Credits to Mr. Jefferson Ramos :)

1. DI ST URBANCES I N
OX Y GE NAT I ON
CARRYI NG
ME C H A N I S M A N D
T RANS P ORT AT I ON
F ACI L I T I ES
Jefferson C. Ramos, RMT RN

2. BLOOD
 Circulatory fluid of the the
Cardiovasclar system that is
circulating constantly through
a closed circuit of tubes.

3. PARTS OF THE BLOOD
 Liquid Portion
 Plasma - a pale, straw
colored fluid that remains
if coagulation is prevented
 Serum - fluid part that
remains after separation
of the clot

4. PARTS OF THE BLOOD
 Solid Portion
 Red Blood
Cells/Erythrocytes
 White Blood
Cells/Leukocytes
 Platelets/Thrombocytes

5. CHARACTERISTICS OF BLOOD
 Volume  Specific Gravity
 5 - 6 liters or 7 - 8% of the  Between 1.055 - 1.065
body weight
 Reaction
 Color
 Venous blood - dark red  Range of 7.35 - 7.45 (avg.
 Arterial blood - bright of 7.4)
scarlet red
 Viscosity
 Thick and sticky (5x that
of water)

6. FUNCTIONS OF BLOOD
 Metabolic Functions
 Respiration  Regulation of body
temperature
 Nutrition
 Transportation of
hormones
 Excretion
 Maintenance of normal
 Regulation of water acid-base balance in the
balance body

7. FUNCTIONS OF BLOOD
 Defensive Functions
 Production of immune
globulins
 Functions as phagocytes

8. ERYTHROCYTES
 Biconcave discs resembling a soft ball
compressed between 2 fingers
 Gases can easily diffuse across it due to
its very thin membrane
 Contains HEMOGLOBIN
 From matured erythrocytes; with Iron
 Makes up 95% of blood mass
 Enables the RBCs to perform its
principal function

9. RBC DESTRUCTION
 120 days
 Removed by the reticuloendothelial cells in the liver
and spleen
 Hemoglobin is recycled
 Bilirubin
 New hgb molecules in the bone marrow
 Sterco- and urobilinogen

10. KINDS OF WBCS
 Granulocytes • Agranulocytes
 Neutrophils • Lymphocytes
 Eosinophils
• Monocytes
 Basophils

11. NEUTROPHILS
 Most abundant type of
phagocyte, 50 - 60%
 Responsible for
neutralizing bacterial
infections
 They engulf pathogens
coated with antibodies
 Does not return to the
blood

12. EOSINOPHILS
 1 - 3%
 They play a crucial
part in killing
parasites
 Neutralize
histamine

13. BASOPHILS
0 - 1% of the
differential count
 Appears in
inflammatory
reactions esp. those
that cause allergic
reations
 Containsheparin &
histamine

14. LYPMHOCYTES
 About 25 - 33% of the
differential
 Usually abnormal
results in diseases
caused by viruses
 Has three kinds:
 Natural Killer Cells
 T Cells
 B Cells

15. MONOCYTES
 About 3 - 7%
 Functions to replenish
resident macrophages
and dendrictic cells
under noramal states
 Also responds to
inflammation signals

16. THROMBOCYTES
 100,000 - 450,000 in
value
 Derivedfrom the
fragmentation of
precursor
megakaryocytes
 Plays
a key role in
hemostasis

17. ASSESSMENT AND DIAGNOSTIC FINDNIGS
Hematologic Studies
 Complete blood count
 Peripheral blood smear
 Hemoglobin
 Hematocrit
 RBC indices

18. ASSESSMENT AND DIAGNOSTIC FINDNIGS
 Bone marrow aspiration
and biopsy
 Bone marrow aspiration
 Bone marrow biopsy

19. MANAGEMENT OF HEMATOLOGIC
DISORDERS

20. ANEMIA
A condition in which Hemoglobin
(Hgb) concentration is lower than
normal
 Hgb = 75 – 175 μg/dL or
13.5-17.5 g/dL (M)
= 65 to 165 μg/dL or
11.5-15.5 g/dL (F)

21. ANEMIA: CAUSES
 Acute or chronic blood loss
 Inadequate dietary intake of vitamins and
minerals
 Increased demands of vitamins and
minerals for RBC production
 Decreased RBC production by bone
marrow
 Increased RBC destruction

22. Hemolytic
ANEMIA Hypo-
proliferative
Bleeding

23. ANEMIA: SIGNS AND SYMPTOMS
 Pallor  Syncope
 Easy  Brittlehair
fatigability  Paresthesia
 Weakness  Cold
 Weight loss sensitivity
 Headache  Anorexia
 Tachycardia  Amenorrhea

24. IRON DEFICIENCY ANEMIA
 Laboratory findings  Assessment
1. CBC- Low levels of 1. Pallor
Hct, Hgb and RBC
count 2. Weakness & fatigue
2. Low serum iron, low 3. Smooth & sore
ferritin tongue
3. Bone marrow
aspiration- MOST 4. Koilonychia
definitive 5. Vinson Plummer
syndrome

25. MEGALOBLASTIC ANEMIAS:
VIT. B12 DEFICIENCY
 Inadequate dietary intake
 Pernicious Anemia
 Due to the absence of intrinsic factor
secreted by the parietal cells
 Intrinsic factor binds with Vit. B12 to
promote absorption

26. MEGALOBLASTIC ANEMIAS:
VIT. B12 DEFICIENCY
Causative factors
1.Strict vegetarian diet
2.Gastrointestinal
malabsorption
3.Crohn's disease
4.Gastrectomy

27. MEGALOBLASTIC ANEMIAS:
MANIFIESTATIONS
1. Weakness
2. Fatigue
3. Listless
4. Neurologic manifestations (only in Vit.
B12 deficiency)
5. Jaundice – due to poor erythropoiesis
6. Red beefy tongue
7. Mild diarrhea
8. Extreme pallor
9. Paresthesias in the extremities

28. MEGALOBLASTIC ANEMIAS: LAB DATA
1. Peripheral blood smear- shows
giant RBCs, WBCs with giant
hypersegmented nuclei
2. Very high MCV
3. Schilling’s test – determines the
cause of Vit B12 deficiency
4. Intrinsic factor antibody test

29. MEGALOBLASTIC ANEMIAS
1. Vitamin supplementation
 Folic acid 1 mg daily
2. Diet supplementation
 Vegetarians should have
vitamin intake or fortified soy
milk
3. Lifetime monthly injection
of IM Vit. B12 – 1000µg (if
intrinsic factor is absent)

30. MEGALOBLASTIC ANEMIAS
1. Monitor patient (neurologic
assessment)
2. Provide assistance in
ambulation
3. Oral care for sore tongue
4. Explain the need for lifetime IM
injection of Vit. B12

31. POLYCYTHEMIA
Refers to an INCREASE
volume of RBCs
The hematocrit (Hct) is
ELEVATED to more than 55%
Classified as Primary or
Secondary

32. POLYCYTHEMIA: PRIMARY
POLYCYTHEMIA VERA
Colleen C. Flores, RN
A proliferative disorder in
which the myeloid stem cells
become uncontrolled
Causative factor: unknown

33. POLYCYTHEMIA: PRIMARY
Uncontrollable
stem cell growth Increased blood
viscosity
Hypercellular
bone marrow
Increase in number Increased RBC,
of blood cells WBC, platelets
Hematopoiesis
in spleen Splenomegaly
Fibrotic bone
marrow

34. POLYCYTHEMIA: PRIMARY
1. Ruddy skin 1. Angina
2. Splenomegaly 2. Claudication
3. Headache
3. Dyspnea
4. Tinnitus
5. Fatigue 4. Thrombo-
6. Paresthesia phlebitis
7. Blurred vision 5. Pruritus
6. Erythromelalgia

35. POLYCYTHEMIA: PRIMARY
Laboratory findings
1. CBC- shows elevated RBC
mass
2. Elevated WBC and platelets
3. Elevated hematocrit
4. Normal oxygen saturation

36. POLYCYTHEMIA: PRIMARY
Complications
1. Increased risk for
thrombophlebitis, CVA and
MI
2. Bleeding due to
dysfunctional platelets

37. POLYCYTHEMIA: PRIMARY
1. To reduce the high blood cell
mass (goal)
Colleen C. Flores, RN
 PHLEBOTOMY
2. Allopurinol (Zyloprim) – if uric
acid is increased
3. Dipyridamole (Persantine)
4. Chemotherapy to suppress
bone marrow (hydroxyurea)

38. POLYCYTHEMIA: PRIMARY
 Patient education: Client instructions on:
1. Avoiding Iron supplements
2. Bathing with cool water (cocoa-butter
based lotion and bath products)
3. Minimize bleeding
 Avoid Aspirin (if with bleeding history)
 Minimize alcohol intake

39. POLYCYTHEMIA: SECONDARY
 Caused by:
 Excessive production of
erythropoietin (hypoxic stimulus)
 Hemoglobinopathies
 Neoplasms (renal cell carcinoma)
 Treat primary problem

40. BLEEDING DISORDERS
Platelets

41. THROMBOCYTOPENIA
Low platelet level due to:
1. Decreased platelet production by bone
marrow
2. Increased platelet destruction (ITP)
3. Increased platelet consumption (DIC)
Manifestation: bleeding and petichiae
(<20,000mm3)

42. IDIOPATHIC THROMBOCYTOPENIC
PURPURA (ITP)

43. ITP
 Goal: safe platelet count (>30,000mm3)
 Immunosuppressants - block the binding
receptors on macrophages so that the platelets
are not destroyed
1. Prednisone
2. Cyclophosphamide (Cytoxan)
3. Azathioprine (Imuran)
4. Dexamethasone (Decadron)
 IVIG
 Spleenectomy
 Chemotherapy – Vincristine (Oncovin)
Colleen C. Flores, RN

44. ITP
 Determine bleeding risks
 Client education regarding
 Medication and treatment
 Lifestyle
 Refrain from vigorous sexual
intercourse (< 10,000/mm3)
 Avoid client constipation

45. HEMOPHILIA
 Inherited (x-linked) bleeding disorder
 Deficient or defective factor VIII (A)
 Deficient or defective factor IX (B)
 Hemorrhage after minimal trauma (joints)

46. HEMOPHILIA: INHERITANCE

47. VON WILLEBRAND’S DISEASE
 Inherited(autosomal dominant)
bleeding disorder; deficiency of the
vWF
 Common manifestations
 Nosebleeds
 Heavy menses
 Lab data = normal platelet count but
prolonged PTT

48. VON WILLEBRAND’S DISEASE: MANAGEMENT
 Cryoprecipitate or FFP
 Desmopressin (DDAVP) – can be used to
prevent bleeding with dental/surgical
procedures or manage mild post-op bleeding

49. DISSEMINATED INTRAVASCULAR
COAGULATION (DIC)
A potentially life-threatening
sign of an underlying condition
Triggered by sepsis, trauma,
cancer, abruptio placenta,
transfusion reactions
(hemolysis)

50. DIC: MANIFESTATIONS
 Minimal occult internal bleeding to
profuse hemorrhage
 Lab data:
 Fibrin degradation products – high
 PTT - high
 Platelet count - low
 PT - high
 Serum fibrinogen - low

51. DIC: MANAGEMENT
Treatunderlying disorder
Correct secondary effects of tissue
ischemia
Cryoprecipitate or FFP
Heparin infusion* – to interrupt
thrombosis