Hematological System PDF

The hematological system is composed of red blood cells, white blood cells, platelets (clotting cells), and other components. Red blood cells are responsible for picking up and delivering oxygen, carbon dioxide, iron, and other nutrients throughout the body. Red blood cells do this job for about 4 m...

The hematological system is composed of red blood cells, white blood cells, platelets (clotting cells), and other components. Red blood cells are responsible for picking up and delivering oxygen, carbon dioxide, iron, and other nutrients throughout the body. Red blood cells do this job for about 4 months before they are recycled and replaced. White blood cells only last about 20 days in the blood before they are destroyed in the lymphatic system. Many types of different white blood cells make up the immune system. Unlike red blood cells, which maintain a stable population, white blood cells are produced as needed and increase in number when a foreign invader like a virus or bacteria is sensed. Immature white blood cells, called “bands” and “stabs,” are used to signal the presence of a new threat. Other white blood cells are triggered as an allergy response. Platelets are the blood cells responsible for repairing injury. They clump together when damage is present and call for clotting factors to surround them as a temporary barrier. Platelets only live for about nine days before they break down and are replaced and recycled. Red Blood Cells (Erythrocytes) 120 Days Platelets (Thrombocytes) 9 Days White Blood Cells (Leukocytes) 20 Days All blood cells are produced in the bone marrow located in the middle of some of the body’s larger bones. Some hematologic alterations can cause the bone marrow to produce too many or not enough of a specific bone cell. In some cases, bone marrow cannot produce enough of all blood cells, leading to a condition called pancytopenia. This can be caused by damage to the bone marrow due to radiation, chemicals, toxins, or specific medications. This condition can be temporary or permanent. If there are too many blood cells, the suffix –cytosis is used to describe the condition. If there are not enough blood cells, the suffix –penia is used. Review this table for a summary. Cell Type Too Many Not Enough Red blood cells Erythrocytosis Erythrocytopenia White blood cells Leukocytosis Leukocytopenia Platelets Thrombocytosis Thrombocytopenia Anemia is measured by looking at three different values: the red blood cell count, hemoglobin, and hematocrit. If one of these three values is below normal, the client has a condition called anemia. This is not a diagnosis; it is a condition caused by an underlying problem. A client can have a normal red blood cell count but a decreased hemoglobin, whereas erythrocytopenia only refers to a low red blood cell count. There are three classifications of anemia, all based on the size of the red blood cell (mean corpuscular volume [MCV]) on the complete blood count (CBC). • Macrocytic anemia—MCV is greater than 100 . • Normocytic anemia—MCV is between 80 and 100 . • Microcytic anemia—MCV is less than 80 . When assessing a client with a hematologic alteration, review and identify history and symptoms that may indicate abnormally high or low levels of blood cell components. Consider other cues in your analysis. Assessment: Symptoms • • • • • • • palpitations symptoms of infection bleeding and/or bruising dizziness or lightheadedness shortness of breath joint pain fatigue or activity intolerance Assessment: Signs • skin color • enlarged or painful lymph nodes • liver enlargement • spleen enlargement • nail changes • jaundice • joint swelling The main hematologic test done to evaluate blood cell counts is the complete blood count (CBC). The most important values to review are the hemoglobin and hematocrit (H & H), the white blood cell count (WBC), and the platelet count (PLT). These values will show if a client’s cells are too low, too high, or within the normal range. These values, along with assessment findings, can identify problems or potential risks for problems. Cell Type Red cells Too Many • Impaired gas exchange • Risk for thromboembolism Not Enough • Impaired gas exchange • Altered peripheral tissue perfusion • Altered cerebral tissue perfusion • Risk for shock • Risk for unstable blood pressure • Fatigue • Imbalanced nutrition White cells • Impaired tissue integrity • Hyperthermia • Risk for shock • Risk for infection Platelets • Risk for thromboembolism • Risk for bleeding • Risk for shock Too few red blood cells, called erythrocytopenia (anemia), can be caused by many different problems. • The body is not producing enough red blood cells, which can be caused by iron deficiency, aplastic anemia, certain medications, or folic acid deficiency. • The body is destroying/recycling the cells faster than it is creating them, which can be caused by antibodies against RBCs, infectious agents, disseminated intravascular coagulopathy, or widespread cancer. • Acute or chronic blood loss is caused by blood vessel rupture, trauma, gastritis, or menstrual flow. Red blood cells Nursing Diagnoses • Impaired gas exchange Nursing Actions • Administer oxygen as prescribed . • Administer blood/fluids as prescribed . • Treat iron deficiency as prescribed . • Altered peripheral tissue perfusion • Altered cerebral tissue perfusion • Risk for shock • Risk for unstable blood pressure • Fatigue • Imbalanced nutrition • Treat B12 or folate deficiency as prescribed . • Monitor for signs of shock . • Monitor for signs of hypoxia . Too many red blood cells, called erythrocytosis, can be caused by lung disease, high altitude, smoking, or anything that causes the body to compensate by creating more red blood cells to carry oxygen. The danger is thromboembolism. Here are some nursing diagnoses and actions to consider. Nursing Diagnoses • Impaired gas exchange • Risk for thromboembolism Nursing Actions • Administer oxygen as prescribed . • Administer anticoagulants as prescribed . • Monitor for symptoms of thromboembolism . Not enough white blood cells, called leukocytopenia, can be caused by many different problems. Either the body is not producing enough, which can be caused by bone marrow suppression due to toxins, chemicals, bone marrow dysfunction, or a virus or autoimmune condition may be limiting the immune system from producing additional white cells. Here is a nursing diagnosis and actions to consider. White cell Nursing Diagnoses • Risk for infection Nursing Actions • • • • • • Monitor for signs of infection . Maintain good hand hygiene. Clean potentially contaminated surfaces . Personal protective equipment as needed . Administer medication as prescribed . Implement neutropenic precautions. Too many white blood cells, called leukocytosis, can be caused by infection, stress, or abnormal white blood cell creation. Sometimes, too many white cells is a sign of blood cancer (leukemia). The main danger is shock. Here are some nursing diagnoses and actions to consider. Nursing Diagnoses • Impaired tissue integrity • Hyperthermia • Risk for shock Nursing Actions • • • • • Monitor for signs of infection . Treat symptoms of infection (fever) . Monitor blood pressure for signs of shock . Administer antibiotics as prescribed . Administer antivirals as prescribed . Not enough platelets, called thrombocytopenia, can be caused by many different problems. Either the body is not producing enough, which can be caused by bone marrow suppression due to toxins, chemicals, bone marrow dysfunction, or a virus or autoimmune condition may be limiting the liver from releasing platelets into circulation. Here are some nursing diagnoses and corresponding actions to consider when there are not enough platelets. Platelet Nursing Diagnoses • Risk for bleeding • Risk for shock Nursing Actions • Monitor for signs of bleeding/bruising . • Administer platelets or blood as prescribed . • Implement bleeding precautions. Too many platelets, called thrombocytosis, can be caused by infection. The main danger is the increased risk of thromboembolism. Here is a nursing diagnosis and corresponding actions to consider when there are too many platelets. Nursing Diagnoses • Risk for thromboembolism Nursing Actions • Monitor for signs of thromboembolism . • Administer fluids as prescribed. • Administer anticoagulants as prescribed . In some cases, white blood cell counts can be so low that opportunistic bacteria or parasites can cause altered tissue integrity by invading organs and tissue, causing infection. The most common instances of this include clients who are taking chemotherapy medications or clients who have an immune deficiency syndrome. Infection control and disease prevention can mean life or death to these clients. Utilizing basic control procedures like hand washing, mask or gown wearing, and maintaining clean surfaces are some of the many interventions nurses use to ensure no increased infection or new infection. Sometimes clients will be placed in neutropenic precautions for their protection. This includes a cart placed outside their room, disposable utensils and equipment, and notification signs warning visitors of needed actions to take in preventing illness for the client. Nursing Care A professional nurse who has signs or symptoms of infection should not work in client care settings until they are able to get treatment or the signs or symptoms resolve. For clients with low red blood cells or platelet counts, the nurse may be asked to administer blood or blood products. Administering blood products can be a significant risk to the client. It is important to follow these general guidelines when performing this nursing action: • Ensure that the blood type and all identifying information match between the blood product and the client. • Verify with another nurse (most hospitals require two signatures) . • Collect baseline vital signs and additional vital signs frequently, especially when starting the infusion. • Monitor the client closely for the first 15 minutes, looking for a potential transfusion reaction. • If a reaction occurs, stop the administration, disconnect the tubing, contact the healthcare provider, and follow hospital policy for transfusion reactions. Reviewing outcomes is essential to ensure that nursing interventions are effective and to continue to plan further client needs while continuing to recognize and update cues and generate further actions. Here are some basic evaluation criteria the nurse can use to verify improvement and plan further action. Improvement of Anemia (low red blood cell count) • • • • • increased red blood cell count on complete blood count (CBC) improved oxygen saturation increased blood pressure decreased pulse improved fatigue Improvement of Leukocytopenia (low white blood cell count) • absence of signs or symptoms of infection • increased white blood cell count Improvement of Leukocytosis (high white blood cell count) • decreased fever • decreased white blood cell count • stable blood pressure Improvement of Thrombocytopenia (low platelet count) • absence of signs or symptoms of infection • increased platelet count Improvement of Thrombocytosis (high platelet count) • absence of signs or symptoms of thromboembolism • decreased platelet count