Hematologic Problems

Care of Clients with
Hematologic Diseases
Earl Francis R. Sumile, RN

Instructor, College of Nursing
University of Santo Tomas
Care of Clients with Hematologic
Diseases
 Blood – transports cellular requirements and
products from one part of the body to another;
composed of plasma (55%) and cellular
component (45%)
 slightly alkaline (ph 7.35-7.4)

5-6 liters or 70-75 ml/kg BW (average volume)
 Pulmonary circulation = 1300 cc

arterial (400cc) + capillary (60cc) + venous (840cc)
 Systemic circulation = 3000 cc
 arterial (550cc) + capillary (300cc) + venous (2150cc)
Care of Clients with
Hematologic Diseases
 Hematopoiesis – blood cell production; done in
the bone marrow (red), pelvis, sternum, ribs,
epiphysis of long bones
 Erythropoiesis – red blood cell production in the
liver in utero (2 to 5 months old) then in bone
marrow.
 needs iron, protein, pyridoxine (B6), cyanocobalamine
(B12), folic acid, and copper
 Reticuloendothilial System – mononuclear
phagocyte system or macrophage (spleen, liver,
lymphatic system, lungs)
Diseases
 Nursing Assessment:
 Pallor – conjunctiva
 Jaundice (hemolytic) – sclera; palms of
hands; soles of feet
 Signs of bleeding such as petechiae,
ecchymosis, hematoma, epistaxis
 Lymph nodes enlargement
 Limited joint range of motion
 Splenomegaly or hepatomegaly
Diseases
 Physical Assessment:
• Auscultate – heart murmur, bruits
• Inspect – above assessment
• Palpate – lymph nodes, location, size, bone
tenderness
• Percuss for ling excursion, splenomegaly,
hepatomegaly
• Evaluate joint ROM asnd tenderness
Diseases
 Diagnostic Assessment:
 Blood
 CBC with differential
a. Hemoglobin – Males13-16 gm/dl

- Females 12-14 gm/dl
b. Hematocrit – Males 42-50%
- Females 40-48%
c. RBC – N=Males 4,600,000 – 6,200,000 per cu.mm
Females 4,200,000 – 5,400,000 per cu.mm
Diagnostic Assessment
 Blood
d. WBC – N=5,000 – 10,000 cu.mm
*neutrophils – N=60-70%
*eosinophils – N=1-4%
*basophils – N=0–0.5%
*monocytes – N=2-6%
*lymphocytes – N=20-30%
e. Platelets – N=200,000-350,000 per cu.mm
 Coagulation studies
• PT Prothrombin time N= 11-18 secs
• PTT Partial Thromboplastin Time – N =50
to 80 seconds
• Clotting Time – N= 5 to 10 minutes
• Bleeding Time – N=30 sec – 6 minutes
Blood chemistries – patients fasts for 6 to 8 hours
 a. Blood Urea Nitrogen (BUN) – N=10-20mgs/dl
 b. Creatinine – N=0.7-1.4mgs/dl
 c. Uric acid – N= 2.5-8.0 mg/dl
 d. Cholesterol – N=150-300 mg/dl
 e. Bilirubin – Total N=0.1-1.0 mg/dl
• direct (N=0.1-0.2mg/dl)
• indirect (N=0.1-0.8mg/dl)
Miscellaneous
a. ESR – N=0 to 20 mm/hr
b. Coomb’s test – indirect blood from mom, direct
blood from baby’s cord
c. Schillings test – Vit.B12 in the gastro-intestinal
system
prep NPO x 8 hours
radioactive Vit.B12 given PO
Vit.B12 nonradioactive given IM
2 hours after urine collection for radioactive
Vit.B12; N = 15-40% of oral dose excreted
 Urine and Stool
 Urinalysis

Hematest

Hemoccult – prep; -no dark colored food x 24 hours prior to
test
 Radiologic

CXR

Scan
 Lymphangiography
 Bone Marrow aspiration and biopsy
 Preferred site – iliac crest, sternum or tibia
 Before: consent, position exposing the site

After: pressure to site x5miuntes
Erythrocyte Disorders
 Anemia – reduction below normal level in
number of erythrocytes, quantity of hemoglobin
and volume of packed RBC’s.

Basic underlying – tissue hypoxia

Signs and Symptoms – depends upon severity and
chronicity and age.
• a. Mild – hemoglobin 10-14 gms; asymptomatic; palpitations,
dyspnea and diaphoresis following strenuous exertion.
• b. Moderate – increased palpitations, dyspnea, and
diaphoresis; fatigue at rest or during activity.
• c. Severe – pale and exhausted all the time, sever
palpitations, sensitivity to cold, loss of appetite, profound
weakness, angina.
Anemia
 Iron Deficiency Anemia
Causes:

Inadequate absorption – increased
requirement

Inadequate intake of iron rich foods

Physiologic need – more in children and
pregnant women

Physiologic loss – menstruation

Blood loss – trauma, GI bleeding
Iron Deficiency Anemia
 Signs and Symptoms:
 Palpitations, dizziness, easy fatigability
 Cold sensitivity, pallor
 Brittle nails, and hair
 Plummer-vinsons syndrome – soreness and
inflammation of mouth and tongue (stomatitis

and glossitis)
Iron Deficiency Anemia
 Nursing management:
*Oral iron – route of choice; given after meals; liquid iron
intake with straw because it stains; mixed with 1 glass
cold H2O, best absorbed with Vitamin C; stool becomes
tarry and constipation may occur.
*Parenteral – avoid tissue staining by using separate
aspiration injection needles; Z-tract method and deep IM;
do not massage but encourage ambulation.
*Dietary – increased in iron and roughage
*Blood transfusion
Anemia
 Pernicious anemia – Vitamin B12
(cyanocobalamine) deficiency of intrinsic factor
in the gastric mucosa which is necessary for
absorption of Vit.B12.
 Hemolytic jaundice – macrolytic hypochromic
 Tingling sensations, paresthesias
 Beefy red tongue

Deficiency or absence of hydrochloric acid in the
stomach
Pernicious anemia
 Drug therapy – Vit B12 injections (monthly) for
life

Folic acid – reverses anemia, decreases
neurological symptoms

Transfusion therapy
 Diagnostic assessment:

Schilling’s test

Gastric analysis
Anemia
 Aplastic anemia – depressed bone
marrow activity secondary to
antineoplastics, radiation, insecticide,
drugs and chemical toxins.
Laboratory Assessment: pancytopenia
 Erythrocytopenia

Leukocytopenia
 Thrombocytopenia
Aplastic anemia
 Blood transfusion
 Prevent and treat infections
 Bone marrow transplant

Drug – corticosteroids; estrogen
 Identify and withdraw offending agent
Leukocyte Disorders
 Leukemia – most common of childhood
(3-5 y/o) cancer; abnormal proliferation of
WBC in blast form.
Predisposing factors:
 Radiation
 Survivors of Hiroshima
 Benzol, aniline dyes
Leukemia
 Types of Leukemia:
*Acute lymphocytic leukemia (ALL)
• 80-85%of childhood leukemia
• 95% chance of obtaining remission with diagnostic
assessment
• 75% chance of surviving over 5 years
*Acute non-lymphocytic anemia (ANLL)
• granulocytic and monocytic
• 60-80% will obtain remission with treatment
• 30-40% cure rate
Leukemia
 Anemia – weakness, pallor, dyspnea
 Petechiae, spontaneous bleeding
 Infection, - fever, malaise
 Enlarged lymph nodes, liver and spleen
 Abdominal pain, weight loss, anorexia
 Bone pain due to expansion of marrow
Leukemia
Nursing management:
*Supportive therapy – rest, blood transfusion, prevent
infection, promote nutrition, oral hygiene, skin care
*Drug therapy – antileukemia – oncovin, prednisone,
methotrexate (2-3 yrs.)
*Radiation
*Bone marrow transplant
Leukocyte Disorders
 Lymphoma – lymphatic tissue
(lymphocytes)

a. Hodgkin’s – malignant neoplasms of
lymphatic tissue originating in lymph nodes
proliferating to spleen and liver
• Signs and Symptoms – enlarged nontender nodes,
Reed Sternberg cells, pruritus Management –
chemotherapy, radiation
Lymphoma
b. NonHodgkins – tumor originating in
lymphatic tissue characterized by diffuse,
undifferentiated cell; prognosis is poorer
than Hodgkin’s.
Management:
• *chemotherapy
• *radiotherapy and
• *surgery for diagnosis and staging

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Care of Clients with

Earl Francis R. Sumile, RN

a. Hemoglobin – Males13-16 gm/dl

 c. Uric acid – N= 2.5-8.0 mg/dl

 d. Cholesterol – N=150-300 mg/dl

 e. Bilirubin – Total N=0.1-1.0 mg/dl

 Cold sensitivity, pallor

 Brittle nails, and hair

 Plummer-vinsons syndrome – soreness and

inflammation of mouth and tongue (stomatitis

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