Podcast
Questions and Answers
Which of the following is the primary mechanism by which albumin contributes to maintaining blood volume?
Which of the following is the primary mechanism by which albumin contributes to maintaining blood volume?
- Regulating the pH of blood.
- Transporting fats and other lipids through the bloodstream.
- Pulling tissue fluid into the venous ends of the capillary networks. (correct)
- Facilitating the transport of clotting factors.
In an individual experiencing chronic hypoxia, what hematological changes would be expected?
In an individual experiencing chronic hypoxia, what hematological changes would be expected?
- Decreased red blood cell production and hemoglobin levels.
- Increased white blood cell count with decreased reticulocyte count.
- Increased red blood cell production and hemoglobin levels. (correct)
- Decreased hematocrit levels with normal red blood cell count.
How does the spleen contribute to the function of the hematologic system?
How does the spleen contribute to the function of the hematologic system?
- By maturing T lymphocytes and producing thymic hormones.
- By producing intrinsic factor necessary for vitamin B12 absorption.
- By activating clotting factors during hemostasis.
- By storing up to one-third of the body's platelets and removing worn blood cells. (correct)
A patient’s lab results indicate an elevated reticulocyte count. What does this suggest about the patient's condition?
A patient’s lab results indicate an elevated reticulocyte count. What does this suggest about the patient's condition?
Which event initiates the intrinsic pathway of coagulation?
Which event initiates the intrinsic pathway of coagulation?
What is the function of lymph nodes?
What is the function of lymph nodes?
What is the expected effect of the administration of erythropoietin on a patient with anemia?
What is the expected effect of the administration of erythropoietin on a patient with anemia?
Which of the following is the significance of basophils releasing histamine and heparin?
Which of the following is the significance of basophils releasing histamine and heparin?
Why are individuals without a spleen more susceptible to certain types of bacterial infections?
Why are individuals without a spleen more susceptible to certain types of bacterial infections?
A patient with liver disease may have prolonged bleeding times because the liver synthesizes:
A patient with liver disease may have prolonged bleeding times because the liver synthesizes:
What is the primary function of erythropoietin?
What is the primary function of erythropoietin?
What is the primary mechanism by which the lymphatic system maintains fluid balance in the body?
What is the primary mechanism by which the lymphatic system maintains fluid balance in the body?
Why might an individual with kidney disease develop anemia?
Why might an individual with kidney disease develop anemia?
What information from a patient's history would be most important when suspecting a hematologic disorder?
What information from a patient's history would be most important when suspecting a hematologic disorder?
Which physical finding suggests a potential bleeding disorder?
Which physical finding suggests a potential bleeding disorder?
A patient is about to undergo a bone marrow biopsy. What nursing intervention is most important prior to the procedure?
A patient is about to undergo a bone marrow biopsy. What nursing intervention is most important prior to the procedure?
Following a lymphangiography, a patient should be monitored for:
Following a lymphangiography, a patient should be monitored for:
What information would be most important to communicate to the health care provider prior to a blood transfusion?
What information would be most important to communicate to the health care provider prior to a blood transfusion?
Why is it important to initiate a blood transfusion within 30 minutes of receiving the blood from the blood bank?
Why is it important to initiate a blood transfusion within 30 minutes of receiving the blood from the blood bank?
What intravenous solution is compatible with blood products?
What intravenous solution is compatible with blood products?
What is the likely intervention for a patient experiencing a mild urticarial reaction during a blood transfusion?
What is the likely intervention for a patient experiencing a mild urticarial reaction during a blood transfusion?
What steps should be taken first if a patient receiving a blood transfusion begins to exhibit signs and symptoms of a hemolytic reaction?
What steps should be taken first if a patient receiving a blood transfusion begins to exhibit signs and symptoms of a hemolytic reaction?
A patient who has received multiple transfusions is at risk for which type of reaction?
A patient who has received multiple transfusions is at risk for which type of reaction?
During a blood transfusion, a patient develops shortness of breath, SpO2 less than 90%, and crackles in the lungs. What immediate action should the nurse take?
During a blood transfusion, a patient develops shortness of breath, SpO2 less than 90%, and crackles in the lungs. What immediate action should the nurse take?
An older adult patient is receiving a blood transfusion. Which signs and symptoms should the nurse monitor to detect transfusion associated circulatory overload (TACO)?
An older adult patient is receiving a blood transfusion. Which signs and symptoms should the nurse monitor to detect transfusion associated circulatory overload (TACO)?
A patient’s complete blood count (CBC) reveals a white blood cell (WBC) count of 15,000/mm3. Which condition is most likely indicated by this result?
A patient’s complete blood count (CBC) reveals a white blood cell (WBC) count of 15,000/mm3. Which condition is most likely indicated by this result?
A patient is diagnosed with thrombocytopenia. What primary self-care measure should the nurse emphasize to this patient?
A patient is diagnosed with thrombocytopenia. What primary self-care measure should the nurse emphasize to this patient?
The nurse is caring for a patient with anemia. Which assessment finding is most consistent with this diagnosis?
The nurse is caring for a patient with anemia. Which assessment finding is most consistent with this diagnosis?
A patient has a prothrombin time (PT) result that is 2.5 times the normal range while on warfarin (Coumadin) therapy. What does this result indicate?
A patient has a prothrombin time (PT) result that is 2.5 times the normal range while on warfarin (Coumadin) therapy. What does this result indicate?
A patient is about to start taking iron supplements for iron-deficiency anemia. What should the nurse educate the patient about regarding the administration of the iron supplements?
A patient is about to start taking iron supplements for iron-deficiency anemia. What should the nurse educate the patient about regarding the administration of the iron supplements?
A patient is diagnosed with folic acid deficiency anemia. What dietary recommendation is most appropriate for this patient?
A patient is diagnosed with folic acid deficiency anemia. What dietary recommendation is most appropriate for this patient?
Which statement accurately describes the role of vitamin B12 in red blood cell production?
Which statement accurately describes the role of vitamin B12 in red blood cell production?
In caring for a patient with lymphedema, what intervention is most important for the nurse to include in the patient's plan of care?
In caring for a patient with lymphedema, what intervention is most important for the nurse to include in the patient's plan of care?
What finding in an older adult patient is most indicative of an age-related change in the hematologic system?
What finding in an older adult patient is most indicative of an age-related change in the hematologic system?
The nurse is reviewing the CBC results for a patient undergoing chemotherapy. The absolute neutrophil count (ANC) is 800 cells/mm3. What nursing intervention is most important based on this result?
The nurse is reviewing the CBC results for a patient undergoing chemotherapy. The absolute neutrophil count (ANC) is 800 cells/mm3. What nursing intervention is most important based on this result?
A patient undergoing a bone marrow biopsy reports feeling anxious and fearful. What is the most appropriate nursing intervention?
A patient undergoing a bone marrow biopsy reports feeling anxious and fearful. What is the most appropriate nursing intervention?
A patient with a history of frequent blood transfusions develops a fever and chills during a transfusion. After stopping the transfusion and notifying the health care provider, what additional action should the nurse anticipate?
A patient with a history of frequent blood transfusions develops a fever and chills during a transfusion. After stopping the transfusion and notifying the health care provider, what additional action should the nurse anticipate?
The nurse is preparing to administer a unit of packed red blood cells (RBCs). What verification step is essential to perform before starting the transfusion?
The nurse is preparing to administer a unit of packed red blood cells (RBCs). What verification step is essential to perform before starting the transfusion?
A patient receiving a blood transfusion suddenly develops hives and itching. What action should the nurse take first?
A patient receiving a blood transfusion suddenly develops hives and itching. What action should the nurse take first?
A patient receiving a blood transfusion suddenly feels a sense of impending doom. What action should the nurse take first?
A patient receiving a blood transfusion suddenly feels a sense of impending doom. What action should the nurse take first?
Which of the following scenarios would most likely result in an increased Erythrocyte Sedimentation Rate (ESR)?
Which of the following scenarios would most likely result in an increased Erythrocyte Sedimentation Rate (ESR)?
How does the body compensate for a chronically reduced oxygen-carrying capacity in the blood?
How does the body compensate for a chronically reduced oxygen-carrying capacity in the blood?
Which of the following compensatory mechanisms is activated in response to significant blood loss?
Which of the following compensatory mechanisms is activated in response to significant blood loss?
How does the lymphatic system contribute to the body's defense against infection?
How does the lymphatic system contribute to the body's defense against infection?
In a patient with a history of splenectomy, what is the most important long-term consideration for preventing complications?
In a patient with a history of splenectomy, what is the most important long-term consideration for preventing complications?
Which of the following findings indicates a potential complication after a bone marrow biopsy?
Which of the following findings indicates a potential complication after a bone marrow biopsy?
How should a nurse interpret a patient's report of increased fatigue and shortness of breath, along with pale conjunctiva?
How should a nurse interpret a patient's report of increased fatigue and shortness of breath, along with pale conjunctiva?
A patient undergoing lymphangiography reports a burning sensation at the injection site. What is the most appropriate initial nursing action?
A patient undergoing lymphangiography reports a burning sensation at the injection site. What is the most appropriate initial nursing action?
What is the primary rationale for administering normal saline solution with blood products?
What is the primary rationale for administering normal saline solution with blood products?
Which intervention is most important when caring for an older adult patient receiving a blood transfusion to prevent circulatory overload?
Which intervention is most important when caring for an older adult patient receiving a blood transfusion to prevent circulatory overload?
A patient receiving a blood transfusion develops sudden onset of dyspnea, crackles, and jugular venous distention. What immediate action should the nurse take?
A patient receiving a blood transfusion develops sudden onset of dyspnea, crackles, and jugular venous distention. What immediate action should the nurse take?
What is the primary reason for staying with a patient for the first 15 minutes of a blood transfusion?
What is the primary reason for staying with a patient for the first 15 minutes of a blood transfusion?
Which of the following statements best describes the intrinsic pathway of coagulation?
Which of the following statements best describes the intrinsic pathway of coagulation?
What is the significance of an elevated band count in a complete blood count (CBC) differential?
What is the significance of an elevated band count in a complete blood count (CBC) differential?
A patient with thrombocytopenia is at increased risk for which of the following complications?
A patient with thrombocytopenia is at increased risk for which of the following complications?
What is the rationale for ordering leukocyte-depleted blood for a patient who is anticipated to need multiple transfusions?
What is the rationale for ordering leukocyte-depleted blood for a patient who is anticipated to need multiple transfusions?
Which of the following laboratory values would be most concerning in a patient receiving heparin therapy?
Which of the following laboratory values would be most concerning in a patient receiving heparin therapy?
Which of the following physical assessment findings would be most indicative of lymphedema?
Which of the following physical assessment findings would be most indicative of lymphedema?
A patient with a history of chronic alcohol abuse is admitted with fatigue and shortness of breath. Which nutritional deficiency is most likely contributing to these symptoms?
A patient with a history of chronic alcohol abuse is admitted with fatigue and shortness of breath. Which nutritional deficiency is most likely contributing to these symptoms?
Why is it important to avoid intramuscular injections in a patient with severe thrombocytopenia?
Why is it important to avoid intramuscular injections in a patient with severe thrombocytopenia?
Which of the following assessment findings would differentiate Transfusion-Related Acute Lung Injury (TRALI) from Transfusion-Associated Circulatory Overload (TACO)?
Which of the following assessment findings would differentiate Transfusion-Related Acute Lung Injury (TRALI) from Transfusion-Associated Circulatory Overload (TACO)?
Which patient statement indicates the need for further teaching regarding prevention of complications associated with thrombocytopenia?
Which patient statement indicates the need for further teaching regarding prevention of complications associated with thrombocytopenia?
The nurse is caring for a patient who is scheduled for a bone marrow biopsy. Which statement is the most appropriate explanation of the procedure to give the patient?
The nurse is caring for a patient who is scheduled for a bone marrow biopsy. Which statement is the most appropriate explanation of the procedure to give the patient?
Following a lymph node biopsy, what instructions should the nurse provide to the patient regarding wound care at home?
Following a lymph node biopsy, what instructions should the nurse provide to the patient regarding wound care at home?
What is the primary function of the spleen in the hematologic system?
What is the primary function of the spleen in the hematologic system?
Which of the following is the most common early sign of a hemolytic transfusion reaction?
Which of the following is the most common early sign of a hemolytic transfusion reaction?
What is the key difference between the functions of lymph nodes and lymph nodules?
What is the key difference between the functions of lymph nodes and lymph nodules?
A patient with a prolonged prothrombin time (PT) is likely deficient in which of the following?
A patient with a prolonged prothrombin time (PT) is likely deficient in which of the following?
Following a blood transfusion, a patient develops urticaria. Which action should the nurse take first?
Following a blood transfusion, a patient develops urticaria. Which action should the nurse take first?
A patient is diagnosed with anemia due to insufficient intrinsic factor. What vitamin supplement will the patient likely need?
A patient is diagnosed with anemia due to insufficient intrinsic factor. What vitamin supplement will the patient likely need?
What is the most important intervention for preventing TRALI?
What is the most important intervention for preventing TRALI?
What finding suggests an age-related change in the hematologic system that a nurse might observe in an older adult?
What finding suggests an age-related change in the hematologic system that a nurse might observe in an older adult?
In an older adult client, which signs and symptoms should the nurse monitor for to detect transfusion associated circulatory overload (TACO)?
In an older adult client, which signs and symptoms should the nurse monitor for to detect transfusion associated circulatory overload (TACO)?
The physician orders to transfuse 2 units of packed red blood cells (PRBC). The nurse knows what is the maximum time frame to administer each unit after the blood leaves the blood bank?
The physician orders to transfuse 2 units of packed red blood cells (PRBC). The nurse knows what is the maximum time frame to administer each unit after the blood leaves the blood bank?
A patient report of increased fatigue is important subjective data to collect for a patient with a hematological disorder because:
A patient report of increased fatigue is important subjective data to collect for a patient with a hematological disorder because:
The nurse reviews the patient’s lab results and notes that the WBC count is 2,000/mm3. What nursing intervention is most important based on this result?
The nurse reviews the patient’s lab results and notes that the WBC count is 2,000/mm3. What nursing intervention is most important based on this result?
The nurse knows the primary goal of blood transfusions is:
The nurse knows the primary goal of blood transfusions is:
What is the most important factor in administering blood products safely?
What is the most important factor in administering blood products safely?
What is the primary role of plasma proteins, such as albumin, in maintaining fluid balance within the circulatory system?
What is the primary role of plasma proteins, such as albumin, in maintaining fluid balance within the circulatory system?
Following a motor vehicle accident, a patient experiences significant blood loss. Which of the following compensatory mechanisms would the body activate to maintain oxygen delivery to tissues?
Following a motor vehicle accident, a patient experiences significant blood loss. Which of the following compensatory mechanisms would the body activate to maintain oxygen delivery to tissues?
A patient with chronic kidney disease has a consistently low red blood cell count. How does impaired kidney function contribute to this hematologic disorder?
A patient with chronic kidney disease has a consistently low red blood cell count. How does impaired kidney function contribute to this hematologic disorder?
Which sequence of events accurately describes the process of hemostasis following a blood vessel injury?
Which sequence of events accurately describes the process of hemostasis following a blood vessel injury?
A patient undergoing chemotherapy has a severely suppressed white blood cell count. Which of the following nursing interventions is most critical to prevent infection?
A patient undergoing chemotherapy has a severely suppressed white blood cell count. Which of the following nursing interventions is most critical to prevent infection?
A patient with a history of heavy alcohol use is admitted with signs of malnutrition. Which of the following vitamin deficiencies is most likely to contribute to anemia in this patient?
A patient with a history of heavy alcohol use is admitted with signs of malnutrition. Which of the following vitamin deficiencies is most likely to contribute to anemia in this patient?
A patient reports increased fatigue and shortness of breath. Physical examination reveals pale conjunctiva and spoon-shaped nails. Which of the following conditions is most consistent with these findings?
A patient reports increased fatigue and shortness of breath. Physical examination reveals pale conjunctiva and spoon-shaped nails. Which of the following conditions is most consistent with these findings?
Which mechanism explains why individuals who have undergone a splenectomy are at an increased risk for certain bacterial infections?
Which mechanism explains why individuals who have undergone a splenectomy are at an increased risk for certain bacterial infections?
During a blood transfusion, a patient suddenly develops hives and itching. What is the most appropriate initial nursing action?
During a blood transfusion, a patient suddenly develops hives and itching. What is the most appropriate initial nursing action?
What is the primary rationale for using only normal saline solution when administering blood products?
What is the primary rationale for using only normal saline solution when administering blood products?
An older adult patient receiving a blood transfusion exhibits new onset dyspnea, crackles, and jugular venous distention. Which complication is most likely occurring?
An older adult patient receiving a blood transfusion exhibits new onset dyspnea, crackles, and jugular venous distention. Which complication is most likely occurring?
Following a bone marrow biopsy, the nurse assesses the patient and notices excessive bleeding and increasing pain at the biopsy site. Which of the following actions is the most appropriate?
Following a bone marrow biopsy, the nurse assesses the patient and notices excessive bleeding and increasing pain at the biopsy site. Which of the following actions is the most appropriate?
A patient with thrombocytopenia is being discharged. What instructions should the nurse include regarding the prevention of complications at home?
A patient with thrombocytopenia is being discharged. What instructions should the nurse include regarding the prevention of complications at home?
Which laboratory test is used to monitor warfarin (Coumadin) therapy, and to what therapeutic range should the results typically be maintained?
Which laboratory test is used to monitor warfarin (Coumadin) therapy, and to what therapeutic range should the results typically be maintained?
A patient is prescribed iron supplements for iron-deficiency anemia. Which of the following instructions should the nurse provide to enhance absorption?
A patient is prescribed iron supplements for iron-deficiency anemia. Which of the following instructions should the nurse provide to enhance absorption?
A patient is undergoing a lymphangiography. Post-procedure, what specific monitoring and teaching points are essential for this patient?
A patient is undergoing a lymphangiography. Post-procedure, what specific monitoring and teaching points are essential for this patient?
During a blood transfusion, a patient develops acute respiratory distress, SpO2 less than 90%, and bilateral pulmonary infiltrates on a chest x-ray. Which of the following transfusion reactions is most likely?
During a blood transfusion, a patient develops acute respiratory distress, SpO2 less than 90%, and bilateral pulmonary infiltrates on a chest x-ray. Which of the following transfusion reactions is most likely?
What is the critical time frame following removal of blood from the blood bank in which a blood transfusion must be initiated to prevent deterioration and bacterial growth?
What is the critical time frame following removal of blood from the blood bank in which a blood transfusion must be initiated to prevent deterioration and bacterial growth?
A patient with a history of frequent transfusions is prescribed leukocyte-depleted blood. What is the primary purpose of using leukocyte-depleted blood products in this patient?
A patient with a history of frequent transfusions is prescribed leukocyte-depleted blood. What is the primary purpose of using leukocyte-depleted blood products in this patient?
Which statement accurately describes the role and maturation process of T lymphocytes?
Which statement accurately describes the role and maturation process of T lymphocytes?
Flashcards
Hematologic System
Hematologic System
Includes the bone marrow, blood, and blood components; responsible for transport, regulation, and protection.
Lymphatic System
Lymphatic System
Includes lymph nodes, nodules, and vessels; filters pathogens and returns lymph to the blood.
Blood Functions
Blood Functions
Transport of substances; regulation of body temperature, pH, and fluid balance; body protection.
Hematopoietic Tissue
Hematopoietic Tissue
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Albumin
Albumin
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Alpha and Beta Globulins
Alpha and Beta Globulins
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Gamma Globulins
Gamma Globulins
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Polycythemia
Polycythemia
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Anemia
Anemia
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Hematocrit
Hematocrit
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Hemoglobin
Hemoglobin
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Reticulocytes
Reticulocytes
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Leukocytosis
Leukocytosis
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Leukopenia
Leukopenia
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Thrombocytosis
Thrombocytosis
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Thrombocytopenia
Thrombocytopenia
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Red Blood Cells (RBCs)
Red Blood Cells (RBCs)
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Oxyhemoglobin
Oxyhemoglobin
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Reduced Hemoglobin
Reduced Hemoglobin
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Erythropoietin
Erythropoietin
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Extrinsic Factor
Extrinsic Factor
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Intrinsic Factor
Intrinsic Factor
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Hemolysis
Hemolysis
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Jaundice
Jaundice
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Blood Type
Blood Type
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Rh-Positive
Rh-Positive
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White Blood Cells (WBCs)
White Blood Cells (WBCs)
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Monocytes
Monocytes
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Neutrophils
Neutrophils
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Eosinophils
Eosinophils
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Basophils
Basophils
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Lymphocytes
Lymphocytes
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Platelets
Platelets
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Hemostasis Mechanisms
Hemostasis Mechanisms
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Extrinsic Pathway
Extrinsic Pathway
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Intrinsic Pathway
Intrinsic Pathway
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Lymph
Lymph
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Lymph System Functions
Lymph System Functions
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Lymph Nodes
Lymph Nodes
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Lymph Nodules
Lymph Nodules
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Spleen
Spleen
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Thymus
Thymus
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Petechiae
Petechiae
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Ecchymoses
Ecchymoses
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Purpura
Purpura
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Lymphedema
Lymphedema
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CBC
CBC
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Bone Marrow Biopsy
Bone Marrow Biopsy
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Lymphangiography
Lymphangiography
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Capillary Fragility Test
Capillary Fragility Test
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Study Notes
- Hematologic system includes bone marrow, blood, and blood components
- Lymphatic system includes lymph nodes, nodules, and lymph vessels
Blood Functions
- Transports substances
- Regulates body temperature, pH, and fluid balance
- Transports protective cells
Blood Composition and Production
- Human body contains 4 to 6 L of blood
- Approximately 45% of blood is formed elements; the remainder is plasma
- All formed elements are produced from stem cells in red bone marrow (hematopoietic tissue) found in flat, irregular bones, and epiphyses of long bones
- T-lymphocyte maturation and differentiation occur in the thymus
Plasma Components and Functions
- Approximately 91% water
- Proteins synthesized by the liver, including clotting factors, albumin, and globulins
- Clotting factors (e.g., prothrombin, fibrinogen) circulate until activated for coagulation
- Albumin maintains blood volume and pressure pulling tissue fluid into venous capillaries
- Alpha and beta globulins are carrier molecules for fats
- Gamma globulins are antibodies produced by lymphocytes
Plasma Functions
- Water in plasma warms in active organs such as the liver/skeletal muscles and distributes heat throughout the body
- Vasodilation in the dermis allows blood to circulate near the body surface, resulting in heat loss
- Vasoconstriction in the dermis shunts blood toward the core of the body for heat retention
Blood pH
- Normal range: 7.35 to 7.45
- Buffer systems moderate acid–base changes to maintain homeostasis
Red Blood Cells (RBCs)
- Mature RBCs are biconcave disks without nuclei
- Transport oxygen bonded to iron in hemoglobin
- Oxyhemoglobin forms in pulmonary capillaries when oxygen bonds to hemoglobin
- Hemoglobin becomes reduced hemoglobin after giving up oxygen to body cells
Oxygen-Carrying Capacity
- Amount of hemoglobin affects how much oxygen blood can carry
- Reduced oxygen-carrying capacity causes anemia, resulting in shortness of breath and fatigue
Erythropoietin and RBC Production
- Hypoxia stimulates kidneys to secrete erythropoietin
- Erythropoietin increases the rate of RBC production and oxygen-carrying capacity
- Reticulocyte (immature RBC) becomes mature when ejecting its nucleus causing it's biconcave shape
- Large numbers of reticulocytes indicate insufficient mature RBCs
Requirements for RBC Production
- Sufficient dietary intake of protein and iron to synthesize hemoglobin
- Folic acid and vitamin B12 are needed for DNA synthesis in stem cells of red bone marrow
- Vitamin B12 (extrinsic factor) from food combines with intrinsic factor
- Intrinsic factor produced by parietal cells of stomach lining promotes vitamin B12 absorption in the small intestine
RBC Lifespan and Destruction
- RBCs live for about 120 days
- Fragile RBCs are phagocytized by fixed macrophages in the liver, spleen, and red bone marrow
- Hemolysis (accelerated RBC destruction) caused by diseases such as malaria and sickle cell anemia can cause an accelerated destruction of RBC's
- Elevated bilirubin levels discolor sclerae, skin, and mucous membranes causing jaundice
Blood Types
- Determined by antigens present on RBCs
- ABO group (A, B, O, or AB) indicates antigens present or not present (type O) on RBCs
- Plasma contains antibodies for antigens that are not present
- Rh-positive: D antigen is present on RBCs
- Rh-negative: D antigen is not present, but antibodies will be produced if exposed to Rh-positive blood
White Blood Cells (WBCs)
- Larger than RBCs and have nuclei when mature
- Granular WBCs (neutrophils, eosinophils, basophils) and agranular WBCs (lymphocytes, monocytes) are produced in red bone marrow
- T lymphocytes complete development in the thymus
- T and B lymphocytes activate, proliferate, and differentiate in lymph nodes, spleen, and lymphatic nodules
- Function within tissue fluid and blood and are involved in immune or inflammatory response
- Generally circulate only a few days before migrating into tissues
WBC Types and Functions
- Monocytes become macrophages in tissues and phagocytize pathogens and viral-infected cells
- Neutrophils phagocytize foreign materials
- Eosinophils combat histamine, detoxify foreign proteins during allergic reactions, and respond to parasitic infections
- Basophils release heparin and histamine as part of inflammatory reactions
- T cells may be helper, suppressor, killer, or memory T cells
- B cells become memory cells and plasma cells, which produce antibodies to foreign antigens
Platelets
- Formed in the red bone marrow as fragments of megakaryocytes
- Involved in hemostasis: vascular spasm, platelet plugs, and chemical clotting
- Lifespan is about 10 days
Clotting Pathways
- Extrinsic pathway begins when a blood vessel or surrounding tissues outside the blood are damaged
- Intrinsic pathway begins when platelets adhere to damaged endothelium and release clotting factors
- Both pathways result in a fibrin clot
Prevention of Excessive Clotting
- Smooth endothelial lining of blood vessels repels platelets
- Heparin produced by mast cells inhibits the clotting mechanism
- Antithrombin inactivates excess thrombin
Lymphatic System Components
- Lymph, lymph vessels, lymph nodes and nodules, spleen, red bone marrow, and thymus
- Returns tissue fluid to maintain blood volume
- Protects the body against pathogens and other foreign material
Lymphatic Vessels
- Lymph is tissue fluid that has entered lymph capillaries which are found in most tissue spaces
- Lymph capillaries anastomose to form larger lymph vessels with valves to prevent backflow
- Lymph from areas below the diaphragm and the upper left half of the body enters the thoracic duct and is returned to the blood in the left subclavian vein
- Lymph from the upper right body enters the right lymphatic duct and is returned to the blood in the right subclavian vein
Lymph Nodes and Nodules
- Lymph nodes are masses of lymphatic tissue along lymph vessel pathways, and house activated lymphocytes and macrophages
- Nodes are concentrated in cervical, axillary, and inguinal regions
- Foreign materials are phagocytized by fixed macrophages and lymphocytes form immune responses
- Lymph nodules (or mucosa-associated lymphatic tissue) are small masses of lymphatic tissue found just beneath the epithelium of all mucous membranes
- Tonsils protect the oral and nasal portions of the pharynx
Spleen
- Located in the upper left quadrant of the abdominal cavity, just below the diaphragm and behind the stomach
- In the fetus, the spleen produces RBCs, a function assumed by the bone marrow after birth
- Contains B cells and T cells, which conduct immune responses
- Fixed macrophages phagocytize pathogens and worn or defective blood cells and platelets
- Heme unit from RBC destruction forms bilirubin, which is sent to the liver for excretion in the bile
- Stores up to one-third of the body’s platelets
Spleen and Immunity
- Considered not vital; other organs compensate for its functions if removed
- Liver and red bone marrow remove worn RBCs from circulation
- Lymph nodes and nodules produce lymphocytes and macrophages for protection
- Without a spleen, a person is more susceptible to certain bacterial infections
Thymus
- Located in the mediastinum, anterior to the trachea
- Atrophies with age
- Contains T lymphocytes (T cells) that mature and proliferate
- Thymic hormones contribute to the maturation of the T cells
Aging and the Hematologic and Lymphatic Systems
- Older adults undergo changes in hematologic and lymphatic systems
Health History
- Data collection begins with an in-depth patient history
- Specific symptoms of hematologic disorders include abnormal bleeding, petechiae, ecchymoses and purpura
- Additional symptoms include fatigue, weakness, shortness of breath, and fever
- Fatigue, malaise, and weight loss can accompany cancers of the lymphatic system
- Biographical data, occupation, religion, age, sex, and ethnic background can give valuable clues to risk factors
- Hemophilia almost always occurs in males, females carry the gene
- Sickle cell anemia occurs mostly in Black people but also affects those of Mediterranean or Asian ancestry
- Pernicious anemia occurs most often in people of northern European ancestry
- Religion may be important if the patient needs a blood transfusion
History Review
- A complete review of past illnesses and family history is always indicated and can provide additional information
- A social history is also useful
- Explore dietary and alcohol intake habits, drug use or abuse, and sexual habits, all of which can cause changes in the hematologic system
- Occupational review can reveal exposure to hazardous substances that can cause bone marrow dysfunction
- Military history can also reveal sources of exposure that can help during the diagnostic phase for hematologic and lymphatic disorders
Physical Examination
- Hematologic and lymphatic disorders can involve almost every body system
- Signs and symptoms of hematologic and lymphatic disorders can be vague, such as dyspnea or fatigue
- Careful data collection will guide nursing care but may also uncover important data that should be reported to the health care provider (HCP).
Blood Tests
- Laboratory studies for patients with hematologic disorders include complete blood count (CBC), total hemoglobin (Hgb) concentration, hematocrit (Hct) level, and platelet level
Coagulation Tests
- Include prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), bleeding time, and capillary fragility test
- Agglutination tests include ABO blood typing, Rh typing, crossmatching of blood samples, and direct antiglobulin tests (also known as the Coombs’ test)
Bone Marrow Biopsy
- Bone marrow biopsy provides information through removal of a small amount of bone marrow with a needle
- Aspiration of marrow is done to obtain a specimen that can be viewed under the microscope
- Purposes of this test include the diagnosis of hematologic disorders; monitoring the course of treatment; discovery of other disorders, such as primary and metastatic tumors, infectious diseases, and certain granulomas; and isolation of bacteria and other pathogens by culture
- An accurate adult bone marrow specimen can be obtained from the sternum, the spinous processes of the vertebrae, or the anterior or posterior iliac crest
- Bone marrow biopsy is considered a minor surgical procedure and is carried out under aseptic conditions.
- For iliac crest aspiration, the patient is placed comfortably on the side with the back slightly flexed. The posterior iliac crest is cleansed and covered with antiseptic solution. The skin, subcutaneous tissue, and periosteum are anesthetized with lidocaine (Xylocaine). A small incision is made to facilitate penetration with a 2- to 4-cm-long bone marrow needle. The incision is made to avoid introducing a skin plug into the marrow cavity, which can cause infection
Nurse's Role in Bone Marrow Biopsy
- Coordinate between the laboratory and the HCP
- Establish a time to do the procedure
- Determine who obtains the supplies, such as the disposable bone marrow aspiration tray and specialized needles
- Obtain an order for an analgesic and to administer it before the procedure
- Assist with positioning the patient before and during the procedure
- Afterward, observe the aspiration site for bleeding and infection
- Provide emotional support to the patient before, during, and after the procedure
Lymphangiography
- Problems in the lymph system, such as lymphoma or metastatic cancers, can be evaluated using lymphangiography
- This procedure involves injection of a dye into the lymphatic vessels of the hand or foot
- X-ray views are then taken to determine lymph flow or blockages
- X-ray examinations are repeated in 24 hours to assess lymph node involvement
- Following the procedure, the HCP may order a pressure dressing and immobilization of the injected limb to prevent bleeding at the site
- Monitor the limb for swelling, circulatory changes, and changes in sensation
- Warn the patient that the skin, urine, or feces may be tinged blue from the dye for about 2 days
Lymph Node Biopsy
- If a lymph node is enlarged, it may be biopsied to determine whether the cause is infection or malignancy
- A biopsy is done with a needle aspiration or surgical incision
- A small dressing or bandage is applied to the site
- Following the procedure, review signs of bleeding and infection with the patient that should be reported to the HCP
Blood Administration
- Blood may be administered by a registered nurse (RN) or licensed practical nurse/licensed vocational nurse (LPN/LVN), depending on the state where you practice
- As an LPN/LVN, you may assist with proper identification procedures and monitoring of vital signs during the transfusion
- Blood may be obtained from donors, or individuals can donate their own blood prior to a procedure in which blood may be needed which is called an autologous transfusion and can reduce the risk of complications
- It can be stored for up to 42 days or frozen for future use
Blood Product Goals
- The main goals are to administer blood products safely and to avoid mistakes
- Make sure to use proper identifying information to ensure that the right patient is receiving the right blood products
- Most institutions require a special transfusion consent form to be completed and present in the patient’s chart
Blood Administration Precautions
- Use only normal saline solution to help dilute the blood and to flush the IV lines before and after transfusions
- Solutions that contain dextrose can cause RBCs to lyse (i.e., destroy their cell membranes)
- Solutions with calcium can cause the blood product to clump, clot, or not infuse at all
- A transfusion must be started within 30 minutes of picking up the blood from the blood bank
- Transfuse each unit of packed cells over 2 hours
- Do not hang the unit longer than 4 hours, to prevent deterioration and bacterial growth
- Filters are used with blood administration tubing to prevent potentially harmful particles from entering the patient
- Most often, the filter that comes with the transfusion tubing is sufficient for each unit of packed RBCs
- In some situations, special filters may be needed to remove leukocytes or micro-aggregates
- The blood bank can advise in these situations
- In some instances, packed RBCs are ordered as “washed”; the washing process removes almost all the plasma to decrease the risk or severity of a febrile reaction
- Leukocyte filters may be used to completely remove all WBCs
- This removal process is used when many transfusions are anticipated to decrease the risk of antigen sensitization, and it can also reduce transmission of certain viruses, such as cytomegalovirus
- If the patient has had severe bleeding and is receiving multiple rapid transfusions, the HCP may consider a blood warmer
- It works just as the name implies, warming the cold blood from the blood bank to the standard body temperature of 98.6°F (37°C)
- This warming helps prevent hypothermia, which can cause heart arrhythmias and prevents shivering, which can destroy blood cells and platelets
Importance of Monitoring
- Whether or not you actually administer the blood, you will likely participate in monitoring to prevent complications or to detect and treat them quickly if they occur
- Stay with the patient for the first 15 minutes of the blood transfusion to monitor for any immediate reactions
- The 15 minutes begins when the blood enters the vein
- If saline solution is in the tubing, it may take several minutes before the blood reaches the patient
- Check and document vital signs before starting the transfusion, after the blood has begun to infuse, and after the infusion is complete
- Always follow institution guidelines for vital sign monitoring
- During the transfusion, continue to monitor the patient for signs and symptoms of complications
Febrile Reaction from Transfusion
- The most common reaction is fever (febrile reaction)
- Occurs up to 2% of the time
- Make sure that blood never transfuses for more than 4 hours
- The risk of a febrile reaction goes up with each unit of blood product given to the patient
- Many times, febrile reactions occur after the transfusion is completed, but they can occur at any time
- The most common signs are an increase in temperature and shaking chills, which can be severe
- Other symptoms include headache and back pain
- If febrile symptoms occur, or the temperature rises greater than 1 degree Fahrenheit, stop the transfusion and notify the HCP
- Acetaminophen may be ordered
- If a hemolytic reaction is not suspected, the HCP may order the transfusion to continue once the patient is more comfortable
- Administering leukocyte-depleted blood can usually prevent future febrile reactions
Urticarial Reaction
- Urticarial (hive) reactions are considered minor allergic reactions, usually associated with antigens in the plasma accompanying the transfusion
- There may be a fever, but the cardinal sign is the appearance of urticaria, a hive-like rash
- On discovery of this reaction, stop the transfusion and notify the HCP immediately
- Expect that the patient will be given a dose of an antihistamine, such as diphenhydramine (Benadryl)
- If the transfusion is restarted, continue to monitor the patient closely
- Make sure the 4-hour administration rule is not violated
Hemolytic Reaction
- The deadliest and, fortunately, rarest of the reactions is an acute hemolytic reaction
- The cause of this reaction is transfusion of incompatible blood
- The result is hemolysis (destruction) of RBCs
- Usually noticed within minutes of starting the transfusion
- The patient may report back pain, chest pain, chills, fever, shortness of breath, nausea, vomiting, or a feeling of impending doom
- As the reaction progresses, the patient begins to show signs of shock, hypotension, oliguria, and decreased consciousness
- Late signs and symptoms include those associated with disseminated intravascular coagulation (e.g., uncontrollable bleeding from many different sites at the same time, usually causing death)
- At the first sign of this type of reaction, immediately stop the transfusion and stay with the patient
- Institute emergency procedures to notify the supervisor, the HCP, and the blood bank
- Keep the vein open with normal saline using a new tubing set (ensuring that no more incompatible blood is administered) so that emergency drugs can be administered
- High volumes of fluids are administered to decrease shock and hypotension
- High doses of diuretics are given to promote urine flow because the kidneys are the most likely organs to be damaged
Anaphylactic Reaction
- Anaphylactic reactions are not common but may be seen more often in patients who have received many transfusions or have had many pregnancies
- Usually, the source of the anaphylaxis is sensitization to immunoglobulins passed from the donor blood product
- In this type of reaction, the first milliliters of blood containing the allergens to pass into the patient’s system may be enough to cause the patient to develop respiratory or cardiovascular collapse
- Other more common symptoms include severe gastrointestinal cramping, vomiting, and uncontrollable diarrhea
- If the patient exhibits these signs and symptoms, stop the transfusion at once and stay with them
- Have someone else notify the RN and the HCP, using institutional emergency procedures
- Emergency resuscitation measures, including cardiopulmonary resuscitation (CPR) if necessary, must be instituted until the rapid response or code team arrives
- Expect the patient to be intubated and receive oxygen, steroids, and other drugs as needed for life support
- After the emergency has passed, this patient may need transfusions from frozen, deglycerolized blood cells
Transfusion-Related Acute Lung Injury (TRALI)
- TRALI is a syndrome caused by a blood transfusion
- Responsible for 30% of transfusion-related deaths in the United States
- Can be either acute or delayed—during or up to 72 hours following a blood transfusion
- Donor plasma used in blood transfusion should be screened for anti-leukocyte antibodies and anti-neutrophil-specific antibodies
- Critically ill patients with sepsis (such as patients with COVID-19) who require massive transfusions or are on mechanical ventilation are at greater risk for TRALI
- Symptoms include acute respiratory distress, SpO2 less than 90% requiring oxygen support, crackles, decreased breath sounds, and use of accessory muscles
- A fever greater than 100.4°F (37°C) with hypotension and tachycardia occur
- Diagnosis is based on chest x-ray showing bilateral pulmonary infiltrates without evidence of pulmonary vascular overload
- During a transfusion, if the patient develops shortness of breath, stop the transfusion immediately and notify both the HCP and blood bank
- Send the unused unit of blood and tubing back to the blood bank so it can be tested for antibodies
- Gradual recovery usually occurs in 2 to 4 days
- The nurse should make sure that deep vein thrombosis (DVT) prophylaxis and pressure injury precautions are implemented
Transfusion-Associated Circulatory Overload (TACO)
- TACO is caused by rapid transfusion in a short period, particularly in older and debilitated patients
- Usual signs and symptoms include chest pain, cough, frothy sputum, distended neck veins, crackles and wheezes in the lung fields, and increased heart rate
- If symptoms occur, stop the transfusion and notify the HCP
- Anticipate administration of diuretics, which help get rid of the excess fluid
- The transfusion may be restarted later at a slower rate
Older Adults and Fluid Excess
- Older patients have less cardiac and renal ability to adapt to changes in blood volume and thus have a much higher risk of fluid overload with IV infusions or blood transfusions
- Carefully monitor lung sounds and vital signs before, during, and after a blood transfusion
- New onset of dyspnea, crackles, hypertension, or bounding pulse during any infusion should be reported to the registered nurse or HCP immediately
- If an older adult requires more than one unit of blood, a diuretic may be ordered between units
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Description
Overview of the hematologic and lymphatic systems. Includes their components, blood functions, blood composition, and the role of plasma proteins like albumin and globulins in maintaining blood volume and transporting substances.
