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Hematology

Oct 03, 20245 min read

Blood is a specialized organ that exists in a fluid state. It is composed of plasma and blood cells. It makes up 7% to 10% of the human body (5 to 6 L). It is created in the red bone marrow (hematopoiesis).

  • Plasma is the liquid part of the blood.
    • Nutrients
    • Foreign Bodies
  • Cells are the formed elements. There are three common cell types:
    • Erythrocytes
    • Leukocytes
    • Thrombocytes (Platelets)

CBC

  1. Hematocrit: the ratio between blood volume and RBC volume. Normally 30 to 40. Increase in Hct indicates FVD, decrease in Hct indicates FVE.
  2. Mean Corpuscular Volume: the size of the RBC. Determines presence of Microcytic, Normocytic, or Macrocytic RBC.
    • An example of Normocytic Anemia is from CKD/RF.
    • An example of Microcytic Anemia is Iron Deficiency Anemia.
    • An example of Macrocytic Anemia is Megaloblastic Anemia.
  3. Hemoglobin is found within RBCs. Its decrease is called anemia, and excess is called polycythemia (found in smokers). Anemia patients display pallor, fatigue, and palpitations.
    • Normal Female Volume: 12 to 14 grams/deciliter
    • Normal Male Volume: 14 to 16 grams/deciliter
    • Red blood cells have a normal lifespan of 120 days.
  4. White Blood Cells: forefront immunologic agents.
    • Normal: 5,000 to 10,000
    • Decreased WBC is termed as leukopenia.
      • Avoid crowded places, limit visitors, and observe hand hygiene and the use of personal protective equipment.
      • Diet for leukopenic patients: low-residue low-fiber high-protein diet.
      • Reverse isolation for patients.
    • Increased WBC is termed as leukocytosis. This suggests an active bacterial infection.
  5. Platelet Count: platelets are important for clotting. They have a normal lifespan of 10 days.
    • Normal Value: 150,000 to 450,000.
    • Thrombocytopenia poses a risk for bleeding as the body is unable to clot wounds.
    • Thrombocytosis produces a risk of excessive clotting.

Renal Failure

Decreased blood oxygen signals to the kidneys to produce erythropoietin, a hormone that stimulates the red bone marrow to produce red blood cells. Renal failure, resulting in a drop in erythropoietin and a subsequent decrease in RBC production, resulting in Normocytic Anemia.

  • Epogen, synthetic erythropoietin, is given to patients with RF to manage anemia. It is given thrice a week subcutaneously. If severe, it is managed through blood transfusion.

Hemolytic Anemia

  1. Hemoglobin is released when the RBC is lysed, and releases Heme, which converts to bilirubin, which leads to the jaundiced presentation of patients with hemolytic anemia (e.g. sickle cell anemia, malaria).

Blood Formation

  1. Immature red blood cells are called reticulocytes, and hold less oxygen than erythrocytes (mature red blood cells).
  2. Immature white blood cells are called blasts, and are unable to fight infection. These are the type of cells that are excessively produced and “drown out” other white blood cells in leukemia. Mature white blood cells are leukocytes.
  3. Platelets begin as megakaryocytes and mature into Thrombocytes.

Leukocytes

  1. Granulocytes: Neutrophils, Eosinophils, and Basophils
    • Neutrophils increase in bacterial infection. It is the most abundant white blood cell.
    • Eosinophils increase in allergic reactions.
    • Basophils are the least abundant.
  2. Agranulocytes: Lymphocytes, Monocytes
    • Monocytes, when they mature, are macrophages. They consume foreign bodies and organisms through phagocytosis.
    • Lymphocytes produce antibodies. The major producer of antibodies is the spleen with its high number of lymphocytes. Other organs include the tonsils and appendix.

Anemia

IDA and Megaloblastic Anemia are nutritional anemias, both treated by supplementation and correction of diet.

  1. Iron-Deficiency Anemia (IDA) is produced by a decrease in iron supply.
    • Causes: bleeding, nutritional deficiencies
    • Diet High in Iron: Meat, Seafoods, Eggs, Liver, Fish (Meat SELF), and Dark Green Leafy Vegetables. Iron is best absorbed with Vitamin C. Ferrous sulfate is best taken with an empty stomach. Stool may appear dark green or black.
    • Diagnostics: microcytic hypochromic anemia and decreased serum ferritin. Pathognomonic sign: koilonychia; spoon-shaped nails.
    • Administration of Iron Supplements: oral, use straw; IM, use Z-track.
  2. Megaloblastic Anemia, further divided into Vitamin B9 (FADA) and Vitamin B12 (Pernicious Anemia) deficiency. These vitamins are important in the production of DNA in RBCs.
    • Diagnostics: Macrocytic Anemia. Pathognomonic Sign of Beefy Red Tongue; Glossitis. Decreased hemoglobin, decreased DNA synthesis, but increased MCV.
    • FADA: those at risk for Vitamin B9 deficiency are alcoholics and those in pregnancy. Some drugs (e.g. Methotrexate) may also cause FADA.
    • Pernicious Anemia: those at risk for Vitamin B12 deficiency are those who had a Billroth I or II procedure (it removes the IF necessary to absorb Vitamin B12).
      • Diagnostic Picture: Glossitis, Beefy Red Tongue, and Paresthesia. 24-hour urine for Schilling Test.
      • These patients require a life-long monthly administration of Vitamin B12.
      • Diet for B12: eggs, meat, poultry, shellfish, milk, and milk products, citrus, legumes
  3. Sickle Cell Anemia: caused by hypoxia and the HbS gene is inherited in the African Race.
    • Avoid high altitudes and cold environments.
    • Definitive Diagnosis: hemoglobin electrophoresis
    • Jaundi(s)ce, Avoid (i)nfection, (C)rescent-shaped RBC, (K)Crisis and Pain, (Lahi) Hereditary, Encourage hydration (3L/day to avoid clotting)
  4. Aplastic Anemia: an idiopathic disorder resulting in insufficient production of blood cells.
    • If determined as autoimmune, this is treated by removing antibodies (splenectomy) and immunosuppression (pharmacologic) and replacement of damaged bone marrow tissue with a bone marrow transplant.
    • Diagnostic Picture: pancytopenia; risk for infection, bleeding, and the 3 Ps of anemia.
    • Nursing Interventions: provide rest for fatigue, avoid caffeine, prevent infection, prevent bleeding (avoid rigorous activities, NSAIDs, Aspirin, etc.)

Example Questions

The balance between clot formation and clot dissolution A.) Hematopoiesis B.) Hemostasis C.) D.) Ratio of RBC Volume to the Volume of Blood A.) Hematocrit B.) MCV C.) D.) Which of the following interventions is appropriate for a patient with a hemoglobin of 7 g/dL? A.) Avoid frequent activities. B.) Avoid infection. C.) D.) Production of blood cells is known as A.) Erythropoiesis B.) Hematopoiesis C.) D.) question A.) B.) C.) D.) question A.) B.) C.) D.) Which individuals are more susceptible to FADA? A.) Smokers B.) Alcoholics C.) History of PUD D.) Diarrhea Which food group does not increase iron absorption? A.) Strawberries B.) Brocolli C.) Yogurt D.) Tomatoes

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