Hematology
Tutoring
Brooke Marcy, Drew Barricklow, Mallory Snider
Locations of Bone Marrow
•Sternum
•Iliac Crest (least fragile)
•End of Long Bones
When aspirating bone marrow, it is usually done in the
iliac crest and sternum. Why? Because it is less painful
and the chance of infection is low.
- Make sure to pre-medicate before aspiration
RBC Numbers
•Memorize 4-6 million RBCs / microliter is normal for both
men and women together (don't worry about specific
numbers/decimals)
•Normal Hemoglobin is 12-16 g/dL
•Normal Hematocrit is 35-50%
•**Keep in mind unit of measurement
*Fun fact: Vitamin B12 helps make Hgb*
•MCV (Mean Corpuscular Volume): average VOLUME -> size of RBC
•Normal is 80-100fL
•Patients with iron deficiency anemia have LOW MCV (why?)
•MCH (Mean Corpuscular Hgb): average amount of HEMOGLOBIN ->
weight
•Normal is 27-34pG
•MCHC (Mean Corpuscular Hgb Concentration): % of Hgb within a
single RBC -> CONCENTRATION
•Normal is 32-36%
•What would affect these values???
LEUKOCYTES
•WBC 5,000-10,000
•Neutrophils: 2,500-8,000
•Neutropenic precautions !!!! When WBC <4,000 and neutrophil <1,000
Frequent hand washing
Private room (Isolation precautions-negative airflow)
Limit visitors
REMOVE FRESH FRUITS (or steam first)// VEGGIES//FRESH FLOWERS
FREQUENT TEMPERATURE CHECKS (for infection)
•When a patient has an infection this increases their WBC count = which releases
lots of IMMATURE WBC which means A SHIFT TO THE LEFT <----------- (their
immune system counteracts the infection by releasing these immature WBC)
•A shift to the right occurs when lots of OLD AND MATURE WBCs are left in
circulation due to autoimmune diseases, chronic inflammation, and low WBC
production (Immune system is worn out)
The Spleen
•Filters out old RBCs
•Contains/releases lymphocytes and monocytes
•Watch for low WBCs after removal of spleen
•Takes up 30% of platelets for itself
•After removal of the spleen, watch for a temporary sharp increase
in blood platelets because that 30% now has nowhere to go
*Neutropenic precautions for 3-6 months after splenectomy*
Platelets (150,000-400,000)
•Thrombocytopenia: When it is less than 150,000
•CRITICAL AT <50,000, and >1 million!!!
•When a patient is at less than 50,000 they have NO
clotting factors!!! Highly at risk for hemorrhaging and
bleeding out!!! Need to carefully move the patient and
try not to bump them!
Disseminated intravascular coagulation: Patient is
bleeding and clotting at the same time=death sentence
•When they are over 1 million they are FORMING
CLOTS !!
Labs
•ESR: measure of how long red blood cells take to settle in a test tube
•should be less than 30
•High ESR means there is inflammation somewhere in the body
•Healthy RBCs float, damaged ones sink (pool tube example)
•Serum Iron: Iron+Proteins
•TIBC: proteins available to bind with iron
•Ferritin: 1st line iron storage protein
•Transferrin: giant protein that also binds with iron, not as well as ferritin
Iron* * * * * * * * * * * * * * *Iron* * * * * * * * * * * * * * * * *Iron
Ferratin* * * * * * * * * * * *TIBC* * * * * * * * * * * * * * *
Transferrin Ability
Clotting Evaluation
•Prothrombin Time (PT): 11-16 seconds.
- Measures Coumadin/Warfarin
•Activated Partial Thromboplastin Time: (aPTT): 25-30
seconds
- Measures Heparin
•International Normalized Ratio:2-3 (this is nationally
standardized)
- Measures Coumadin/Warfarin
*These times are without any drugs*
How do you know if an anti-platelet/clotting drug is
effective?
Hemophilia
•Hereditary bleeding disorder=A type: classic, Factor VIII
(8) Most cases is this*
•"Christmas disease": Factor IX
•Von Willebrand Disease: congenital disease
•*More common in males due to X-linked genetics
Medical Management of
Hemophilia:
•Replace clotting factor !! VIII or IX
•NO aspirin
•Monitor for bleeding precautions (head/joints)
•Minor bleeds: trx for 72 hours
•Surgeries: trx for 10-14 days
*treat w/ infusion of clotting factors*
•DDAVP: synthetic vasopressin (clotting factor). Works for factor
VIII or Von Willebrand, but not for factor X.
Anemia
•Iron deficiency: due to not eating enough iron or having a GI
problem
•Most common type of anemia
•Fix underlying problem
•Pallor, fatigue, headache, chapped lips (chelitis)
•Common in alcoholics because GI tract is destroyed
•Give iron (PO, IM, IV)
•Give with vitamin C!!
•NOT milk or soda
Thalassemia
A genetic disorder
•Inadequate production of hemoglobin
•Causes buildup of iron in the blood because of lack of Hgb to bind
with it
•Minor: triggered in old age
•Major: present at birth, sometimes fatal
•Keep Hgb around 10g/dL to allow body to keep making it
on its own
•Always check iron levels and give iron binding drugs to
prevent too much free iron
Cobalamin Deficiency/Pernicious
Anemia
•Cobalamin deficiency= lack of B12 for whatever reason
•Pernicious anemia means lack of INTRINSIC FACTOR
•Due to damage or disease of GI tract
•Since giving B12 orally will be useless, must give IM injections or
nasal spray
•Sometimes will see neuro symptoms such as parasthesia,
weakness, confusion
•Give 1000 ug or B12 IM daily for 2 weeks, then monthly ($$$)
Folic Acid Deficiency
Ask Mrs. Rivera
•Typically due to poor diet
•Pregnant women MUST have enough folic acid to prevent spina
bifida in baby
•Oral contraceptives/seizure drugscan decrease folic acid
absorption
•Common in alcoholics due to GI trauma
•Fix with diet first:
•Kale, spinach, brussels sprouts
Aplastic Anemia
•Life-threatening stem cell disorder that can result in
pancytopenia
•Causes: acquired (disease trx, pregnancy, idiopathic) and
congenital
•Leads to increased risk of infection, fatigue, and dyspnea
- Why?
•Can also cause thrombocytopenia
Sickle Cell Anemia
Genetic Disorder
•Mutated Hgb causes crescent shaped RBCs
•High occurrence in the African American population
Genetics:
•Autosomal recessive: If both parents are carriers of the
trait, there is a 25% chance of having a kid with SCA.
Sickle Cell Anemia Cont.
•Can result in a crisis: Mutated Hgb cannot bind to oxygen causing
the cell to be abnormally shaped. This leads to small vessel
occlusion which causes pain (due to ischemia causing lactic acid
buildup)and possibly tissue death.
Nursing Management:
•Avoid stressors (things that increase oxygen needs)
•Avoid dehydration
•Pain is controlled by large doses of narcotics (Morphine) during a
crisis
•Wound healing is slowed. Treat wounds carefully and with more
oxygen (Hyperbaric chambers)
