DISORDERS OF THE BLOOD

Ma. Tosca Cybil A. Torres, RN

POLYCYTHEMIA
An increase in RBC and hemoglobin production It is a compensatory response to chronic hypoxia Hypoxia
Erythropietin production by the kidneys Stimulation of the bone marrow to increase RBC production

POLYCYTHEMIA VERA
Due to HYPERPLASIA of the bone marrow Increased RBC (erythrocytosis); increased WBC (leukocytosis); and increased platelets (thrombocytosis) Cause is unknown; associated with genetics

POLYCYTHEMIA VERA
Increased RBC,WBC and platelets
Blood viscosity organ infiltration capillary over distension

Thromboembolism

Hepatomegaly Splenomegaly Arthalgia Cerebral hypoxia

rupture
hemorrhage

hypovolemia

POLYCYTHEMIA VERA
Clinical Manifestations 1. Ruddy complexion 2. Headache 3. Dizziness 4. Blurred vision 5. Fatigue 6. Hepato-splenomegaly

POLYCYTHEMIA VERA
Management 1. Increase fluid intake 2. Monitor for signs and symptoms of bleeding 3. Monitor for signs and symptoms of thromboembolism (angina, claudication, thrombophlebitis, pruritus) 4. Administer analgesic as ordered 5. Therapeutic phlebotomy 6. Chemotherapy 7. Radiation therapy (Na phosphate/IV) 8. Avoid high altitude

ANEMIA
Decrease availability of oxygen to the tissues Types: a. Iron deficiency Anemia b. Folate Deficiency Anemia c. Aplastic Anemia d. Pernicious Anemia

ANEMIA
Causes: 1. Acute/Chronic blood loss 2. Inadequate dietary intake of vitamins and minerals needed for RBC production 3. Decreased RBC production by the bone marrow 4. Increased destruction of RBC 5. Increased demands of vitamins/ minerals needed for RBC production

ANEMIA
Common Clinical Manifestations 1. Pallor 2. Easy fatigability 3. weakness 4. Anorexia/weight loss 5. SOB 6. Headache/dizziness/syncope 7. Tachycardia/palpitations 8. brittle hair/nails 9. Paresthesia 10. Cold sensitivity

IRON DEFICIENCY ANEMIA

Microcytic, hypochromic anemia S/Sx: a. Vinson-Plummers Syndrome (stomatitis, dysphagia) b. atrophic glossitis (smooth, sore tongue) c. Cheilosis (dry scaling of the lips and mouth) d. Koilonychia (thin and concave fingernails with raise edges) e. Pica (clay, laundry starch, ice) f. tinnitus g. Hgb -7.5 mg/dl; increased PR, SOB, CHF

IRON DEFICIENCY ANEMIA

Management 1. Iron Supplement a. Oral (Fe SO4, Fe gluconate, Fe fumarate) b. Parenteral: Iron Dextran (Imferon) Nursing Intervention: a. Oral Fe should be given p.c b. Oral Fe to be administered with straw c. Vit. C increase fe absorption d. Dont administer with antacids and milk e. Imferon: Z-track deep IM; do not massage site of injxn f. Iron salts change color of stool to dark green or back 2. O2 therapy 3. BT as needed

IRON DEFICIENCY ANEMIA

Nursing Management 1. Promote rest 2. Provide good oral care 3. Provide good skin care 4. Diet: Iron-rich foods (organ meats, beans, green leafy vegs, raisins)

FOLATE DEFICIENCY ANEMIA/ MEGALOBLASTIC ANEMIA

Causes: 1. Poor dietary intake 2. Rarely eat uncooked fruits and vegetables 3. Alcoholism 4. Chronic malnutrition 5. Pregnancy 6. Anorexia Nervosa 7. Malabsorption 8. Malignancy 9. Prolonged TPN 10. Chronic hemodialysis

FOLATE DEFICIENCY ANEMIA/ MEGALOBLASTIC ANEMIA

Manifestations: 1. Cracked lips, sore tongue 2. s/sx of pernicious anemia
Management: 1. well-balanced diet 2. Folic acid 1 mg/day

PERNICIOUS ANEMIA
Macrocytic, hyperchromic anemia Causes: gastric surgery; crohns disease
Decrease intrinsic factor production decrease vit B12 absorption Decrease RBC production Decrease DNA synthesis in maturing RBC (megaloblastic cells) Impairment of integrity of cells (mouth, stomach, anus, vagina, axon of neurons)

PERNICIOUS ANEMIA
1. Diagnostic tests: Tubeless Gastric Analysis Diagnex blue/Azuressin tablet Collect urine specimen

(+)blue

(-) blue

HCl is present

(-) HCl (Achlorhydria)

(-) Pernicious anemia

(+) Pernicious anemia

PERNICIOUS ANEMIA
2. Schillings Test Most definitive diagnostic test Oral radioactive Vit B12 followed by IM nonradioactive Vit. B12 Collect 24-hour specimen Decreased excretion of Vit. B12 in the urine (+) Pernicious anemia

PERNICIOUS ANEMIA
Clinical Manifestations 1. Beefy red inflamed tongue 2. Achlorhydria 3. Tingling, numbness 4. Lack of balance, uncoordinated movements 5. Confusion 6. Paralysis 7. Depression, psychosis 8. Jaundice (faulty erythropoiesis)

PERNICIOUS ANEMIA
Management: 1. Vit. B12 IM 7 days (daily) 10 weeks (weekly) lifetime (100mg/mo.) monthly 2. HCl p.o for 1 week 3. Iron therapy 4. BT as needed 5. PE every 6 months * Patient is at risk for Gastric cancer

APLASTIC ANEMIA

1. 2. 3. 4. 5. 6.

Hypoplasia of the bone marrow causing pancytopenia Fat replaces bone marrow Causes Congenital Acquired Idiopathic Infections Medications Heavy metals

APLASTIC ANEMIA
Diagnostic Tests: Bone marrow aspiration/biopsy Adults (post. Iliac crest); prone position; brief sharp pain Child (tibia) ; side lying position Medical Management Immunosuppressive therapy (ATG) central line for 7-10 days BT prn Stool softener: high fiber diet

APLASTIC ANEMIA
Nursing Interventions 1. Assess for signs and symptoms of infection, tissue hypoxia and bleeding 2. Frequent rest periods 3. Good oral care 4. Use soft-bristled toothbrush 5. Male clients use electric razor 6. Dont give ASA (aspirin) 7. Reverse/protective isolation 8. Practice asepsis 9. No fresh fruits/fresh flowers in the patients unit 10. Limit visitors 11. Dont allow persons with s/sx of infection to visit

LEUKEMIA
1. 2. 3. 4. 5. Chronic or acute neoplasm of blood-forming cells in the bone marrow and lymph nodes where there is proliferation of abnormal WBCs that do not mature beyond the blast phase In the bone marrow , blast cells crowd out healthy WBCs, RBCs, and platelets, leading to bone marrow depression. Blast cells also infiltrate other organs, most commonly the liver, spleen, kidneys and lymph tissues. Most common form of child cancer Causes: Idiopathic Viral Genetic Radiation Chemicals

LEUKEMIA
Types: 1. Acute Myelogenous Leukemia (AML) Malignant disorder that affects monocytes, granulocytes, erythrocytes and platelets Survival 1-3 years (with chemotherapy); 2-5 months (if untreated) 2. Chronic Myelogenous Leukemia (CML) Malignancy of the myeloid stem cells that leads to uncontrolled proliferation of granulocytes. Survival: 3-5 years (if without BMT)

LEUKEMIA
3. Acute Lymphocytic Leukemia (ALL) Malignant proliferation of lymphoblasts arising from a disorder of a single lymphoid stem cell. 80-85% of childhood leukemia Survival : 5 years (with chemotherapy and radiation therapy) 50% can be cured 4. Chronic Lymphocytic Leukemia (CLL) Caused by a proliferation of small, abnormal B lymphocytes Survival: 5-7 years

LEUKEMIA
Proliferation of Immature WBCs
Immunocompromised state Decreased production of RBCs and platelets Hypertrophy of the bone marrow Organ infiltration Bone pain, hepatosplenomegaly, renal insufficiency, hyperuricemia, increase ICP (meningeal irritation)

LEUKEMIA
Clinical Manifestations 1. Anemia due to decreased production of RBCs; weakness, pallor, dyspnea 2. Bleeding due to decreased platelet production, petechiae, spontaneous bleeding and ecchymosis 3. Infection due to decreased WBC production, fever, malaise 4. Enlarged lymph nodes 5. Enlarged spleen and liver 6. Abdominal pain with weight loss and anorexia 7. Bone pain due to expansion of marrow

LEUKEMIA
Management 1. Chemotherapy 2. BMT 3. BT Nursing Interventions 1. Protect from infection a. reverse/protective isolation b. Practice asepsis c. Limit visitors d. Dont allow people with injections to visit 2. Prevent trauma a. Minimize parenteral injxn b. Use small gauge needle c. apply pressure at injection site for 5 minutes d. Support/handle body parts gently e. Use soft-bristled toothbrush f. Use electric razor g. dont administer ASA

LEUKEMIA
3. Conserve energy/increase oxygen supply a. adequate rest b. O2 supplementation

HODGKINS LYMPHOMA
Malignant noplasm of lymph tissue, usually originating in localized group of lymph nodes; a proliferation of lymphocytes Metastasizes first to adjacent lymph nodes Cause is unknown Most prevalent in adolescents; accounts for 5% of all maliganancies Prognosis now greatly improved for these children; influenced by stage of disease and histologic type Long term effects include increased incidence of 2nd malignancy; especially leukemia and infertility

HODGKINS LYMPHOMA
Clinical manifestations 1. Major presenting symptom is enlarged nodes in low cervical region; nodes are nontender, firm and movable 2. Recurrent intermittent fever 3. Night sweats 4. Weight loss, malaise, lethargy 5. Pruritus 6. Diagnostic test: presence of Reed-Sternberg cells

HODGKINS DISEASE
Medical Management 1. Radiation therapy 2. Chemotherapy 3. Supportive care Nursing Intervention 1. Provide care for child receiving radiation therapy. 2. Administer chemotherapy as ordered and monitor or alleviate side effects. 3. Protect client from infection, especially if splenectomy is performed. 4. Provide support for child/parents; specific needs of adolescent client must be considered.

NON-HODGKINS LYMPHOMA
Tumor originating in lymphatic tissue Significantly different from Hodgkins lymphoma : a. control of primary tumor is difficult b. Disease is diffuse, cell type undifferentiated c. Tumor disseminates early d. Includes wide range of disease entities: lymphosarcoma, Burkitts lymphoma primary sites include GIT, ovaries, testes, bone, CNS, liver, breast. Affects all age groups

NON-HODGKINS LYMPHOMA
Clinical Manifestations: 1. Depend on anatomic site and extent of involvement 2. Rapid onset and progression 3. May have advanced disease at diagnosis

NON-HODGKINS LYMPHOMA
Medical Management: 1. Chemotherapy: multiagent regimens including cyclophosphamide (Cytoxan), vincristine, prednisone, procarbazine, doxorubicin, bleomycin 2. Radiation therapy: primary treatment in localized disease 3. Surgery for diagnosis and clinical staging
Nursing Interventions 1. Provide care for child receiving chemotherapy, radiation therapy, and surgery