Hematological System - For Students

HEMATOLOGICAL SYSTEM Created by Crystal Patenaude RN 2024 Adapted by LT RN 2024 for NRSG 311 HEMATOLOGIC SYSTEM The Hematologic System (blood components and the organs that form them) play a vital role in maintaining homeostasis on the entire body, affecting multiple cellular activities, includ...

HEMATOLOGICAL SYSTEM Created by Crystal Patenaude RN 2024 Adapted by LT RN 2024 for NRSG 311 HEMATOLOGIC SYSTEM The Hematologic System (blood components and the organs that form them) play a vital role in maintaining homeostasis on the entire body, affecting multiple cellular activities, including: Oxygen transport and delivery Hemostasis Immune response. 2 ANATOMY & PHYSIOLOGY Blood: suspension of erythrocytes, leukocytes, platelets and other particulate material in aqueous colloid solution Provides medium for exchange between fixed cells in body and external environment Nutrients (i.e. oxygen and glucose) are carried to each cell Cellular waste (i.e. carbon dioxide and nitrogen) are removed. Other essential functions include: Regulation of PH Regulation of temperature Regulation of cellular water Prevention of fluid loss through coagulation Protection against toxins and foreign microbes 3 Blood Components Plasma Blood Cells: Erythrocytes (RBC) Leukocytes (WBC) I. Neutrophils II. Eosinophils III. Basophils IV. Monocytes V. Lymphocytes VI. Plasma cells Thrombocytes (platelets) 4  Plasma ◦Liquid component of blood ◦Makes up about 55% of its total volume ◦Essential for transporting nutrients, hormones, waste products, and blood cells throughout body 5  Composition of Plasma About 90% water, helps maintain hydration and transport substances Remaining 10% consists of dissolved substances, including: Proteins (albumin, fibrinogen, immunoglobulins) o Albumin the primary protein found in Plasma; maintains blood volume, regulates PH, regulates electrolyte balances and transportation of substances. Electrolytes (sodium, potassium, calcium) Nutrients (glucose, amino acids, fatty acids) Waste products (carbon dioxide, urea, creatinine) Hormones (insulin, growth hormones) Gases (oxygen and carbon dioxide) 6  Key Functions of Plasma Transports blood Contains Contains Plasma Plays role Water cells (RBC, fibrinogen antibodies proteins, in content WBC, platelets) and other (immuno- especially maintaining allows it to 1. Transport: throughout 2. Clotting: clotting 3. Immune Function: Pressure and Volume: 5. Acid-Base Balance: body’s pH Regulation: act as heat 6. Temperature globulins), albumin, 4. Maintaining Blood circulatory factors proteins help balance conductor system essential that help maintain (7.35–7.45) Distributes Carries nutrients for blood body fight oncotic Carries heat absorbed from clotting infections, pressure, buffering throughout digestive system When identify and regulating agents, body, helps to tissues/organs vessel is neutralize movement helps regulate Transports waste injured, bacteria, of fluids neutralize body products (e.g. fibrinogen viruses, between excess temperature urea, carbon converted and other blood and acids or dioxide) to into fibrin, pathogens tissues bases, organs (e.g. forming Transports Helps ensures kidneys, lungs) clot to WBCs to prevent proper for excretion prevent areas of edema, cellular Distributes excessive infection or ensures function hormones bleeding injury proper produced by circulation glands to target of fluids organs, coordinates bodily functions 7  Clinical Significance for Nursing: Fluid and Electrolyte Imbalance: Plasma is critical in understanding fluid and electrolyte balance in patients Nurses need to monitor plasma levels of electrolytes (e.g. sodium and potassium) during IV therapy, dehydration, or electrolyte disorders Blood Transfusions: Plasma is often separated from blood during transfusions Fresh Frozen Plasma (FFP) used in patients with clotting disorders, liver disease, or massive blood loss to replace clotting factors Plasma Volume Expanders: In cases of hypovolemia (low blood volume) due to trauma or surgery, plasma expanders (like albumin or synthetic colloids) can be administered to restore blood volume and maintain circulation Plasma Donation: Plasma can be donated separately from blood through a process called plasmapheresis Often used for patients requiring specific components like clotting factors or immune proteins 8 Critical Thinking A 68-year-old patient with a history of chronic liver disease is admitted with signs of ascites and generalized edema. Blood tests reveal low levels of albumin in the plasma (hypoalbuminemia). The physician orders an infusion of 5% albumin. Part 1 As the nurse, explain how hypoalbuminemia affects fluid balance in the body, and describe the rationale behind administering albumin. 9 How hypoalbuminemia affects fluid balance in the body 1. Decreased Oncotic Pressure: Albumin helps retain water in blood vessels by exerting oncotic pressure. When albumin levels drop, pressure decreases. As a result, fluid leaks out of blood vessels into surrounding tissues, causing edema 2. Fluid Shift to Interstitial Space: Without sufficient oncotic pressure to balance fluid distribution, water tends to move from intravascular space into interstitial space This can lead to fluid accumulation in tissues, especially in legs, arms, and abdomen. 3. Intravascular Dehydration: As more fluid moves into tissues, blood volume decreases. This can lead to hypotension and reduced perfusion to vital organs, potentially causing symptoms like dizziness, fatigue, or fainting. 4. Compensation Mechanisms: Body attempts to compensate for fluid shift by activating mechanisms like renin-angiotensin- aldosterone system (RAAS) and release of antidiuretic hormone (ADH), which retain sodium and water to increase blood volume. However, this compensation may worsen fluid retention and exacerbate edema without solving underlying problem. 10  Erythrocytes ◦ Most abundant type of blood cell ◦ Adults: approximately 5 million RBCs per microliter of blood ◦ Play vital role in body by transporting oxygen from lungs to tissues and returning carbon dioxide from tissues to lungs for exhalation 11  Key Characteristics of Erythrocytes 1.Shape:  Erythrocytes have unique disc-like biconcave shape, increases the cell's surface area  Allows for more efficient gas exchange, gives RBCs flexibility, enabling them to travel through capillaries. 2.Lack of Nucleus:  Mature erythrocytes in humans do not have a nucleus or other organelles, allows more space for hemoglobin, the protein that binds to oxygen and carbon dioxide  Because they lack organelles, erythrocytes cannot repair themselves and have a lifespan of about 120 days 3.Hemoglobin:  Iron-containing protein that gives erythrocytes their red color and allows them to carry oxygen  Each Hg molecule can carry up to four oxygen molecules. Oxygen binds to the iron in hemoglobin, forming oxyhemoglobin in oxygen- rich environments like lungs  In tissues where oxygen is lower, Hg releases oxygen and picks up carbon dioxide, forming carbaminohemoglobin, which is carried back to lungs for exhalation 4.Erythropoiesis:  Erythrocytes are produced in bone marrow through a process called erythropoiesis, stimulated by erythropoietin (EPO), a hormone released by the kidneys in response to low oxygen levels in blood (hypoxia)  Erythropoiesis is tightly regulated to maintain appropriate number of RBCs, ensuring enough oxygen is transported while preventing blood from becoming too viscous 5.Lifespan and Destruction:  After about 120 days, aged erythrocytes are removed from circulation by spleen and liver through hemolysis  Iron from hemoglobin is recycled, while other components of RBC are broken down and excreted 12 Lab Values associated with RBC ◦ Hematocrit- proportion of blood that consists of packed RBCs expressed as a percentage of volume ◦ Women 37%-47% ----- Men 40%-54% ◦ RBC Count ◦ Women 4.2-5.4 million/mm3 ----- Men 4.6-6.2 million/mm3 ◦ Hgb ◦ Women 120-160 (12-16 g/dl) ----- Men 140-180 (14-18 g/dl) ◦ Platelets – 150,000-400,000ul ◦ Aid in hemostasis and maintenance of vascular integrity ◦ MCV – mean corpuscular volume: Average volume of RBCs in a sample ◦ MChgb content – Average Hgb content of a RBC sample ◦ MChgb concentration – Average Hgb content in 100ml of blood 13  Hgb ◦ 300 different types of genetically determined hgb ◦ Primary vehicle of O2 & C02 transport ◦ Buffers PH by binding to hydrogen ions ◦ Types of Hemoglobin: Hemoglobin A (HbA): The most common form in adults. Hemoglobin F (HbF): Predominant in fetuses and infants, having a higher affinity for oxygen to facilitate oxygen transfer from the mother’s blood. Hemoglobin S (HbS): A variant found in individuals with sickle cell disease, which causes red blood cells to take on a sickle shape under low oxygen conditions, leading to complications 14  HgB A1C ◦Measures the average blood glucose levels over the past 2 to 3 months. ◦Commonly used to diagnose and manage diabetes. ◦Reflects how blood sugar levels have been controlled over time. Normal: Less than 5.7% Prediabetes: 5.7% to 6.4% Diabetes: 6.5% or higher 15  Clinical Considerations 1. Anemia:  Condition where hemoglobin levels are lower than normal, reducing oxygen-carrying capacity of blood  Common causes: iron deficiency, chronic disease, hemolysis, and blood loss.  Symptoms: fatigue, weakness, shortness of breath, and pallor. 2. Sickle Cell Disease:  Hemoglobin S (HbS), a mutated form of hemoglobin, causes red blood cells to become rigid and sickle-shaped under low oxygen conditions  Leads to blockages in small blood vessels, pain crises, and complications such as stroke and organ damage. 3. Thalassemia:  Genetic disorder that results in reduced production of either the alpha or beta globin chains of hemoglobin  Leads to ineffective erythropoiesis and hemolytic anemia. 4. Hemoglobinopathies:  Conditions like Hemoglobin C or E variants  Cause different degrees of anemia, hemolysis, or mild disease, depending on the genetic mutation 5. Polycythemia:  Condition characterized by overproduction of red blood cells and, consequently, hemoglobin  Increases viscosity of blood and risk of clotting or stroke. 16 Platelets/Thrombocytes ◦ Small, disc-shaped cell fragments in the blood ◦ Play a crucial role in blood clotting (hemostasis) ◦ Derived from large bone marrow cells called megakaryocytes ◦ Vital for preventing bleeding by forming blood clots at sites of vessel injury Key Functions of Platelets: 1.Hemostasis: When a blood vessel is injured, platelets: i. Adhere to the damaged site by binding to the exposed collagen of the vessel wall. ii. Activate and release chemical signals (e.g., ADP, thromboxane A2) that recruit more platelets to the site of injury. iii. Aggregate by sticking together to form a platelet plug iv. Help stabilize the platelet plug by facilitating the coagulation cascade, leading to the formation of a fibrin clot that seals the wound. 2.Wound Healing: ◦ After clot formation, platelets release growth factors like platelet-derived growth factor (PDGF), which are essential for tissue repair and healing 17 Platelet Activation and the Clotting Process 1. Vascular Injury: When endothelium (inner lining of blood vessel) is damaged, platelets are exposed to substances like collagen and von Willebrand factor (vWF), which trigger their activation 2. Platelet Adhesion: Platelets adhere to exposed collagen at injury site using glycoprotein receptors on their surface (e.g., GPIb-IX-V complex binds to vWF) 3. Platelet Activation: Once adhered, platelets change shape and release granules containing ADP, serotonin, calcium, and thromboxane A2, which enhance the activation and recruitment of more platelets to the site 4. Platelet Aggregation: Activated platelets use fibrinogen as a bridge to link together via glycoprotein IIb/IIIa receptors, forming a temporary platelet plug 5. Clot Formation: Clotting cascade is initiated, leading to conversion of fibrinogen into fibrin, which reinforces platelet plug and forms a stable blood clot 18 Coagulation Factors 19  Platelet Disorders Thrombocytopenia Causes: Can result from bone marrow disorders (e.g., leukemia, aplastic anemia), autoimmune diseases (e.g., immune thrombocytopenic purpura, or ITP), medications, infections, or excessive platelet destruction.  Symptoms: Easy bruising, prolonged bleeding from cuts, petechiae (small red or purple spots on the skin), nosebleeds, gum bleeding. Thrombocytosis Causes: Can be primary (due to bone marrow disorders like essential thrombocythemia) or secondary (reactive) to conditions like inflammation, infection, or after surgery.  Symptoms: May be asymptomatic, but increased risk of thrombosis (blood clots) or, paradoxically, bleeding due to abnormal platelet function. Platelet Dysfunction: Causes: Can occur due to inherited disorders like Glanzmann thrombasthenia (deficiency of GPIIb/IIIa receptors) or Bernard-Soulier syndrome (deficiency of GPIb).  Acquired dysfunction can result from medications like aspirin (which inhibits thromboxane A2 production) or clopidogrel (which blocks ADP receptors) 20  Case Study You are a nurse working on Surgical. Your patient, Mrs. J, a 56-year-old woman, 2 days post op radical mastectomy with a history of breast cancer, is currently undergoing chemotherapy. Upon assessment you notice bruising, petechiae, and a nosebleed that she states has been ongoing for an hour. Upon review of her laboratory results, you note that her platelet count is 18,000/µL What is your initial “red flag” and critical thinking diagnosis for this patient? 21  Case Study If initially you are suspecting thrombocytopenia what further assessments are priority? 22 Further Assess Neurological assessment is Assess for additional critical to rule out signs of bleeding, such intracranial bleeding, as hematuria, melena especially if the patient or gingival bleeding. reports headaches, dizziness, or confusion. Vital signs: Monitor for signs of hypovolemia due to blood loss 23 Testing? What tests or evaluations might help identify the underlying cause of her thrombocytopenia? 24  Diagnostics Bone marrow biopsy (if needed) to assess the bone marrow’s function. Complete blood count (CBC): To evaluate other cell lines (e.g., red and white blood cells) and check for pancytopenia. Peripheral blood smear: To identify any abnormal platelet morphology or destruction. Coagulation studies: To rule out other coagulopathies. 25 Case Study Potential Causes of Thrombocytopenia in Mrs. J 26 Causes Chemotherapy-induced thrombocytopenia: Many chemotherapy agents, especially those used to treat cancer, can damage the bone marrow, leading to reduced platelet production. Bone marrow suppression: In patients with cancer, the disease itself can infiltrate the bone marrow, further impairing its ability to produce platelets. Other potential causes of thrombocytopenia include immune thrombocytopenic purpura (ITP), infection, or medications, but chemotherapy is the most likely cause here. 27 Management/Treatment What immediate interventions are necessary for Mrs. J? 28  Treatment Plan Platelet transfusion: Given her platelet count of 18,000/µL and active bleeding, Mrs. J will likely require a platelet transfusion to raise her platelet count and control the bleeding. Local measures to stop the nosebleed: Apply pressure to the nostrils, administer topical hemostatic agents, and pack the nose if necessary (rhino rocket) Avoidance of invasive procedures: No procedures like IM injections, central line insertions, or catheterizations should be performed unless absolutely necessary, as they can increase the risk of bleeding. 29 Leukocytes/WBC Body's PRIMARY defense against infection 6 types ◦ Neutrophils ◦ Eosinophils ◦ Basophils ◦ Monocytes ◦ Lymphocytes ◦ Plasma Cells 30  Neutrophils: Attach and destroy bacteria and viruses through phagocytosis  Eosinophils: Attach to surface of parasites, then release substances that kill the organism; detoxify inflammatory substances that occur in allergic reaction  Basophils: Prevent coagulation and speed fat removal from blood after a fatty meal  Monocytes: Consume bacteria, viruses, necrotic tissue, and other foreign material  Lymphocytes: Provide immunity against acquired infections; bases for antibody formation  Helper T Cells: regulate immune functions; destroyed by AIDS  Cytotoxic T Cells: (killer T cells) capable of direct attack on microorganisms (also on body's own cells: role in destroying cancer cells and heart transplant cells)  Suppressor T Cells: protect from attack by person's own immune system; suppresses cytotoxic T-cell functions  Plasma Cells: Produce Y-globulin antibodies in response to specific antigens 31 Case Study You are a nurse in a vaccine clinic, and you are seeing Lily, a 6- month-old infant, for her routine immunizations. Her mother, Mrs. K, is concerned about the number of vaccines Lily is scheduled to receive today. Mrs. K asks why so many immunizations are necessary and how vaccines work to protect her child from diseases. She specifically wants to understand how immunizations activate Lily's immune system 32 How do Vaccines work? 33 ◦ Vaccines introduce an antigen into the body. This antigen could be: ◦ A weakened (attenuated) form of the virus or bacteria (e.g., measles, mumps, and rubella (MMR) vaccine) Understandin ◦ An inactivated (killed) form of the pathogen (e.g., polio vaccine) g How ◦ A component of the pathogen, such as a protein from the surface of the virus (e.g., hepatitis B or human papillomavirus (HPV) vaccine) Vaccines ◦ Upon encountering the antigen, the body’s immune system mounts Work: a response by: ◦ Activating antigen-presenting cells (APCs), such as dendritic The Immune cells or macrophages, which recognize the antigen and present it to T cells Response ◦ T cell activation: Helper T cells recognize the antigen and stimulate B cells to produce antibodies, while cytotoxic T cells help destroy infected cells ◦ B cell activation: B cells are stimulated to differentiate into plasma cells, which produce antibodies specific to the pathogen's antigens ◦ Memory formation: Both memory B cells and memory T cells are produced, providing long-term immunity. When Lily is exposed to the actual pathogen in the future, her immune system will recognize and quickly neutralize it, preventing 34 illness DISORDERS OF RBCS MATCHING GAME CAN YOU GUESS WITH LITTLE INFORMATION 36 The most common type of anemia??? 37 Iron Deficiency Anemia is the most common type of anemia ◦Caused by insufficient iron, which is needed for hemoglobin production ◦Often due to blood loss (e.g., gastrointestinal bleeding, heavy menstruation), poor dietary intake, or malabsorption. Symptoms: Fatigue, weakness, pale skin, shortness of breath. Treatment: Iron supplementation, addressing the underlying cause of iron loss. 38 Often because of a lack of intrinsic factor 39 Pernicious Anemia ◦Caused by a deficiency in vitamin B12 due to the body’s inability to absorb it, often because of a lack of intrinsic factor in the stomach. Symptoms: Neurological symptoms (tingling, numbness), fatigue, glossitis (inflamed tongue). Treatment: B12 injections or high-dose oral supplementation 40 Bone marrow fails to produce sufficient red blood cells 41 Aplastic Anemia ◦Rare condition ◦Bone marrow fails to produce sufficient red blood cells, white blood cells, and platelets ◦Often due to autoimmune disorders, toxic chemicals, or medications Symptoms: Fatigue, frequent infections, easy bruising, and bleeding Treatment: Bone marrow transplant, immunosuppressive therapy 42 Caused by Sickle Cell Anemia 43 Hemolytic Anemia: ◦Results from destruction of red blood cells at a faster rate than they can be produced ◦Causes: autoimmune diseases, certain medications, infections, or inherited disorders like sickle cell anemia Symptoms: Jaundice, fatigue, dark urine, enlarged spleen Treatment: Corticosteroids, immune suppression, blood transfusions 44 Leads to blockages in blood vessels 45 Sickle Cell Disease: ◦Inherited disorder in which abnormal hemoglobin (HbS) causes red blood cells to become rigid and sickle-shaped, leading to blockages in blood vessels ◦Symptoms: Painful crises, fatigue, jaundice, risk of infections, stroke ◦Treatment: Pain management, hydroxyurea, blood transfusions, bone marrow transplant 46 Increases blood viscosity and the risk of clotting 47 Polycythemia ◦ Polycythemia: Overproduction of red blood cells, which increases blood viscosity and risk of clotting Polycythemia Vera: A myeloproliferative disorder characterized by an abnormal increase in RBCs, often accompanied by elevated white blood cells and platelets Symptoms: Headaches, dizziness, itching, increased risk of thrombosis. Treatment: Phlebotomy (blood removal), aspirin, medications to suppress bone marrow activity. 48 WBC DISORDER  WBC disorders “coles notes” 1.Leukopenia: A condition characterized by a low white blood cell count. It can be caused by: 1. Bone marrow disorders: Such as aplastic anemia or leukemia. 2. Autoimmune diseases: Like lupus. 3. Infections: Certain viral infections can reduce WBC counts. 2.Leukocytosis: An elevated white blood cell count, which can result from: 1. Infections: The body produces more WBCs to fight infection. 2. Inflammatory conditions: Such as rheumatoid arthritis. 3. Leukemia: A type of cancer that affects blood and bone marrow. 3.Leukemia: A group of cancers that affect blood and bone marrow, characterized by the proliferation of abnormal WBCs. Types include: 1. Acute Lymphoblastic Leukemia (ALL): Rapid proliferation of immature lymphoblasts. 2. Acute Myeloid Leukemia (AML): Rapid growth of abnormal myeloid cells. 3. Chronic Lymphocytic Leukemia (CLL): Slow proliferation of abnormal lymphocytes. 4. Chronic Myeloid Leukemia (CML): A progressive increase in abnormal myeloid cells. 4.Lymphoma: Cancers of the lymphatic system that involve abnormal lymphocytes. Types include: 1. Hodgkin Lymphoma: Characterized by the presence of Reed-Sternberg cells. 2. Non-Hodgkin Lymphoma: A diverse group of lymphomas that don't have Reed-Sternberg cells. 5.Multiple Myeloma: A cancer of plasma cells, which are a type of WBC responsible for producing antibodies. It leads to the accumulation of abnormal plasma cells in the bone marrow. 6.Myelodysplastic Syndromes (MDS): A group of disorders caused by poorly formed or dysfunctional blood cells. It often leads to a reduced number of healthy WBCs, RBCs, and platelets. 50 Leukemia Acute Leukemia Chronic Leukemia Acute Lymphoblastic Chronic Lymphocytic Leukemia Leukemia (ALL): (CLL): Characteristics: Rapid growth of Characteristics: Slow proliferation of immature lymphoblasts (a type of abnormal lymphocytes (a type of white white blood cell). blood cell). Often asymptomatic in early Age Group: Most common in stages. children, but can also affect adults. Age Group: More common in older adults. Acute Myeloid Leukemia Chronic Myeloid Leukemia (CML): (AML): Characteristics: Progressive increase in Characteristics: Rapid growth of abnormal myeloid cells. Often associated abnormal myeloid cells (a type of with the Philadelphia chromosome, which white blood cell). is a genetic abnormality. Age Group: More common in Age Group: Most common in adults. adults but can occur at any age. 51  Leukemia Diagnosis Typically Involves: Blood Tests: To check for abnormal levels Common Symptoms of Leukemia: of white blood cells, red blood cells, and Fatigue and weakness platelets. Frequent infections Bone Marrow Biopsy: To examine the bone marrow for the presence of abnormal Unexplained weight loss cells. Easy bruising or bleeding Genetic Testing: To identify specific Bone pain or tenderness genetic abnormalities associated with different types of leukemia. Swollen lymph nodes Imaging Tests: Such as X-rays, CT scans, Pale skin or MRIs, to check for lymph node or organ involvement. 52  Leukemia Treatment options depend on the type and stage of leukemia and may include: Chemotherapy: To kill cancer cells or stop their growth Radiation Therapy: To target and kill cancer cells in specific areas Targeted Therapy: Drugs that target specific genetic changes in cancer cells Immunotherapy: Uses the body's immune system to fight cancer Stem Cell Transplant: Replaces damaged bone marrow with healthy stem cells Supportive Care: Includes medications and therapies to manage symptoms and side effects 53 Bleeding Disorders ◦Conditions that affect body’s ability to control bleeding (hypocoagulability) or clot properly (hypercoagulability). ◦Include Platelet disorders ◦They can be inherited or acquired and vary in severity. 54 Unable to Control the Bleeding Hemophilia Hemophilia A: Caused by a deficiency in clotting factor VIII. It is the most common type. Hemophilia B: Caused by a deficiency in clotting factor IX. Sometimes called Christmas disease. Symptoms: Excessive bleeding from minor injuries, spontaneous bleeding, joint pain and swelling, and internal bleeding. Von Willebrand Disease Characteristics: A genetic disorder caused by a deficiency or dysfunction of von Willebrand factor, which is crucial for platelet adhesion and clot formation. Symptoms: Frequent nosebleeds, easy bruising, heavy or prolonged menstrual bleeding, and excessive bleeding after surgery or dental work55 Clotting too Much Clotting Factor Deficiencies Factor V Leiden Mutation: A genetic mutation that increases the risk of abnormal blood clotting, which can lead to deep vein thrombosis (DVT) or pulmonary embolism (PE) Antithrombin Deficiency: A condition where the body lacks antithrombin, a protein that helps regulate blood clotting Disseminated Intravascular Coagulation (DIC) Characteristics: A serious condition involving widespread clotting throughout the small blood vessels, leading to bleeding due to the consumption of clotting factors and platelets Causes: Often secondary to severe infections, trauma, pregnancy complications, or certain cancers Symptoms: Bleeding from multiple sites, organ dysfunction, and symptoms of shock Acquired Bleeding Disorders Liver Disease: Liver dysfunction can impair the production of clotting factors, leading to bleeding problems Vitamin K Deficiency: Vitamin K is essential for the synthesis of certain clotting factors. Deficiency can lead to bleeding Medications: Certain medications, such as anticoagulants (e.g., warfarin) and antiplatelet drugs (e.g., aspirin), can increase the risk of bleeding 56 Disseminated Intravascular Coagulation ◦ Serious and complex condition characterized by widespread activation of clotting cascade throughout small blood vessels ◦ Results in formation of small blood clots throughout the body, which can lead to multiple organ dysfunction and severe bleeding due to consumption of clotting factors and platelets Key Features of DIC 1.Widespread Clotting: Small blood clots form throughout the small blood vessels, leading to impaired blood flow to organs 2.Consumption of Clotting Factors: The continuous clotting process depletes clotting factors and platelets, which increases the risk of bleeding 3.Organ Damage: Reduced blood flow to organs can cause organ dysfunction or failure 57 Disseminated Intravascular Coagulation Causes Symptoms Sepsis: Severe infections that spread Bleeding: From multiple sites such as throughout the body. gums, skin, and internal organs. Trauma: Major injuries or surgeries. Symptoms may include bleeding from Pregnancy Complications: Conditions like IV sites, bruising, or blood in the urine. eclampsia, placental abruption, or amniotic Organ Dysfunction: Symptoms may fluid embolism. vary depending on which organs are Certain Cancers: Particularly leukemia or affected. Common issues include metastatic cancers. kidney failure, liver dysfunction, or Severe Burns: Extensive burn injuries can respiratory distress. trigger DIC. Shock: Symptoms include rapid Transfusion Reactions: Severe reactions to heartbeat, low blood pressure, confusion, and dizziness blood transfusions. 58  Disseminated Intravascular Coagulation Treatment Diagnosis Treat Underlying Condition: Effective Blood Tests: management of condition causing DIC is crucial Complete Blood Count (CBC): May show low platelet count Supportive Care: Includes fluid resuscitation, Coagulation Studies: Prolonged blood transfusions, and medications to support prothrombin time (PT) and activated blood pressure and organ function partial thromboplastin time (aPTT), low fibrinogen levels, and elevated D- Clotting Factor Replacement: Transfusion of dimer levels clotting factors, platelets, or fresh frozen Fibrinogen Levels: Decreased levels plasma to manage bleeding can indicate DIC Anticoagulants: In some cases, medications Peripheral Blood Smear: May show the presence of microangiopathic such as heparin may be used to control hemolytic anemia (fragmented red excessive clotting, though this is carefully blood cells) managed to avoid exacerbating bleeding 59 Platelet Disorders Immune Thrombocytopenic Purpura (ITP): Autoimmune disorder where immune system attacks and destroys platelets Thrombotic Thrombocytopenic Purpura (TTP): Rare condition characterized by low platelet counts, hemolytic anemia, and organ damage due to small blood clots. Symptoms: Easy bruising, bleeding gums, petechiae (small red spots on the skin), and prolonged bleeding from cuts or injuries 60  Diagnosis & Treatment Treatment depends on specific disorder and may include: Factor Replacement Therapy: For Diagnosis of bleeding disorders typically involves: hemophilia, to replace deficient clotting factors Blood Tests: To measure clotting factors, Medications: Such as desmopressin for von platelet counts, and evaluate bleeding Willebrand disease or corticosteroids for ITP times Platelet Transfusions: For conditions like TTP Genetic Testing: For inherited bleeding Lifestyle Adjustments: To minimize bleeding disorders, to identify specific genetic risk, such as avoiding certain medications and mutations activities Bone Marrow Biopsy: To assess for Treatment of Underlying Conditions: underlying conditions affecting blood cell Managing liver disease, vitamin deficiencies, or production infections 61  WHAT IS… JEOPARDY? https://www.playfactile.com/jeopardy-game/m60byo1imj