Hematologic System

COURSE OUTLINE
A. Review on Anatomy and Physiology
1. Organs of Hematologic System
2. Blood and Blood Components
3. Immunity
4. Blood Groups and Blood Typing
B. Laboratory/Diagnostic Examination
1. Complete Blood Count
2. Coagulation Screening Test

3. Antiglobulin Tests
4. Bone Marrow Aspiration and Biopsy
5. Skin Tests

C. Hematologic Disorders
1. Anemia
a. Iron Deficiency
b. Thalassemia RED BLOOD CELLS
c. Megaloblastic • Erythrocytes unnucleated biconcave disks
d. Pernicious • Has thin membrane that enable gases such as
e. Folic Acid Deficiency oxygen and carbon dioxide to diffuse
f. Aplastic Hemolytic immediately
g. Sickle Cell • JOB: transports oxygen between lungs and
2. Polycythemia Vera tissues
3. Agranulocytosis ERYTHROPOEISIS: process of formation of RBC’s
4. Multiple Myeloma LIFESPAN: 120 days
5. Idiopathic Thrombocythopenia
Purpura GRANULOCYTES
6. Hypoprothrombinemia NEUTROPHIL: essential in preventing or limiting
7. Disseminated Intravascular bacterial infection via phagocytosis
Coagulation AVRG LIFE SPAN: 2 to 4 hours
8. Hemophilia EOSINOPHIL: involved in allergic reactions,
9. Leukemia neutralizes histamine; digests foreign
10. Lymphomas proteins,phagocytosis of parasites
11. Infectious Mononucleosis BASOPHIL: contains histamine, integral part of
hypersensitivity reactions
HEMATOLOGIC SYSTEM AGRANULOCYTES
Consists of the blood and the sites where blood is MONOCYTES: enters tissue as macrophage;highly
produced including the bone marrow and the phagocytic especially against fungus; immune
reticuloendothelial system surveillance

BLOOD LYMPHOCYTES:
• Specialized organ A. T lymphocytes: cell mediated immunity, recognizes
• Differs from other organs in that it exists in a material as “foreign”
fluid state B. B lymphocytes: humoral immunity, many mature
• Composed of plasma,proteins and clotting into plasma cells to form antibodies
factors such as FIBRINOGEN PLATELETS
• Thrombocytes
PLASMA: fluid portion of blood, occupies 55% of total • Granular fragments of giant cells in the bone
blood volume marrow called MEGAKARYOCYTES
• Production: regulated in part by hormone
FUNCTIONS OF BLOOD THROMBOPOEITIN
• Carries oxygen and nutrients to the body cells • JOB: essential role in the control of bleeding
for cellular metabolism • LIFE SPAN: 7 to 10 days
• Carries waste products PLASMA AND PLASMA PROTEINS
• Carries hormones, antibodies • ALBUMIN: maintenance of fluid balance
• WHEN THERE IS DANGER(-._.-) • Produced by liver
• Intricate clotting mechanism is activated to • Has capacity to bind to several substances that
seal any leak in the blood vessels are transported in the plasma
• HEMOSTASIS: balance between clot formation GLOBULIN:
and clot dissolution • Alpha
• • Beta
BONE MARROW • Gamma
• Site of hematopoeisis RETICULOENDOTHELIAL SYSTEM
• Highly vascular • encompasses a range of cells capable of
• Consists of islands of cellular components (RED phagocytosis - macrophages and monocytes.
MARROW) separated by fat (YELLOW • mononuclear phagocytic system
MARROW) • maybe freely circulating within the blood or
• CHILD: all skeletal muscles fixed to various connective tissues.
• ADULT: pelvis,ribs,vertebrae and sternum • Examples of the site of fixed cells includes
pulmonary alveoli, liver sinusoids, skin, spleen
BLOOD CELLS and joints.
• Normally make up 40-45% of total blood FUNCTIONS:
volume • remove senescent cells from circulation
HEMATOPOEISIS: complex process of formation and • provide phagocytic cells for both inflammatory
maturation of blood cells and immune responses
PRIMARY HEMOSTASIS
SECONDARY HEMOSTASIS
Complete Blood Count
• Includes the red blood cell (RBC) count,
hemoglobin, hematocrit, RBC indices, WBC
count with or without differential and platelet
count
RBC Count
• Measure the number of RBCs in mm3
• Useful in verifying findings from other
hematopoietic tests for diagnosis of anemia
and polycythemia
• Hemoglobin level
• Used to evaluate the hemoglobin content (iron
status and oxygen carrying capacity) of RBCs
by measuring the number of grams of
hemoglobin
• Complete Blood Count
Hematocrit Level
• Measure the volume of RBCs in the whole
blood expressed as a percentage
• Roughly three times the hemoglobin
concentration
Red Blood Cell Indices
• Measures of erythocyte size and hemoglobin
content
• 3 indices: Mean Corpuscular Volume, Mean
Corpuscular Hemoglobin, Mean Corpuscular
Hemoglobin Concentration
Platelet Count
• Valuable in assessing the severity of
thrombocytopenia and thrombocytosis
• White blood cell count
• Used to detect infection or inflammation and to
monitor a client’s response to or adverse
effects of chemotherapy or radiation therapy
• White blood cell differential
• Determines the proportion of each of the 5
types of WBC in a sample of 100 WBCs
• Used in evaluating the body’s capacity to resist
and overcome infections, in detecting and
classifying leukemias, allergies, helminthic
infections and other disorders
Coagulation Screening Test
• Performed to discern whether the bleeding
problem is related to a platelet, coagulation or
vascular defect
Components
Platelet count
Prothrombin Time (PT)
Partial Thromboplastin Time (PTT)
Bleeding time
Platelet Count
Measures the number of circulating platelets in venous
or arterial blood
NV = 150,000 – 450,000/mm3
Low counts results in prolonged bleeding time and
impaired clot retraction; diagnostic of
thrombocytopenia
Prothrombin Time
• Determines activity and interaction of factors
V, VII and X, prothrombin and fibrinogen;
determines dosages of oral anticoagulant drugs
• NV = 11-15 secs
• INR = 2-3.5
• Prolonged PT is seen in clients receiving
anticoagulant therapy; with low or deficiencies
of fibrinogen, clotting factors II, V, VII and X,
impaired prothrombin activity in the presence
of circulating anticoagulants as seen in SLE
Partial Thromboplastin Time
• Complex method for testing the normalcy of
intrinsic coagulation process; employed to
identify deficiencies of coagulation factors,
prothrombin and fibrinogen; used to monitor
heparin activity
• NV = 25-38 secs
• Prolongation of time indicates coagulation
disorder that is related to deficiency of a
coagulation factor; not diagnostic for platelet
disorders
Bleeding Time
• Measure ability to stop bleeding after a small
puncture wound
• NV = 3-8 minutes in adults
• Prolonged bleeding time in severe coagulation
problems and therapeutic administration of
heparin
Antiglobulin test
• Indirect Antiglobulin test identifies antibodies
to erythrocyte antigens in the serum of clients
who have a greater than normal chance of
developing transfusion reactions
• Direct Antiglobulin test (Coomb’s test) uses
• Detect certain antigen-antibody reactions
between serum antibodies and RBC antigens
• Differentiate between various forms of
hemolytic
• Determine unusual blood types
• Identify hemolytic disease in newborns
Bone Marrow Aspiration and Biopsy
• Used to assess and identify most blood
dyscrasias
• Reveals the number, size, shape of the RBCs,
WBCs, and platelet precursors
• Most commonly taken at the posterior iliac
crest; 2nd common: sternum
Preprocedure Care
• Explain about the procedure and that there will
be pain during the procedure
• Obtain informed consent
• Provide sedation as prescribed
• Position client on side-lying position with the
side from where the biopsy will be taken
uppermost
• Clean client’s skin with antiseptic solution
• Applying ice to the contralateral side to reduce
pain
Postprocedure Care
• Apply pressure until bleeding stops
• Pressure dressing and sandbag may be applied
• Clients may require a mild analgesic for
discomfort or pain
• Monitor site for bleeding
Skin Test
• Confirm sensitivity to a specific allergen and to
detect presence of antibodies
• Positive reaction indicate an antibody (B cell)
response to a previous exposure to the antigen
• Methods
• Patch test
• Scratch test
• Intradermal allergy test
Nursing Assessment of the Hematologic System
• Assessment of Patients with Disorders of the
Hematologic System
• Health History
• History of Present Illness
• Easy bruising
• Prolonged bleeding
• Chronic fatigue
• Past Medical History
• Cancer or prior treatment to cancer –
immunosuppression due to chemotherapy
• HIV infection - immunosuppression
Past Medical History
• Liver disease – liver can also be used in
production of blood cells in cases of bone
marrow destruction, fibrosis or scarring; this
process is called extramedullary hematopoiesis
 • Kidney disease – kidney is responsible for the
production of erythropoietin: a kidney hormone
that tends to increase the number of RBCs and General Survey
cut down the need for blood transfusions in • Responsiveness
cases of chronic anemia • Mood
• Malabsorption disorder - malabsorption of • Expression
certain nutrients like Vit.B12, iron and folate • Posture
which are needed in the production of RBCs • Skin
• Prolonged bleeding • Color
• History of blood transfusions • Dryness
• Brittle fingernails and toenails
• Current medications – aspirin and other • Bruising
NSAIDs may prolong bleeding
• Petechiae
Family History
• Purpura
Blood disorders – sickle-cell disease, hemophilia
• Ecchymosis
Death at young age for reasons other than trauma
• Head and Neck
Review of Systems
• Bleeding
• Integumentary
• Cracking at the corners of the mouth
• Change in skin color
• Thorax
• Dryness
• Respiratory rate
• Pruritus
• Breath sounds
• Brittle fingernails or toenails
• Heart rate
• Neurologic
• Abdomen
• Dizziness
• Liver enlargement
• Vertigo
• Petechiae
• Confusion
• Purpura
• Pain
• Ecchymosis
• Headache – may indicate low RBC count
• Mental status change – intracranial bleeding • Stool guaiac test
from low platelet count Dipstick urine sample for blood
• Change in vision
• Respiratory – symptoms of low RBC count: Anemia
• Epistaxis Decreased availability of oxygen to the tissues
• Hemoptysis Types of anemia
• Dyspnea • Iron Deficiency Anemia
• Thalassemia
• Cardiovascular – symptoms of low RBC count: • Folate Deficiency Anemia
• Palpitations
• Pernicious Anemia
• Chest pain
• Aplastic Anemia
• Dizziness
• Sickle Cell Anemia
• Postural hypotension Causes of Anemia
• Gastrointestinal
• Acute/chronic blood loss
• Change in eating habits • Inadequate dietary intake of vitamins/minerals
• Nausea needed for RBC production
• Vomiting • Decreased RBC production by the bone marrow
• Bleeding • Increased destruction of RBC
• Pain • Increased demands for vitamins/minerals
• Change in bowel habits/ blood in stool needed for RBC production
• Genitourinary Common Manifestations
• Blood in urine • Pallor and syncope
• Heavy menses in women • Easy fatigability and Weakness
• Musculoskeletal • Anorexia and Weight loss
• Numbness or pain in bones or joints – may • Shortness of breath
indicate bleeding has occurred in the joint • Headache/dizziness
• Endocrine • Tachycardia/palpitations
• Fatigue • Brittle hair and nails
• Cold intolerance • Paresthesia
• Functional Assessment • Cold sensitivity
• Occupation & Hobbies – know patient’s job and • Amenorrhea
hobbies. For eg., someone who builds models • Iron Deficiency Anemia
for a hobby may be exposed to unusual glues • Microscopic, hypochromic anemia
or paints, which may affect blood count
• Caused by inadequate intake or excessive loss
• Self-concept – change in appearance because of iron, which is essential to the oxygen-
of the disease may adversely affect patient’s
carrying function of heme
self-concept Clinical Manifestation
• Activity & Exercise
• Vinson-Plummer syndrome (stomatitis,
• Sleep & Rest dysphagia, atrophic glossitis)
Functional Assessment
• Cheilosis (cracks at the side of the lips)
• Nutrition • Koilonychias (spoon-shaped/concave
• Interpersonal Relationships fingernails)
• Coping & Stress • Pica (craving for non-edible substances)
• Perception on Health • Tinnitus
• Physical Examination • Cardiovascular symptoms (tachycardia, chest
• Vital Signs pain, shortness of breath)
• Tachycardia Medical Management
• Tachypnea • Iron supplements
• Hypotension • Should be given with food or pc to prevent GI
• Height and Weight irritation
 • Oral liquid iron to be administered with straw • Decreased excretion of Vitamin B12 in the
to prevent permanent staining of the teeth urine indicates (+) pernicious anemia
• Vitamin C increases iron absorption Assessment
• Do not administer with milk, antacid • “beefy”, red inflamed tongue (most
• Parenteral: administer through Z track (deep characteristic manifestation)
IM) • Achlorhydria
• Can change the color of stools • Tingling, numbness
• Nursing Interventions • Lack of balance, uncoordinated movements
• Promote rest to reduce oxygen demand • Confusion
• Provide good oral care to prevent stomatitis • Paralysis
• Provide good skin care to prevent pressure • Depression, psychosis
sore • Jaundice (faulty erythropoiesis)
• Diet: iron rich foods such as organ meats, • Management
green leafy vegetables, raisins and other dried • Vitamin B12 supplements
fruits • Hydrochloric acid
• Iron therapy
Thalassemia • Blood transfusion as needed
• Inherited disorder of the RBCs that results in • Physical examination every 6 months
reduced rate of normal globin chains synthesis • Folic Acid Deficiency Anemia
• Classification • Results from diet lacking in foods such as
• Alpha – defective production of A globin green leafy vegetables, liver, citrus fruits and
• Beta – defective production of B globin yeast
(Cooley’s Anemia) • Associated with use of alcohol, oral
• Beta Thalassemia major – defect on both B contraceptives, anticonvulsant medications,
globin antimetabolites
• Beta Thalassemia minor – defect on 1 B globin • Causes no neurologic manifestations
• Thalassemia • Management: Folic acid supplement, Vitamin C
Manifestations (to help in erythropoiesis)
• Blood cells are vulnerable to mechanical injury
and easily die Aplastic Anemia
Management • Hypoplasia of the bone marrow
• Blood transfusion • Fat replaced bone marrow
• Bone marrow transplant • Pancytopenia (Anemia, Leukopenia,
• Chelating agents (eg. Deferoxamine) to Thrombocytopenia)
prevent iron build up Diagnostic tests: Bone marrow aspiration/biopsy
• Megaloblastic Anemia • Causes
• Causes • Congenital
• Poor dietary intake (deficiency of Vitamin B12 • Acquired
and folic acid) • Idiopathic
• Rarely eat uncooked (raw) fruits and • Infections
vegetables • Medications
• Alcoholism • Heavy metals
• Chronic malnutrition • Hepatitis
• Pregnancy Medical Management
• Anorexia nervosa • Bone marrow transplantation
• Malabsorption • Immunosuppressive therapy
• Malignancy • Blood transfusion as necessary
• Prolonged Total Parenteral Nutrition • Stool softeners, high-fiber diet to avoid
• Chronic hemodialysis constipation thereby prevent rectal bleeding
• Megaloblastic Anemia Nursing Management
Assessment • Assess for s/s of infection, tissue hypoxia,
• Cracked lips, sore tongue bleeding
• Same as Pernicious anemia • Frequent rest periods to reduce oxygen
Collaborative Management demands of tissue
• Well-balanced diet • Good oral care
• Folic acid 1mg/day • Use soft-bristled toothbrush/soft swabs to
• Eat food from animal sources prevent gum bleeding
• Avoid aspirin administration
Pernicious Anemia • Reverse/protective isolation
• Macrocytic, hyperchromic anemia • Practice asepsis
• Decreased intrinsic factor production by the • Avoid fresh fruits/flowers or raw foods in the
parietal cells of the stomach client’s unit
• DNA synthesis and cell replication are impaired
Causes Sickle Cell Anemia
• Gastric surgery • Inherited disorder of hemoglobin synthesis
• Crohn’s disease resulting in tissue hypoxia and obstruction of
• Diagnostic Tests blood vessels
• Tubeless Gastric Analysis • Primarily affects the Blacks because the
• Checks for presence of HCl in urine abnormal hemoglobin is more resistant to the
• HCl and instrinsic factor are both produced by parasite that causes malaria in Africa
the parietal cells of the stomach • Sicke cell hemoglobin (Hb S) resumes a sickle
Schilling’s Test or crescent shape when deoxygenated
• Most definitive diagnostic test for pernicious • Once RBC sickles, it becomes rigid and blood
anemia becomes more viscous and obstructs capillary
• Oral radioactive Vitamin B12 is administered blood flow leading to more sickling
• Collect 24-hour urine specimen • Organs commonly affected: brain, kidneys,
bone marrow and spleen
 • Sickle cell crisis – acute exacerbation of the Clinical Manifestations
disorder due to respiratory infections or other • Severe fatigue and weakness
stressors that reduce blood oxygen levels • Sore throat, ulcerations of oral mucosa
Manifestations • High fever and severe chills
• Usually manifested at 6 months old • Absence of granulocytes on bone marrow
• Weakness and fatigue aspiration
• Developmental delays and growth retardation
• Sluggish circulation Leukopenia
• Infarctions Specimen cultures that are positive for bacteria
Sickle Cell Crisis Management
• Cardiac systolic murmurs, dysrhythmias, heart Elimination of potentially toxic agents
enlargement Surveillance cultures of blood, throat, sputum, urine
• Dyspnea, chest pain, cyanosis and stool
• Sensorimotor manifestations of increased Erythropoietin
intracranial pressure due to cerebral Granulocyte-stimulating factor
hemorrhaging
• Renal manifestations of uremia, such as Multiple Myeloma
decreased cardiac output and edema • B cell neoplastic condition characterized by
Diagnostic Findings abnormal malignant proliferation of plasma
• Stained blood smears cells
• Sickle cell slide preparations – blood specimen • Associated with heredity, radiation and
is observed after deoxygenation of blood occupational chemical exposures
• Sickle-turbidity tube test – blood is mixed with • Crowding of plasma cells in the bone marrow
a solution and observed for cloudiness results to bone destruction, disruption of RBC,
• Hemoglobin electrophoresis – differentiates WBC and platelet production
sickle cell anemia from sickle cell trait Manifestations
Management • Backache or bone pain
• Supportive care • Pathologic fractures with severe pain
• Administration of packed RBC • Sternum and rib cage deformities
• Anticoagulants, steroids, cobalt treatments • Osteoporosis
• Hydroxyurea and erythropoietin • Diffuse bone lesions
• Fluids to prevent dehydration • Renal stones
• Provide rest periods • Immobilized clients
• Avoid high altitudes • Bence-Jones protein in the urine
• Client teaching on the possibility of being a • Management
carrier of the trait • Aimed at early recognition and treatment of
• Polycythemia Vera the complications
• Hyperplasia of the bone marrow • Chemotherapy
• Increased RBC (erythrocytosis), increased WBC • Palliative radiation
(leukocytosis), increased platelets • Bone marrow transplantation
(thrombocytosis) • Etidronate disodium (Didronel) or Gallium
• Cause is unknown; associated with genetics nitrate (Ganite) to decrease serum calcium
Signs and Symptoms levels
• Ruddy complexion • Increase oral fluids
• Headache • Antiemetics, stool softeners as ordered
• Dizziness • Idiopathic Thrombocytopenic Purpura
• Fatigue • Autoimmune bleeding disorder characterized
• Blurred vision by the development of autoantibodies to one’s
• Hepatosplenomegaly own platelets, the binding of autoantibodies to
• Increased risk of CVA and MI due to antigens and the destruction of platelets in the
thromboembolism spleen
Collaborative Management Clinical Manifestations
• Increase fluid intake to reduce blood viscosity • Petechiae, ecchymosis, epistaxis
• Monitor for signs and symptoms of bleeding • Bleeding gums and easy bruising
• Monitor for signs and symptoms of • Heavy menses or bleeding between periods in
thromboembolism women
• Angina • Thrombocytopenia
• Claudication • Prolonged bleeding time
• Thrombophlebitis • Bone marrow aspirate containing increased
• pruritus number of megakaryocytes
Collaborative Management • Complications
• Administer analgesics as ordered • Cerebral hemorrhage
• Administer antihistamine to decrease pruritus • Severe hemorrhages from the nose, GIT and
• Therapeutic phlebotomy to reduce circulating urinary system
volume • Bleeding into the diaphragm
• Chemotherapy to inhibit hyperactivity of the • Nerve pain, paralysis, paresthesia
bone marrow • Management
• Radiation therapy • Steroids to inhibit the macrophage ingestion of
• Avoid high altitude the antibody-coated platelets
Agranulocytosis • Plasmapheresis
• Acute, potentially fatal blood dyscrasia • Splenectomy
characterized by profound neutropenia • Chemotherapy
(decreased neutrophils) • IV gamma globulin to increase platelet count
• More common in females
• Associated with chemotherapy, radiation, Hypoprothrombinemia
aplastic anemia, drug toxicity, autoimmune • Deficiency in the amount of circulating
diseases, hypersensitivity prothrombin
 • Develops from Vitamin K deficiency or liver • All forms of bleeding (bleeding gums,
damage or from overdose of coumadin and hematuria, gastric hemorrhage, intracranial
aspirin, prolonged antibiotic administration that bleeding, etc.)
sterilizes the bowel Management
• Danger of bleeding or spontaneous • Stop topical bleeding asap
hemorrhage occurs • Supply the missing clotting factor causing the
Clinical Manifestations hemorrhage
• Ecchymosis • Prevent complications leading to and caused by
• Epistaxis bleeding
• Postoperative hemorrhage • Joint immobilization and ice pack for
• Hematuria hemarthrosis
• GI bleeding • Analgesics and corticosteroids
• Prolonged bleeding from venipuncture • Leukemia
Management • Chronic or acute neoplasm of blood-forming
• Treatment of underlying cause cells in the one marrow and lymph nodes
• Vitamin K supplement such as Phytoadione Causes
(Aquamephyton) or menadione (Synkayvite) • Idiopathic
• Stop anticoagulant therapy • Viral
• Transfusion of prothrombin concentrates • Genetic
• Radiation
Disseminated Intravascular Coagulation • Chemicals
• Complex syndrome of activated coagulation • Types of Leukemia
that results in bleeding and thrombosis • Acute Myelocytic Leukemia
• Imbalance between thrombin (causes • Malignant disorder that affects monocytes,
thrombosis) and plasmin (causes lysis) that granulocytes, erythrocytes, platelets
occur simultaneously • Survival: 1-3years (with chemotherapy); 2-5
• Causes: infection, introduction of tissue months (if untreated)
coagulation factors into the circulation,
damage to vascular endothelium, stagnant Types of Leukemia
blood flow Chronic Myelocytic Leukemia
Clinical Manifestations • Malignancy of the myeloid stem cells that leads
• Acute - hemorrhagic condition associated with to uncontrolled proliferation of granulocytes
excess plasmin formation • Most common type of leukemia in adults
• Subacute - not apparent initially but becomes • Characterized by the presence of Philadelphia
severe as it progress chromosomes
• Thrombosis attributed to excessive formation • Survival: 3-5 years (if without bone marrow
of thrombin transplantation)
Acute Lymphocytic Leukemia
• Chronic- seen in clients with cancer or in • Malignant proliferation of lymphoblasts arising
women carrying dead fetus from a disorder of a single lymphoid stem cell
• thrombosis • Most common type of leukemia among children
• Acute Manifestations (hemorrhagic) • Survival: 5 years (with chemotherapy and
• Purpura, petechiae, ecchymoses radiation therapy)
• Prolonged bleeding from venipuncture • 50% can be cured
• Severe, uncontrolled hemorrhage Chronic Lymphocytic Leukemia
• Excessive bleeding from gums and nose • Caused by a proliferation of small, abnormal B-
• Intracerebral and GI bleeding lymphocytes
• Renal hematuria • Survival: 5-7 years
• Tachycardia and hypotension Management
• Dyspnea, hemoptysis, respiratory congestion • Chemotherapy
Management • Bone marrow transplantation
• Identification and elimination of causative • Blood transfusion
factor • Protect from infection
• Reinstitution of hemostasis by replacing • Prevent trauma and bleeding
missing blood components • Conserve energy/oxygen supply
• Provision of supportive therapy
• Antibiotics for infection LYMPHOMAS
• Monitor laboratory values • Malignant lymphomas
• Neoplastic disorders
Hemophilia • Lymph nodes
• X-linked genetic disorder that results in a • Spleen
deficiency of coagulation factors that causes • Painless lymphadenpathy
spontaneous bleeding
• Splenomegaly
• Forms Types
• Hemophilia A (classic form) – due to deficiency • Hodgkin’s disease (Lymphadenoma)
in factor VIII • Lymphosarcoma
• Hemophilia B (Christmas disease) – due to
• Burkitt’s Lymphoma (Stem cell lymphoma)
deficiency in factor IX Assessment
• Von Willebrand’s disease –deficiency in factor
• General malaise
VIII and defective platelet function
• Sweating
Clinical Manifestations
• Fever
• Bleeding that usually presents at circumcision
• Fatigue
or at the beginning of ambulation or primary
• Weight loss
dentition
Hodgkin’s Lymphoma
• Hemarthrosis (bleeding into the joints) –
• Cause: unknown
hallmark of hemophilia
• Common among males, adolescents, young
adults
Stages of Hodgkin’s Disease
 • Stage 1 - involvement of a single lymph node
• Stage 2 – involvement of 2+ lymph node
region on same side of diaphragm
• Stage 3 – involvement of lymph node regions
on both sides of diaphragm
• Stage 4 – diffuse or disseminated involvement
of 1+ extra lymphatic organs, with or without
lymph node involvement (liver, lung, marrow,
skin)
Clinical Manifestation
• Painless lymphadenopathy
• Reed-Sternberg cells are the malignant cells
• Pain (pressure on nerves)
• Edema (obstruction of venous/lymph drainage)
• Cough, dyspnea, dysphagia (enlarged
mediastinal nodes)
• Abdominal pain (splenomegaly)
Management
• Radiation therapy
• Chemotherapy
• MOPP (Nitrogen Mustard, Oncovin,
Procarbazine, Prednisone)
• Supportive Care
• Protect client from infection
• Splenectomy is done in advanced disease
• INFECTIOUS MONONUCLEOSIS
• Benign
• Infectious
• Lymphatic system is affected
• Epstein Barr Virus (EBV) is the causative agent
Assessment
• Sore throat
• Gingivitis
• Headache
• Fatigue
• Anorexia
• Body malaise
• Fever
Lymphadenopathy
• Abdominal tenderness
• Increased WBC
• Self-limiting
• High risk groups
• Homosexual-anal intercourse
• Bisexual males – anal intercourse
• IV drug users
• Infants: HIV-infected parents
• Blood/blood products before 1985
Manifestations
• Fever
• Diarrhea
• Muscle aches
• Rashes
• Weight loss
• Night sweats
• Persistent generalized lymphadenopathy
• Management
• Treatments are aimed at controlling the
manifestations
• Bed rest
• Acetaminophen, TSB, fluids for fever
• Warm saline for sore throat
• Avoid aspirin
• Avoid contact sports
 Laboratory Normal Values

CBC
Blood Coagulation
RBC : (male) 4.6-6.2 M/cu. mm.
PT : 9.5-12 sec.
(female)4.2-5.4 M/cu. mm.
PTT : 20-45 sec.
WBC : 5,000-10,000/cu. mm. (activated)
PLT : 100,000-400,000/cu. mm.
Bleeding Time : 1-9 min.
HGB : (male) 13-18 gm/dL
(female)12-16 gm/dL ESR (male) : <15 mm/h [under50]
(female): <20 mm/h [under50]
HCT : (male) 42-50%.
(female)40-48%
BUN : 6-23 mg/dL
Creatinine : 0.7-1.4 mg/dL
Differential Count Cholesterol : 150-200 mg/dL
Lymphocytes : 20-40% Glucose : 60-110 mg/dL
Neutrophils : 60-70% Iron : 50-160/µg/dL
Monocytes : 2-8% Lactic Dehydrogenase:100-225 U/L
Eosinophils : 1-4% Uric Acid : 2.5-8 mg/dL
Basophils : 0.5-2% Zinc : 55-150 /µg/dL
Lead : up to 40 µg/dL
ABG
pH : 7.35-7.45
paCO2 : 35-45 mmHg
HCO3 : 22-26 mmol/L Levels of Compensation:
PaO2 : 80-100 mmHg pH is Nº : Fully Compensated
O2 Sat. : 94-100% pH is Abº (look at opposite partner)
90-110 : adequate Nº : Uncompensated
80-89 : mild hypoxia Abº: Partial Compensation
70-79 : moderate hypoxia
↓69-69 : severe hypoxia

Urinalysis
Color : yellow - straw
Sp. Gravity : 1.010-1.030
pH : 5.0-8.0
Glucose : negative
Sodium : 130-200 mEq/24h
Potassium : 40-65 mEq/24h
Chloride : <8mEq/L
Protein : negative-trace
Osmolality : 270-380 mOsm/L

General Chemistry
Sodium : 135-145 mEq/L
Potassium : 3.5-5.0 mEq/L
Calcium : 8.5-10.5 mg/dL
Magnesium : 1.3-2.4 mEq/L
Phosphate : 2.5-4.5 mg/d