–Transport Of Copper And Iron
  • Gamma Globulin———–Maintain Immunity

Cellular component      RBC, W B C, PLATELETE





R B C (erythrocyte)

  • Normal count is 4.5 to 5.5ml/mm3
  • Immature R B C is known as recticulocyte. it contain nucleus when R B C mature nucleus become Hb
  • R B C are produced in bone narrow
  • For the production of R B C the element needed are iron, vita B12,.and vita B9(folic acid)
  • R B C destruction  mainly happen in the spleen
  • average life span of R B C is 90-120 days
  • when the R B C destroyed it divided in to iron and bilirubin

Haematocrit:- concentration of R B C in 100ml of blood normal value is 35-45%

 

W B C (leukocyte)

Normal count is 4000 to 11000/mm3

Types  :-  Granulocyte and Agranulocyte

Granulocyte               N-neutrophill

E-esnophill

B-basophill

Agranulocyte            Mo -monocyte

Ly -lymphocyte

Neutrophill:- phagocytosis

Esnophill:- allergic response. because it is a reservoir of histamine.

Basophile:- preventing clotting in microcirculation and allergic response. because it is a good reservoir of heparin and histamine

Monocyte :- phagocytosis

Lymphocyte :-phagocytosis

Types:                          

  • B Lymphocytes:-it is produced from lymphnode and it produce antibody
  • T Lymphocytes:- generated from thimas gland regulation of immune response

PLATELET (thrombocyte)

  • Normal count is 1.5 -4.5 lack/mm3
  • It is produced from bone narrow and it takes part in clotting process

ANEMIA

It is a condition characterized by Hb is less than 10g/dl and HCT<30%

Types

  • Iron deficiency
  • Megalo blastic anemia
    • folic acid deficiency anemia
  • pernicious anemia
  • Hemolytic anemia
    • Sickle cell anemia
    • Beta thalassemia anemia
    • G6PD
  • Aplastic anemia

IRON DEFICIENCY ANEMIA

Cause:

  • Dietary deficiency
  • Decreased absorption
  • Increased requirement
  • Increased milk intake
  • Pica
  • Due to some medication
  • common in young women, pregnant, and lactating women

SIGNS AND SYMPTOMS

  • Fatigue, pallor, weakness
  • Irritability
  • Exertional dyspnea
  • Dry skin ,thin hair and nail
  • R B C hypocromic(colorless),and microcytic(small size)

Management:

  • Increase the dietary intake of iron
  • Provide green leafy vegetable
  • Provide parental supplement
  • Provide adequate rest
  • Provide blood transfusion if necessary
  • Give vitamin C along with iron
  • Decrease intake of milk with iron
  • Provide follow up care

PERNICIOUS ANEMIA

  • It is the anemia due to deficiency of vita B12
  • Intrinsic factor is necessary for the absorption of vita B12 in the small intestine
  • Intrinsic factor is produced by stomach so pernicious is the deficiency of intrinsic factor

Cause:

  • Gastrectomy,
  • Aging commonly after 5oyrs
  • Remaining same like iron deficiency anemia

SIGNS AND SYMPTOMS

  • Anemia with fatigue, pallor, and exertional dyspnea
  • Paraesthesia
  • Peripheral neuropathy
  • Depression
  • Psychosis
  • GI symptoms like weight loose and decreased thirst
  • Red beefy tong (cardinal sign)
  • R B C:- normocromic (normal color),and  Macrocytic (large size)

Diagnosis:

Schilling test

Step 1: radioactive vita B12 orally and IM vita B12 for fasting patient. collect 24 hrs urine and measure radioactive vita B12 and note

Step 2:- 

  • one to two week after 1st step
  • administer radioactive vita B12 and intrinsic factor orally
  • collect 24hrs urine and measure radioactive vita B 12 and note
  • if it is greater than the first step value indicate intrinsic factor deficiency

Management:

  • provide green leafy vegetables
  • provide safty precautions if patient have paraesthesia
  • check the temperature of bathing water, food, and liquids

Medical management:

  • vita B12 IM, if it is intrinsic factor deficiency, every week until become stabilize and every month throughout the life

FOLIC ACID DEFICIENCY ANEMIA

Cause:

  • Excessive cocking of food
  • Alcoholism
  • Same like anemia

signs and symptoms 

  • R B C are Macrocytic (large size),and Normocromic (normal color)
  • Folic acid deficiency in pregnancy can lead to neural tube deficiency like spina bifida
  • Other same like pernicious anemia expert beefy tong

Management:

  • Replacement of folic acid by oral foam
  • Provide food supplement (curry leafs)

HAEMOLYTIC ANEMIA

1) SICKLE CELL ANEMIA

  • It is an anemia characterized by sickle shaped R B C

Cause:

  • Genitic factor
  • Autosomal recessive trait
  • Sickles cells R B C life span is 6-20 days
  • Sickles cells clumped together and obstruct small capillary O2 carrying capacity reduced and recticulocyte count will be increased also iron and bilirubin level will increased in the blood
  • Increased iron in the body is called haemosiderosis

signs and symptoms

Acute

  • Vase occlusive crisis:- it is a painful condition due to occlusion of the vessel with the sickle shaped R B C
  • Splenic sequestration crisis:–it is consider as an abnormal process or foreign body by the immunosystem so more blood will go to the spleen to expel the foreign body and decreased in the blood volume resulting in shock and death
  • Aplastic crisis:-stop production of all cellular component by bonemarrow

Precipitating factor

  • Dehydration
  • Hypoxia
  • Extreme climate change
  • High attitude
  • Acidosis
  • Trauma
  • Surgery
  • Infection
  • Physical stress and mental stress

Chronic symptoms

  • Jaundice
  • Gall bladder stone due to increase production of bilirubin
  • Fibrotic spleen
  • Progressive changes in kidney due to increase amount of iron
  • Growth failure and high risk of infection due to reduced O2 carrying capacity
  • Decreased life span
  • Sickle cell anemia is not diagnosed up to 4 to 5 months because of maternal r b c present in the baby’s body

Diagnosis:

Peripheral blood should be obtain and O2 is removed from a drop of blood if the R B C become crescent or sickle shape under microscopy indicate sickle trait or diseases

Sickle dex

One drop of blood is mixed with a reagent solution and if the solution become cloudy that indicate sickle trait or diseases

Haemoglobin electrophorosis

Blood is subjected to electrical current, cell are separated .if there are more than 50% sickle cell    R B C indicate sickle diseases. If there are less than 50%R B C (sickle cell) indicate trait or other hemoglobin abnormality

Management

    • Provide hydration
    • Administrate oxygen
    • Provide adequate rest
    • Provide comfortable position do not elevate bed more than 45 degre
    • Administer pain medication (morphine sulfate) demerol should be avoid because it leads to seizures
    • In severe case give hydroxy urea or hydrea (antineoplastic drug) to prevent the formation of sickle cell R B C by suppressing bonemarrow
    • Prevent precipitating factor like contact sports ,football, and climbing mountain
    • Give genetic council to the parents




BETA THALASSEMIA (COOLEY’S) ANEMIA

  • it is a haemolytic anemia due to autosomal recessive trait in which congenital absence of one beta chain

Hb 

4 Haem  ——– 2 alpha chain

1Globin  —————- 2betachain

It is very common in India, Pakistan, South Africa, Medi terranean descent.

signs and symptoms

  • Signs and symptoms of anemia
  • Iron over load
  • Hapatosplenomegali
  • Wide set eye
  • Flat nose
  • Maxilary prominence
  • Frontal bossing
  • Delayed growth

Management

  • Blood transfusion 500ml every 2-3 week
  • Hb level should keep between at least 9-10g/dl
  • Give iron chealating therapy Dexferal (deferoxamine)
  • Reduce the intake of dietary iron
  • Remain same like sickle cell anemia
  • Genitical counseling for parents
  • Prevent infection
  • Provide follow up care

G6 PD deficiency anemia (glucose 6 phosphate dehydrogenize)

  • G6PD is an enzyme necessary for the production and life of blood

Management

  • Blood transfusion
  • Administration of G6PD enzyme

APLASTIC ANAEMIA

  • Absence of all cellular components in blood

Cause:

  • Chemotherapy
  • Radiation
  • Congenital

Diagnosis:- Bonemarrow biopsy

signs and symptoms

  • Anaemia
  • Infection
  • Bleeding

Management

  • remove the cause
  • anemia should be treat
  • avoid crowed
  • Avoid contact with infection people
  • avoid IV and IM injection
  • use electrical racer
  • avoid injury
  • if severe administer blood transfusion and prepare the patient for bonemarrow transplantation

HEMOPHILIA:

  • It is bleeding disorder due to deficiency of clotting factor

Cause

  • X-linked disorder
  • Autosomal recessive trait

Female                                  Male

XX- normal                               XY – normal

Xxn carrier                               no carrier

xnxn diseased                          xnY diseased

TYPES

  1. Haemophilia A(classic haemophilia): due to deficiency of factor VIII
  2. Hemophilia B(Christmas diseases): due to deficiency of factor IX
  3. Hemophilia C: due to deficiency of factor VIII,IX,XI

signs and symptoms

  • Bleeding
  • Bleeding time (BT) normal (because platelet will adhere the situation)
  • CT and platelet are normal
  • APTT prolonged

Management

  • Administration of FFP
  • Administrate cryoprecipatitate means give only deficiency factor
  • Provide vita K rich diet like green leafy vegetable
  • Immobilized affected extremity
  • Access neurological status
  • Avoid contact sports but swimming can be provided
  • Provide helmet and knee pad
  • Wear medi alert bracelet
  • Give genitical counseling
  • Follow up care
  • Avoid sharp object for feeding
  • Pad the crib to prevent injury
  • Toy should not have any sharp edges
  • Weight bearing exercise should be avoid
  • Give soft brush for brushing the teeth
  • avoid flossing the teeth

 

THROMBOCYTOPNEA

  • Decreased production of platelet in bone narrow

Cause

  • Bone narrow suppression
  • Massive transfusion of R B C
  • Unknown cause
  • Autoimmune disorder
  • viral infections

signs and symptoms

  • Ecchymosis
  • Petechia
  • Bleeding tendency

Management

  • Remove the cause
  • Administration of platelet
  • Administration of corticosteroids for unknown cause
  • Spleenectomy to decrease the rate of destruction

POLYCYTHAEMIA VERA:

  • It is the condition with abnormally increased production of R B C and also leukocytes and platelet

Cause

  • Unknown cause
  • Above age 50yrs
  • Common in Jewish people
  • Death occurs within 10 years
  • SECONDRY POLYTHAEMIA VERA: is secondary to cyanotic heart diseases

signs and symptoms

  • Increased R B C
  • Increased H CT
  • Increased Hb
  • Increased Blood volume
  • Increased Blood velocity
  • Increased B P
  • Red color skin
  • Headache
  • Flushed face
  • Feeling of fullness of the head
  • Decreased blood flow due to increased viscosity
  • Thrombous formation:- C V A, DVT, and pulmonary embolism and MI
  • Heaptomegaly
  • Splenomegaly
  • Gout because of increased uric acid

Diagnosis

  • W B C increased or decreased
  • Increased bilirubin
  • Increased uric acid
  • Increased H C T and R B C
  • Bonemarrow biopsy shows increased immature cells

Management

  • increased fluid intake
  • avoid prolonged rest
  • encourage ambulation
  • decreased iron rich diet
  • prevent infection
  • provide follow up care
  • prepare the patient for phlebectomy at a time 250 to 500ml of blood can remove
  • chemotherapy
  • radiation therapy

 

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