Alterations of Hematologic Function AI.pptx

Learning Outcomes 1. Describe the pathophysiology, etiologies, clinical manifestations, diagnostic findings, nursing and interprofessional management of blood disorders of ↓ RBC production, chronic disease, aplastic disorders, ↑ RBC destruction, diseases of RBC dysfunction and diseases of homeostasi...

Learning Outcomes 1. Describe the pathophysiology, etiologies, clinical manifestations, diagnostic findings, nursing and interprofessional management of blood disorders of ↓ RBC production, chronic disease, aplastic disorders, ↑ RBC destruction, diseases of RBC dysfunction and diseases of homeostasis 2. Differentiate the etiologies, clinical manifestations, and diagnostic findings of blood disorders listed in objective #1. 3. Identify nursing diagnoses associated with listed blood disorders 4. Describe nursing interventions associated with nursing care for listed blood disorders. 1 Laboratory Values To Know.. • See resources in Canvas… • Related to Hematology, you should know… • HGB • HCT • WBC Count • Platelets 2 You are reviewing the CBC for a patient who has been admitted for knee arthroscopy. Which value is most important to report to the provider before prepping the patient for surgery? A. Hct of 33% B. Hgb of 10.9g/dL C. Plt count 426,00/mm³ D. WBCs of 16,000/mm³ 3 3 Composition of Blood • Plasma • 55% of the blood volume • Consists of Water, Proteins, Electrolytes, Nutrients, Clotting factors… • “Serum” is plasma minus the Clotting Factors • Cellular components • Derived from the Bone Marrow Stem Cells • Erythrocytes: Red blood cells (RBCs) • Leukocytes: White blood cells (WBCs) • Thrombocytes: Platelets 4 Hematopoiesis • Blood cell production in bone marrow RBCs—Think: oxygen carrying capacity WBCs—Think: immune system Plts—Think: clotting 5 Cellular Components: Platelets • Platelets are tiny – only about 20% of the diameter of a RBC • Irregularly shaped, no nucleus • Life Span ~10 days • Normal platelet count: 150,000-300,000 • Thrombocytopenia: Platelet count below 150,000/mm 3 • Depending on the Platelet Count, manifests as prolonged bleeding from minor trauma • Platelet count below 20,000/mm3 can lead to spontaneous bleeding • < 1% of blood volume  Approximately 1/3 are stored in the Spleen and released into the circulation as needed. • Formed from cell fragments of a Megakaryocyte which are derived from stem cells in the bone marrow 6 Causes of Thrombocytopenia • Decreased Platelet production • Decreased bone marrow function • Acute viral infections • EBV, rubella, CMV, HIV • Autoimmune diseases • Nutritional deficiencies • Radiation therapy/ Chemotherapy • Disseminated Intravascular Coagulation (DIC) • Hypersplenism 7 Spleen • Filters and cleanses blood, serves as a reservoir for blood, part of the immune system • Hypersplenism • Overactive spleen • In hypersplenism, the spleen sequesters red cells, white cells and platelets • Leads to anemia, increase in infections and bruising/bleeding tendencies. • Treatment: • For severe cases, Splenectomy 8 Platelet Disorders: Immune thrombocytopenic purpura (ITP) • Autoimmune disorder • Common in Children • Platelets accumulate and are destroyed by phagocytes in the spleen and other lymphoid tissues. • Destruction exceeds the bone marrow’s ability to replace the platelets • Frequently follows a viral disease • Symptoms include… • Easy bruising, bleeding from gums, epistaxis, melena • May have Splenomegaly • Treatment: • Children: Rarely need treatment • Adults: Steroids, blood transfusions, splenectomy (rarely) 9 Platelet Disorders: Thrombotic thrombocytopenic purpura (TTP) • Less common • Enhanced aggregation of Platelets, which form thrombi in arterioles and capillaries • Characterized by… • Hemolytic anemia • Thrombocytopenia • Fever not associated with infection • Neurologic and renal abnormalities • Caused by a deficiency in an enzyme that usually breaks down a particular clotting factor • Medical emergency because bleeding and clotting occur simultaneously 10 Platelet Dysfunction: Nursing Role • What might be potential Nursing Diagnosis for the patient with Thrombocytopenia? • Risk for bleeding related to inadequate ability to clot… • As the nurse caring for a patient with Thrombocytopenia, what might be priority Nursing Interventions? Supportive Care Vital signs and assessments Education & safety considerations Bleeding precautions 11 11 Cellular Components: Leukocytes • White Blood Cells • Normal WBC Count is 4,500 to 10,000 cells/mm3 • Classified into two groups based on the presence of granules in the cytoplasm… • Granulocytes • Agranulocytes • What is the purpose of WBC’s? • Defend the body against infection • Remove debris 12 13 13 CELLULAR COMPONENTS: LEUKOCYTES • Increased numbers of Bands in a CBC is called a “leftshift” • “Left Shift” • Change in the ratio of Bands when compared with Segs • “Bands” increase 14 14 Cellular Components: Leukocytes • “Leukopenia” • Reduction in total WBC Count • “Neutropenia” • Reduction in Neutrophils • Absolute Neutrophil Count (ANC) = WBC * %Neutrophils • ANC < 1,000 cells/μl • Severe Neutropenia is a count less than 500 • Predisposed to infection with opportunistic pathogens 15 Cellular Components: Leukocytes • Manifestations of Neutropenia: • Frequent infection • Typical symptoms of infection are altered… • Classic inflammation symptoms may not occur • Purulent drainage may not occur • WBC’s are the main component of Pus • Low grade fever is significant • Could indicate septic shock… • Neutropenic fever (>100.4 F) with an ANC < 1,000 is a MEDICAL EMERGENCY 16 Neutropenia: Nursing Role • What might be a potential Nursing Diagnosis? • Risk for infection related to inadequate secondary defenses… • In caring for a patient with Neutropenia, what might be pertinent Nursing Interventions? • Supportive Care • Vital signs and assessments • Infection Control and Infection Protection • Cultures as needed • Education & safety considerations • Antibiotics as prescribed, TIMELY • Neutropenic Precautions 17 Cellular Components: Erythrocytes • Red Blood Cells • Most abundant cells of the blood • Small, round, with no nucleus • 80-120 day life cycle • Responsible for tissue oxygenation. • HGB: • Males 13-18 • Females 12-16 • HCT • Males 42-50% • Females 40-48% 18 Erythropoiesis • Production of Red Blood Cells • Red Blood Cells mature in stages… • Start with Erythroblasts, transform into Reticulocytes, mature into Erythrocytes • “Reticulocyte count” • Measure of immature erythrocytes • Indicates erythropoietic activity 19 Anemia • Definition of Anemia includes… • Reduction in the total number of erythrocytes in the circulating blood • Decrease in the quality or quantity of hemoglobin • Decreased volume of packed red blood cells (Hematocrit) • Causes of anemia include… • Impaired erythrocyte production • Acute or chronic blood loss • Increased erythrocyte destruction • World Health Organization (WHO), anemia is the most common disease, affecting >1.5 billion people worldwide 20 Clinical Manifestations of Anemia • Fatigue • Shortness of breath • Headaches • Lightheadedness • Pallor • Chest pain • Cold extremities 21 Skin A. B. C. color of the person with Anemia, will most likely be… Flushed Pale Cyanotic In anemia, the oxygen carrying capacity of the blood is decreased, the body tries to compensate. Will the heart rate increase or decrease? Increase Will the respiratory rate and depth increase or decrease? Increase When the anemia is severe, such as in the case of acute blood loss, the body protects the vital organs of the body. How? Shunts the blood from the periphery to the vital organs 22 Classifications of Anemias by Etiology… Anemias of Deficient Red Blood Cell Production • Iron deficiency Anemia • Megaloblastic Anemias • Such as Folic Acid Deficiency and Cobalamin • Aplastic Anemia* • Anemia from medications, such as Chemotherapy… • Thalassemia Hemolytic Anemias Premature destruction of Red Blood Cells Sickle Cell Disease Blood Loss Anemia • May be internal or external bleeding • May be rapid blood loss or slowly developing loss 23 Anemias of Deficient RBC Production Includes… • Iron Deficiency Anemia • Vitamin B12 (Cobalamin) deficiency • Folic Acid deficiency • Thalassemia • Aplastic Anemia* • Chemicals/medications* • Chemotherapy 24 Iron Deficiency Anemia • Most common type of anemia worldwide • Most common blood disorder of infancy and childhood • Possible causes… • Dietary deficiency/malabsorption • Loss of iron through chronic bleeding • Hemolysis • Who is at greatest risk? • Those living in poverty; Those with poor diets • Women of childbearing age • Children under the age of 2 years • Increased demand for iron during growth • Chronic bleeding… 25 IRON DEFICIENCY ANEMIA • s/s of Iron Deficiency Anemia… • Skin color pale or flushed? • Energetic or Fatigued? • Tachypnea or bradypnea? • Tachycardia or Bradycardia? • Skinny tongue or inflamed tongue (glossitis)? • Skinny lips or inflamed lips (cheilitis)? Why? Remember… iron is necessary for hemoglobin formation, thus Iron Deficiency Anemia may lead to decrease in oxygen delivery 26 Iron Deficiency Anemia: Diagnosis • CBC • H&H Low • Iron Studies • Low • Total Iron Binding Capacity (TIBC) • TIBC is High with decreased iron stores • Body is looking for the iron! • Mean Corpuscular Volume (MCV) [size of RBCs] • Decreased [Microcytic] • RBCs are pale [hypochromic] – Hgb not complete b/c no iron bound to Hgb • Stool for Occult Blood • Endoscopy/Colonoscopy 27 Interprofessional Care: Iron Deficiency Anemia • Treat underlying problem causing iron deficiency… • Alcoholism, poor nutrition, chronic bleeding… • Replace iron • Nutritional therapy • What foods are high in iron? • Meats, breads, legumes, eggs… • Oral iron supplements • To enhance absorption… • Take one hour before meals • Take with Vitamin C or Orange Juice • But GI upset is common and thus may need to be taken with meals • Undiluted liquid iron may stain teeth • Dilute and ingest through a straw • GI side effects are common • Heartburn, constipation, diarrhea… • Take with meals if necessary • Stools will be black • Transfusion of packed RBCs • For severe anemia 28 Megaloblastic Anemias • Megaloblastic Anemias have enlarged red blood cells, and normal Hemoglobin concentrations • Includes… • CoBalamin (Vitamin B12) Deficiency Anemia • Folic Acid Deficiency Anemia • Megaloblastic anemias are, by definition, which of the following? (Select all that apply) a. Microcytic Anemia b. Macrocytic Anemia c. Normochromic Anemia d. Hypochromic Anemia 29 Cobalamin (Vitamin B12) deficiency • Vitamin B12 necessary for normal RBC maturation and division • It is absorbed in the ileum after binding to Intrinsic Factor (protein found in the gastric parietal cells) • Vitamin B12 is particularly important for formation of the myelin sheath around nerves • What foods contain Vitamin B12? • Fish, lamb, shellfish, pork, chicken, beef, milk, eggs, cheese, yogurt, almonds, shitake mushrooms, soy milk, fortified tofu… • Which patient would require additional education about dietary choices to prevent Vitamin B12 deficiency? A. A 60-year-old Male recovering from stent placement after an MI 3 days ago B. A 16-year-old Male cross-country runner presenting for his annual physical C. A 18-year-old Female starting college who recently decided to become vegan presenting for her annual pap smear D. A 36-year-old Female with three young children presenting for her flu shot 30 Cobalamin (Vitamin B12) deficiency: Causes • “Pernicious Anemia” • Autoimmune disorder that leads to destruction of the gastric mucosa and loss of the parietal cells – which would have what effect? • Leads to a lack of the Intrinsic Factor necessary for absorption of Vit B12 • Chronic Gastritis • Chronic Alcoholism • Gastrectomy • Ilium resection • Ilium inflammation or neoplasm 31 Folic Acid Deficiency Anemia • Folic Acid is necessary for normal RBC maturation and division • Absorbed in the small intestine • Which foods contain Folic Acid? • Green leafy vegetables, fruits, fortified cereals and meats… • Causes of Folic Acid Deficiency include… • Pregnancy • Malnutrition • Alcoholism • Dietary lack of Folic Acid • Malabsorption Syndromes, such as Celiac Disease • Anorexia 32 Megaloblastic Anemias… • Clinical Manifestations • Insidious onset • Manifestations are due to tissue hypoxia • Sore, “beefy” red tongue – why? • Anorexia, Nausea and Vomiting • Abdominal Pain • Weakness, Parasthesias • Diagnostic: Serum levels of… • Vitamin B12 or Folic Acid • CBC to look at the size of the RBC (Macrocytic) • Anti –IF antibodies to diagnose Pernicious Anemia 33 Interprofessional Management: Megaloblastic Anemias • Cobalamin Deficiency… • Parenteral or intranasal administration of cobalamin. • High-dose oral cobalamin and sublingual cobalamin are also available for those in whom GI absorption is intact. • Physical therapy may be warranted • Folic Acid Deficiency… • Folic Acid replacement therapy • Dietary education 34 Thalassemias • Autosomal recessive blood disorder • Common in ethnic groups near Mediterranean, • parts of Asia, Middle East and Africa • Reduction in the production of normal HgB • Decreased in α or β-Globin Chains. • β-Thalassemia is a deficiency in the β chain • α-Thalassemia is a deficiency in the α chain • Thalassemia leads to Anemia because… • Hemoglobin deficiency • Hemolysis 35 Thalassemia Minor & Major • Thalassemia Minor… • Carrier only • Frequently asymptomatic. • May have mild to moderate anemia • Thalassemia Major… • Thalassemia Gene from both parents • Life Threatening • Physical and mental deficits • Severe Anemia: • Jaundice • Splenomegaly • Hepatomegaly • Failure to Thrive • Shortness of Breath • Weakness/Fatigue • Bone deformities 36 Interprofessional Care: Thalassemia • No treatment necessary for Thalassemia Minor • Thalassemia Major… • Blood transfusions or Exchange transfusions • Iron Chelation • Binds to iron and reduces the iron overload that occurs with frequent transfusion therapies • Available in oral, Subcutaneous and IV formulas • Iron supplements should NOT be given • Folic Acid and Zinc Supplements may be necessary 37 Hemolytic Anemias • Causes… • Sickle Cell Disease • Enzyme Deficiency (G6PD) • Acquired Factors • Physical Destruction • Prosthetic Heart Valve • Extracorporeal Circulation • Infections such as Malaria • Antibodies against RBC’s 38 Acquired Hemolytic Anemia • Physical destruction of RBCs results from exertion of extreme force on cells • Hemodialysis, Prosthetic heart valves, Extracorporeal circulation… • RBCs can be fragmented and destroyed as they try to pass through abnormal arterial or venous microcirculation 39 Hemolytic Anemia: Clinical Manifestations Physical Signs and Symptoms: • Jaundice • Dark Urine Laboratory Signs and Symptoms: • Increased Schistocytes (fragments of RBCs) • Increased Reticulocyte Count (response of the bone marrow) • Increased LDH (released in the lysis of the RBCs) • Decreased Haptoglobin (binds to free Hgb) 40 Acquired Hemolytic Anemia: Treatment and Management • Determine and treat causative agent • Immunosuppressive agents may be necessary • Supportive care • Emergency preparedness is essential for potential hemolytic crises • Hydration, electrolyte replacement, corticosteroids, blood products, splenectomy… 41 Sickle Cell Disease • Defect in the hemoglobin in the red blood cell • Hemoglobin S • RBC is stiff and elongate, taking on a “sickle shape” • Inherited Disease • Autosomal Recessive Disorder • “Trait” • Carrier of disease – only inherited one gene • About 35-45% of the total hemoglobin is HgbS • Often asymptomatic • “Disease” • Sickle Cell Gene from both parents • RBCs normal EXCEPT in times of stress: dehydration, acidosis, hypoxia, altitude, temperature extremes 42 Sickle Cell Disease: Clinical Manifestations • Typical patient is asymptomatic except during sickling episodes • Symptoms of Sickle Cell Disease are primarily a result of: • Obstruction caused by the sickled RBC’s • Increased RBC destruction • Symptoms during Sickle Cell Crisis, may include… • Pain from tissue hypoxia and damage • Pallor of mucous membranes • Hemolysis can lead to excess bilirubin… • Jaundice • Gallstones (cholelithiasis) • Gallstones are produced from excess bilirubin 43 Sickle Cell Disease: Acute Chest Syndrome • Acute pulmonary complications include… • Pneumonia • Tissue infarction • Fat embolism • Characterized by… • Fever, chest pain, cough, pulmonary infiltrates, dyspnea… • Leads to multiple serious complications • Pulmonary Hypertension • Heart Failure/ Cor Pulmonale • Myocardial Infarction 44 Sickle Cell Disease: Complications • Infection • Due to splenic dysfunction • Retinal detachment and blindness • Due to retinal vessel obstruction • Kidney damage • Due to increase in blood viscosity and hypoxia • Pulmonary Embolus and Stroke • Due to increase in blood viscosity • Osteoporosis • Due to infarction • Leg ulcers • Due to poor circulation • Priapism • Due to occlusion of penile vein 45 Sickle Cell Disease: Diagnostic Studies • Peripheral blood smear • May reveal sickling hemoglobin • Sickling test • Exposes RBC to deoxygenated environment • Electrophoresis of hemoglobin • Assesses the number of Hemoglobin S • To assess for complications… • Skeletal x-rays • Magnetic resonance imaging (MRI) • Doppler studies… 46 Interprofessional Management: Sickle Cell Disease • Patient and caregiver teaching and support are important… • In caring for a patient with Sickle Cell Disease, what should the patient & family be taught in an effort to avoid Sickle Cell Crisis? • Avoid stress; emotional and physical – pain control at home • Avoid extreme temperature variances • Avoid traveling to high altitude locations • Good nutrition and rest • Avoid being around others who are sick • Report to HCP promptly with symptoms of any illness • Stay well hydrated 47 In caring for a patient in Sickle Cell Crisis, what interdisciplinary therapeutic modalities would you expect to be implemented? • Frequent assessments and vital signs • Encourage adequate rest • May need DVT Prophylaxis • Pain control, how? • May require continuous and breakthrough analgesia with morphine and hydromorphone • Involve emotional and adjunctive measures • Maintain adequate oxygenation • Maintenance of hydration • Administer fluids to decrease viscosity of blood • Monitoring of lab results • Treatment of infection(s) 48 May also need… • Hydroxyruea (Hydrea) • Increases production of Hemoglobin F • Alters the adhesion of sickled RBC’s • Vigilance for respiratory failure • Respiratory failure is a common cause of death • Transfusion therapy • Aggressive total RBC exchange transfusion • Administer folic acid supplements • Chronic hemolysis results in increased utilization of folic acid stores • Hematopoietic stem cell transplantation (HSCT) • Only available cure • Rarely used because of cost, donor availability, risk… 49 Blood Loss Anemia • Common cause of anemia • Many causes… • Trauma, Disease…. • Chronic blood loss • Bleeding ulcer, hemorrhoids, menstrual, postmenopausal… • Leads to Iron Deficiency Anemia. Manifestations and treatment will be the same. • Acute blood loss • Sudden hemorrhage due to trauma, complications of surgery, conditions or disease that disrupts vascular integrity…. • May lead to hypovolemic shock… 50 Blood Loss Anemia: Symptoms • Symptoms will vary based on amount & speed • What are the physiologic responses you’d expect to see from blood loss? • Tachycardia, Hypotension, Tachypnea, SOB, AMS, Pain • May decrease vascular volume and lead to Shock • Decreased H&H – Late Sign!! • May see normal values until the body attempts to compensate by increasing plasma volume • Treatment • Fix the Cause 51 You are the Nurse in a busy ED. You admit a patient with a significant amount of acute blood loss from an injury. What will you do? • Vitals • Rapid head to toe assessments • Assess blood loss • Stop bleeding • Access (lines) large gauge/central • Expect to obtain labs • Blood type/match, CBC, Electrolytes • Oxygen • Education and support • Anticipatory guidance 52 Blood Transfusions.. • Transfusions are NOT risk-free • Transfusions should be considered only if improvement in RBC count cannot be achieved through nutrition, drug therapy or treating the underlying disease • Blood should only be administered based on appropriate indications • Hgb level of 7 - 8 g/dL… • Blood Typing… • http://www.redcrossblood.org/learn-about -blood/blood-types 53 Types of Blood Component Therapies • Whole Blood • Packed Red Blood Cells • Platelets • Blood Clotting Factors • Plasma • Antibodies • Blood Substitutes 54 54 Whole Blood • Composed of RBCs, Plasma, WBCs and Platelets • Whole Blood is rarely used for transfusion • May be used for acute massive blood loss • Most Whole Blood units are used to separate RBCs, Platelets and Plasma components 55 Packed Red Blood Cells (PRBC) • Prepared by removing 200-250mL of plasma from whole blood • PRBCs consist of… • Same RBC mass as whole blood • 20-30% of original plasma volume • Some Leukocytes and Platelets • Advantages of PRBCs include… • Decrease in volume delivered • Decreased risk of circulatory overload • Decrease in amount of potassium, ammonia and other metabolic byproducts transfused • PRBCs are not used for volume expansion 56 Fresh Frozen Plasma • Liquid portion of the blood • Contains bile pigments, bilirubin, electrolytes, enzymes, hormones, clotting factors… • FFP Used for… • Active bleeding with coagulation factor deficiencies, Warfarin reversal, DIC, Massive transfusions in trauma Platelets • Will consist of only Platelets and plasma • Administered for thrombocytopenia 57 Blood Transfusions: Administration • Follow institutional policy/procedures • Ensure right patient, right blood, right time • Ensure access, tubing primed, equipment • Verification by second RN • Frequent vital signs and assessment as policy dictates • Monitor for transfusion reactions • Change in vital signs, fluid overload… 58 58 A transfusion of PRBCs has been infusing for 5 mins when the patient becomes flushed and tachypneic and says, “I’m having chills. Please get me a blanket.” Which action should you take first? A. Call the MD B. Check the patient’s VS C. Stop the transfusion D. Administer Benadryl 59 59 Aplastic Anemia • Bone marrow & blood stem cells are damaged. • Leads to a deficiency of all three blood cell types, “pancytopenia” • Red blood cells • White blood cells • Platelets • May be Congenital or Acquired • May be acquired by… • Idiopathic • Exposure to chemicals, drugs, radiation, infection, immune diseases… 60 Aplastic anemia • What symptoms would you expect from… • RBC deficiency? • WBC deficiency? • Platelet deficiency? • Diagnostics: blood analysis • CBC, platelets • Serum Iron and Iron Binding • Bone marrow biopsy • Interprofessional Management • Supportive Care • Education • Immunosuppressive treatment for Autoimmune causative factors • Safety considerations 61 Polycythemia • Myeloproliferative Disorders • Overproduction of cells in the bone marrow • Primary Polycythemia • Abnormality of stem cells in the bone marrow • Polycythemia Vera (PV) • Secondary Polycythemia • Most common • Increase in erythropoietin as a normal response to chronic hypoxia • May be caused from high altitude living, smoking, in persons with COPD and persons with chronic heart failure 62 Polycythemia Vera • Chronic overproduction of RBC, WBC & Platelets • Chromosomal mutation in stem cell leads to increased production of cells • Increased blood viscosity and volume leading to congestion of organs and tissues • May interfere with blood flow and cardiac output • Increased formation of blood clots • Commonly accompanied by… • Splenomegaly • Spleen has to work harder than usual • Depletion of iron stores 63 Polycythemia: Signs and Symptoms Too Many Blood Cells => Clogging Up the System • Headache, Vertigo, Dizziness • Tinnitus, Visual disturbances • Generalized pruritus • Painful burning & redness of the hands & feet • Angina, Heart Failure • CVA, Vessel Rupture • Splenomegaly, Hepatomegaly • Gout 64 Interprofessional Management: Polycythemia • Phlebotomy • Reduce hematocrit to 45-48% • Approximately 300-500mL every 2-3 months • Hydration therapy, why? • Drug therapy • Hydroxyurea • Aspirin • What might be a possible Nursing Diagnosis? • Activity Intolerance related to insufficient oxygen secondary to pulmonary congestion and tissue hypoxia 65 Hemophilia • Bleeding disorder caused by inadequate CLOTTING FACTORS • Hemophilia A – Factor VIII (Classic Hemophilia, ~75% of cases) • Hemophilia B – Factor IX (Christmas Disease) • X-linked recessive disorder: Hereditary disorder carried by the female on the X chromosome but only presents in males 66 Hemophilia: Signs and Symptoms • • • • • • • • Bleeding/bruising easily Prolonged bleeding Hemorrhage with minor cuts or teeth erruption Hemarthrosis – bleeding in the joint • Stiffness • Tingling/aching • Inability to move joint • Warmth • Redness • Swelling • Pain Epistaxis Hematuria Internal Bleeding Intracranial Bleeding 67 Interprofessional Management: Hemophilia • Administer Factor VIII • Control bleeding • RICE • Manage pain • No rectal temps • Blood products • Administer DDAVP (increases Factor VIII by releasing factors from storage sites) • PT after bleeding for control of muscle and joint strengthening • Reinforce teaching for family/patient/caregivers: • Medic-Alert Bracelet • Padding furniture corners (for toddlers) • Avoid contact sports • S/S hemoarthritis • Soft toothbrush and regular dental exams • Avoid ASA 68 Aging and the Hematologic System • Erythrocyte lifespan is normal, but erythrocytes are replaced more slowly. • Platelet adhesiveness may increase with age. • Lymphocyte function decreases with age. • T-cell function (cellular immunity) declines somewhat. • Humoral immune system is less responsive. 69