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Objectives
Describe physiology of blood components Discuss pathophysiology and signs and symptoms of specific hematological disorders Outline general assessment and management of patients with hematological disorders
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Scenario
You are called to a day camp on a sweltering summer day to care for a child who fainted. Your 6year-old patients lips and nail beds appear pale against her bronze skin. Her respirations and heart rate are rapid, and she is very anxious. She has a history of sickle cell disease and is complaining of severe abdominal pain. Counselors tell you they had just finished a strenuous game when she complained of a headache and then passed out.
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Discussion
Based on your present information, discuss the urgency of this call What complications of her disease could cause her present illness? What additional assessments do you need to perform? What are your priorities of care for this child?
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Hematological System
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Red blood cells (erythrocytes) White blood cells (leukocytes) Cell fragments (platelets)
Surrounded by plasma
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Chief functions
Delivery of substances needed for cellular metabolism in tissues Defense against invading microorganisms and injury Acid-base balance
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AdultsRed marrow in membranous bone Vertebrae Pelvis Sternum Ribs Yellow marrow produces some white cells Composed mainly of connective tissue and fat
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Lymph nodes
Spleen
Liver
Plasma
Albumin Most plentiful Gives blood gummy texture Keeps water concentration of blood low so that water
diffuses from tissues into blood
Plasma
Maintain blood pH Transport fat-soluble vitamins, hormones, and carbohydrates Allow body to digest temporarily for food
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As cells age: Internal chemical machinery weakens Lose elasticity Become trapped in small blood vessels in bone marrow,
liver, and spleen
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Mature Erythrocytes
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Hematocrit (Hct)
Reticulocyte count
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Hemoglobin Molecule
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5000-10,000 cells/mm3 Monocytes: 5% Increase with chronic infections Lymphocytes: 27.5% Neutrophils: 65% Eosinophils and basophils together: 2.5%
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Leukocyte disorders
Leukemia Increased WBCs in tissues and/or blood Leukocytosis Abnormal increase in circulating WBCs Leukopenia Abnormal decrease in WBCs
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Redness, heat, swelling, pain Injured cells release histamine and other substances:
Cause blood vessels in injured tissue to dilate Increased blood flow carries neutrophils and monocytes (phagocytic cells) to site of injury
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Immunity
Autoimmune diseases
Alterations in immunologic response
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Platelets (Thrombocytes)
Platelets to site, swell into irregular shapes Adhere to damaged vessel wall Platelets plug leak; cells stick to them, forming clot If vessel damage is too great, platelets signal clotting cascade
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Platelets
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Blood Groups
Mixed with foreign plasma, red blood cells either clump together or do not Four types of human blood
A, B, AB, and O Type A blood has anti-B antibodies Will clump type B blood Type B blood has anti-A antibodies Will clump type A blood
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Blood Groups
Universal recipient
Rh Factor
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Hemostasis
Anemia
Chronic or acute blood loss Decreased production of erythrocytes Increased destruction of erythrocytes
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Iron-Deficiency Anemia
Lack of iron inhibits hemoglobin production in bone marrow Cells small and pale centered Reduced oxygen-carrying capacity
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Iron-Deficiency Anemia
Causes
Diet low in iron Vitamin deficiency NSAID or ASA therapy GI disorders Bleeding (internal or external) Gastrectomy
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Hemolytic Anemia
Hemolysis
Acquired disorder
Fatigue and headaches Sore mouth or tongue Brittle nails Severe - breathlessness and chest pain Fever Skin or mucous membrane bleeding
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Anemia
Diagnosis
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Leukemia
Several types of cancer Disorganized proliferation of WBCs in bone marrow Impairs normal RBC production
Acute or chronic
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Fatigue Bone pain Elevated temperature Diaphoresis Heat intolerance Abdominal fullness Bleeding
Bruising Headache Weight loss Night sweats Enlarged lymph nodes Enlarged spleen, testes, liver
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Leukemia
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Lymphomas
Group of diseases Slowly growing chronic disorders to rapidly evolving, acute conditions Hodgkins disease
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Hodgkins Disease
Hodgkins Disease
Fatigue
Chills Night sweats Itching, cough, weight loss Shortness of breath, chest pain Peak incidence in 20s
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Hodgkins Disease
Radiation Chemotherapy
Curable cancer
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Non-Hodgkins Lymphomas
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Non-Hodgkins Lymphomas
Treatment
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Polycythemia
Excess production of RBCs, WBCs, and platelets Response to hypoxia (secondary polycythemia) Unknown reasons (primary polycythemia)
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Polycythemia Vera
Increased RBC production Headache, dizziness Blurred vision Itching Red hands/feet; red-purple complexion Hypertension Splenomegaly
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DIC
Free thrombin in blood, fibrin deposits, aggregation of platelets Hemorrhage from depletion of clotting factors
Management
Hemophilia
Tooth extraction
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Hemophilia
Joints, deep muscles, urinary tract, and intracranial sites most common
Controlled by infusions of factor VIII Most hemophiliacs seek emergency care for complicated problems and trauma
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Weakness Aching
Fever
Joint pain
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Triggered by:
Dehydration Stress Infection Trauma Exposure to temperature extremes Lack of oxygen Strenuous physical activity
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Management
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Multiple Myeloma
Results in:
Multiple Myeloma
Diagnosed by:
Treatment
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Oxygen IV Analgesia Other symptomatic care Transport to hospital, where patient receives primary care if possible
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Conclusion
The paramedics knowledge of hematologic diseases enhances assessment skills and provides an understanding of treatment strategies needed for these patients.
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Questions?
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