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Chapter 35Hematology : 

Chapter 35Hematology Galveston College EMS 2009

Topics : 

2/35 Topics Anatomy, Physiology, and Pathophysiology General Assessment and Management Managing Specific Patient Problems

Hematology : 

3/35 Hematology The study of blood and blood-forming organs Includes study of blood disorders: Red blood cell disorders White blood cell disorders Platelet disorders Coagulation problems

Anatomy, Physiology, and Pathophysiology : 

4/35 Anatomy, Physiology, and Pathophysiology Components Blood, bone marrow, liver, spleen, kidneys Hematopoiesis Pluripotent stem cell Erythropoietin Blood volume

Components of Blood (1 of 6) : 

5/35 Components of Blood (1 of 6) Plasma Water 90–92% by volume Proteins 6–7% by volume Other 2–3% by volume Fats, carbohydrates, electrolytes, gases, and chemical messengers

Components of Blood (2 of 6) : 

6/35 Components of Blood (2 of 6) Red blood cells Hemoglobin Oxygen transport Bohr effect 2,3 DPG Oxygen-hemoglobin dissociation curve

Components of Blood (3 of 6) : 

7/35 Components of Blood (3 of 6) Red blood cells Production Erythropoiesis Hemolysis Sequestration Laboratory analysis of red blood cells Red blood cell count Hematocrit Hemoglobin

Components of Blood (4 of 6) : 

8/35 Components of Blood (4 of 6) White blood cells Margination Phagocytosis White blood cell count

Components of Blood (5 of 6) : 

9/35 Components of Blood (5 of 6) White blood cells Leukopoiesis Granulocytes Neutrophil Basophil Eosinophil Lymphocytes Monocytes

Components of Blood (6 of 6) : 

10/35 Components of Blood (6 of 6) White blood cells Immunity Subpopulation of lymphocytes known as T cells and B cells T cells develop cellular immunity. B cells produce humoral immunity. Autoimmune disease Alterations in the immune process Inflammatory process

Immune Response : 

11/35 Immune Response

Components of Blood : 

12/35 Components of Blood Platelets Megakaryocytes Thrombocytopenia Thrombocytosis

Hemostasis (1 of 3) : 

13/35 Hemostasis (1 of 3) Controlling blood loss Vascular spasms Platelet plugs Stable fibrin blood clots

Hemostasis (2 of 3) : 

14/35 Hemostasis (2 of 3)

Hemostasis (3 of 3) : 

15/35 Hemostasis (3 of 3) Fibrinolysis Thrombosis Fibrinolytics Medications affecting clot formation Alter the enzyme on the platelet Affect the coagulation cascade Enhance clotting

Blood Products and Blood Typing (1 of 2) : 

16/35 Blood Products and Blood Typing (1 of 2) Blood types Antigens A, B, AB, O Universal donors Rh factor © Gaillard/Jerrican/Photo Researchers, Inc.

Blood Products and Blood Typing (2 of 2) : 

17/35 Blood Products and Blood Typing (2 of 2)

Transfusion Reactions (1 of 2) : 

18/35 Transfusion Reactions (1 of 2) Hemolytic reactions Signs and symptoms Facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, fever, chills, and cyanosis Treatment Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringer’s. Consider furosemide, dopamine, and diphenhydramine.

Transfusion Reactions (2 of 2) : 

19/35 Transfusion Reactions (2 of 2) Febrile nonhemolytic reactions Signs and symptoms Headache, fever, and chills Treatment Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or lactated Ringer’s. Consider diphenhydramine and an antipyretic. Observe closely to ensure reaction is nonhemolytic.

General Assessment and Management (1 of 3) : 

20/35 General Assessment and Management (1 of 3) Scene size-up Initial assessment Focused history and physical exam SAMPLE history Hematological disorders are rarely the chief complaint. Physical exam Evaluate nervous system function.

General Assessment and Management (2 of 3) : 

21/35 Physical exam Skin signs Lymphatic signs Gastrointestinal signs Musculoskeletal signs Cardiorespiratory signs Genitourinary signs General Assessment and Management (2 of 3) John Callan/Shout Picture Library

General Assessment and Management (3 of 3) : 

22/35 General Assessment and Management (3 of 3) General treatment guidelines Maintain ABCs. Provide high-flow, high-concentration oxygen or assist ventilations as indicated. Consider volume replacement. Monitor cardiac rhythm and vital signs. Treat rhythm disturbances. Provide reassurance, comfort care, and transport.

Managing Specific Patient Problems : 

23/35 Managing Specific Patient Problems Diseases of the red blood cells Diseases of the white blood cells Diseases of the platelets/blood clotting abnormalities Other hematopoietic disorders

Diseases of the Red Blood Cells (1 of 4) : 

24/35 Diseases of the Red Blood Cells (1 of 4) Anemias Anemia is a sign, not a separate disease process. Signs and symptoms may not be present until the body is stressed. Differentiate chronic anemia from acute episode. Treat signs and symptoms. Maximize oxygenation and limit blood loss. Establish IV therapy if indicated.

Diseases of the Red Blood Cells (2 of 4) : 

25/35 Diseases of the Red Blood Cells (2 of 4)

Diseases of the Red Blood Cells (3 of 4) : 

26/35 Diseases of the Red Blood Cells (3 of 4) Sickle cell disease Sickle cell crises Vaso-occlusive Hematological Infectious Management Follow general treatment guidelines. Consider analgesics.

Diseases of the Red Blood Cells (4 of 4) : 

27/35 Diseases of the Red Blood Cells (4 of 4) Polycythemia Overproduction of erythrocytes Occurs in patients >50 years old or with secondary dehydration Results in bleeding abnormalities Epistaxis, spontaneous bruising, GI bleeding Management Follow general treatment guidelines.

Diseases of the White Blood Cells (1 of 3) : 

28/35 Diseases of the White Blood Cells (1 of 3) Leukopenia/neutropenia Too few white blood cells or neutrophils Follow general treatment guidelines and provide supportive care. Leukocytosis An increase in the number of circulating white blood cells, often due to infection Leukemoid reaction

Diseases of the White Blood Cells (2 of 3) : 

29/35 Diseases of the White Blood Cells (2 of 3) Leukemia Cancer of hematopoietic cells Initial presentation Acutely ill, fatigued, febrile and weak, anemic Often have a secondary infection Management Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection.

Diseases of the White Blood Cells (3 of 3) : 

30/35 Diseases of the White Blood Cells (3 of 3) Lymphomas Cancers of the lymphatic system Presentation Swelling of the lymph nodes Fever, night sweats, anorexia, weight loss, fatigue, and pruritis Management Follow general treatment guidelines. Utilize isolation techniques to limit risk of infection.

Diseases of the Platelets : 

31/35 Diseases of the Platelets Thrombocytosis and Thrombocytopenia Thrombocytosis An abnormal increase in the number of platelets Thrombocytopenia An abnormal decrease in the number of platelets Management Provide supportive care and follow general treatment guidelines.

Blood Clotting Abnormalities (1 of 2) : 

32/35 Blood Clotting Abnormalities (1 of 2) Hemophilia Deficiency or absence of a blood clotting factor Deficiency of factor VIII causes hemophilia A. Deficiency of factor IX causes hemophilia B. Deficiency is a sex-linked, inherited disorder. Defective gene is carried on the X chromosome. Signs and symptoms Numerous bruises, deep muscle bleeding, and joint bleeding

Blood Clotting Abnormalities (2 of 2) : 

33/35 Blood Clotting Abnormalities (2 of 2) Hemophilia Management Treat the patient similarly to others. Administer supplemental oxygen. Establish IV access. Be alert for recurrent or prolonged bleeding, and prevent additional trauma. Von Willebrand’s disease Deficient component of factor VIII Generally results in excessive bleeding Generally is not serious; provide supportive care

Other Hematopoietic Disorders : 

34/35 Other Hematopoietic Disorders Disseminated intravascular coagulation System activation of coagulation cascade Results from sepsis, hypotension, OB complications, severe tissue or brain injury, cancer, and major hemolytic reactions Multiple myeloma Cancerous disorder of plasma cells Pathologic fractures common

Summary : 

35/35 Summary Anatomy, Physiology, and Pathophysiology General Assessment and Management Managing Specific Patient Problems