, ▪
Module 2
1 Hematologic System
◦ Review Anatomy and Physiology
2 Incorporation of the Clinical Judgement Model for Patients with Hematologic Disorders
◦ Recognize (Assessment)
◦ Analyze (Analysis)
◦ Prioritize (Analysis)
◦ Solutions (Planning)
◦ Actions (Implementation)
◦ Evaluation (Evaluation)
Anemia
Leukemia
Pancytopenia
Clotting disorders
3 Diagnostic Tests and Procedures
◦ Imaging
◦ Laboratory values
◦ aPTT
◦ PT/INR
◦ D-dimer
◦ CBC
Bone marrow and Blood
Blood stem cells - Unspecialized cells that are capable of becoming any type of blood cell , depending on
body’s needs ( produced in BONE MARROW)
—> Committed stem cells ( need special growth factor for specialization)
BONE MARROW
• Red blood cells RBC’s (erthyrocyte)-
Largest in the body , biconcave disk shaped , no nucleus , produce hemoglobin( iron necessary )
Each Hemoglobin can carry 4 O2’s
• White blood cells WBC’s (leukocyte )
Protect through inflammation and immunity
• Platelets (thrombocytes)
Smallest blood cells,intimate repair after vessel damage
, Perfusion - total arterial blood flow through the tissues (peripheral ) and blood pumped by the heart
(central)
Clotting- complex , multi step process by which blood forms a protein-based structure (clot) in an
area to prevent bleeding
Erythropoiesis- selective growth of bone marrow stem cells into erythrocytes
• erythropoietin produced by kidneys is the RBC growth factor
Hypoxia- tissue oxygen is less than normal
Hemostasis - multi step process controls blood clotting , while maintains perfusion in times of
bleeding
Accessory organs of
blood formation
Spleen and liver - accessory organs
Spleen contains 3 tissues : white pulp,red pulp,marginal pulp
Spleen balance blood cells production and destruction , destroys
old or imperfect RBC’s
Splenectomy reduced immune function
Liver produces prothrombin and other clotting factors , filters
vitamin K , stores whole blood and blood cells
Hormones :
Kidney - erythropoietin (RBC growth factor )
Liver - prothrombin ( clotting)
Anticlotting forces
Fibrinolysis - process that dissolves fibrin clot edges with special enzyme , starts by activating plasminogen to
plasmin , plasmin is an active enzyme that dissolves fibrin,fibrinogen,prothrombin
Cascade of fibrinolysis : plasminogen->plasmin(enzyme)->dissolve fibrin,fibrinogen,prothrombin
Aging factors ASSESSMENT OF OLDER ADULTS
• Nail bed capillary refill
Older adults have
• Hair distribution
• Decreased blood volume
• Skin moisture
• Lower levels of plasma proteins
• Skin color
• Fewer red blood cells
OTHER FACTORS
• Lower number of RBC’s and WBC’s
• Nutrition status
• Family history and genetic risk
• Current health problems
LOOK T TABLE 36.1 PAGE 783
, NOTE ***
Anticoagulant drugs work by interfering with one or more steps involved in blood clotting cascade
Fibrinolytic drugs selectively break down fibrin threads in present blood clots ( Med: Alteplase )
ANEMIA
Physical assessment Psychosocial assessment
• Skin Diagnostic assessment
• Head and neck • Blood cells count
• Respiratory
• Cardiovascular • Serum levels
• Kidney and urinary • LAP ( leukocyte
• Musculoskeletal alkaline phosphate )
• Abdominal • Coombs test
• Central nervous system Bleeding and coagulation tests
Imaging assessment • PT - prothrombin time ( 11-12.5 seconds ,
85-100% of the time ) shows how fast blood clots
• radioisotopic imaging ( IV given 3 hours before the
• INR - international normalized ratio, 2-3 ( is
procedure )Isotopes are used to evaluate for cites of
individualized )
active blood cell formation and iron storage
• PTT - partial thromboplastin time , assesses the
Bone marrow aspiration and biopsy clotting cascade and the action of factors desired
• invasive procedure , helps assess patients range is 1.5-2.0 times normal values
hematologic status , results provide • Anti-factor Xa - amount of anti-activated factor X
functioning of bone marrow , MD or ARN can ( anti Xa) affected by heparin ( reference range
perform this for adults receiving heparin is less than 1IU/mL)
• Lasts 5-15 minute , local anesthetic used ( in • Platelet aggregation test - mixing patient plasma
some-cases sedatives) with an agonist substance that causes clumping
Anemia - reduced numbers of function of RBC’s , can
cause hypoxia
• deficiency such as lacking iron,vitamin B12 , folic
acid , copper , pyridoxine,cobalt and nickel can
cause this condition
Module 2
1 Hematologic System
◦ Review Anatomy and Physiology
2 Incorporation of the Clinical Judgement Model for Patients with Hematologic Disorders
◦ Recognize (Assessment)
◦ Analyze (Analysis)
◦ Prioritize (Analysis)
◦ Solutions (Planning)
◦ Actions (Implementation)
◦ Evaluation (Evaluation)
Anemia
Leukemia
Pancytopenia
Clotting disorders
3 Diagnostic Tests and Procedures
◦ Imaging
◦ Laboratory values
◦ aPTT
◦ PT/INR
◦ D-dimer
◦ CBC
Bone marrow and Blood
Blood stem cells - Unspecialized cells that are capable of becoming any type of blood cell , depending on
body’s needs ( produced in BONE MARROW)
—> Committed stem cells ( need special growth factor for specialization)
BONE MARROW
• Red blood cells RBC’s (erthyrocyte)-
Largest in the body , biconcave disk shaped , no nucleus , produce hemoglobin( iron necessary )
Each Hemoglobin can carry 4 O2’s
• White blood cells WBC’s (leukocyte )
Protect through inflammation and immunity
• Platelets (thrombocytes)
Smallest blood cells,intimate repair after vessel damage
, Perfusion - total arterial blood flow through the tissues (peripheral ) and blood pumped by the heart
(central)
Clotting- complex , multi step process by which blood forms a protein-based structure (clot) in an
area to prevent bleeding
Erythropoiesis- selective growth of bone marrow stem cells into erythrocytes
• erythropoietin produced by kidneys is the RBC growth factor
Hypoxia- tissue oxygen is less than normal
Hemostasis - multi step process controls blood clotting , while maintains perfusion in times of
bleeding
Accessory organs of
blood formation
Spleen and liver - accessory organs
Spleen contains 3 tissues : white pulp,red pulp,marginal pulp
Spleen balance blood cells production and destruction , destroys
old or imperfect RBC’s
Splenectomy reduced immune function
Liver produces prothrombin and other clotting factors , filters
vitamin K , stores whole blood and blood cells
Hormones :
Kidney - erythropoietin (RBC growth factor )
Liver - prothrombin ( clotting)
Anticlotting forces
Fibrinolysis - process that dissolves fibrin clot edges with special enzyme , starts by activating plasminogen to
plasmin , plasmin is an active enzyme that dissolves fibrin,fibrinogen,prothrombin
Cascade of fibrinolysis : plasminogen->plasmin(enzyme)->dissolve fibrin,fibrinogen,prothrombin
Aging factors ASSESSMENT OF OLDER ADULTS
• Nail bed capillary refill
Older adults have
• Hair distribution
• Decreased blood volume
• Skin moisture
• Lower levels of plasma proteins
• Skin color
• Fewer red blood cells
OTHER FACTORS
• Lower number of RBC’s and WBC’s
• Nutrition status
• Family history and genetic risk
• Current health problems
LOOK T TABLE 36.1 PAGE 783
, NOTE ***
Anticoagulant drugs work by interfering with one or more steps involved in blood clotting cascade
Fibrinolytic drugs selectively break down fibrin threads in present blood clots ( Med: Alteplase )
ANEMIA
Physical assessment Psychosocial assessment
• Skin Diagnostic assessment
• Head and neck • Blood cells count
• Respiratory
• Cardiovascular • Serum levels
• Kidney and urinary • LAP ( leukocyte
• Musculoskeletal alkaline phosphate )
• Abdominal • Coombs test
• Central nervous system Bleeding and coagulation tests
Imaging assessment • PT - prothrombin time ( 11-12.5 seconds ,
85-100% of the time ) shows how fast blood clots
• radioisotopic imaging ( IV given 3 hours before the
• INR - international normalized ratio, 2-3 ( is
procedure )Isotopes are used to evaluate for cites of
individualized )
active blood cell formation and iron storage
• PTT - partial thromboplastin time , assesses the
Bone marrow aspiration and biopsy clotting cascade and the action of factors desired
• invasive procedure , helps assess patients range is 1.5-2.0 times normal values
hematologic status , results provide • Anti-factor Xa - amount of anti-activated factor X
functioning of bone marrow , MD or ARN can ( anti Xa) affected by heparin ( reference range
perform this for adults receiving heparin is less than 1IU/mL)
• Lasts 5-15 minute , local anesthetic used ( in • Platelet aggregation test - mixing patient plasma
some-cases sedatives) with an agonist substance that causes clumping
Anemia - reduced numbers of function of RBC’s , can
cause hypoxia
• deficiency such as lacking iron,vitamin B12 , folic
acid , copper , pyridoxine,cobalt and nickel can
cause this condition
