Anda di halaman 1dari 16

POLYCYTHEMIA

(Primary & Secondary)


7/20/2014 2
Definition of POLYCYTHEMIA
It is the production and presence of
increased numbers of RBCs. The increase
in RBCs can be so great that blood
circulation is impaired as a result of
hyperviscosity and hypervolemia.

Etiology &
Pathophysiology
Types of Polycythemia:
1. Primary Polycythemia/Polycythemia Vera
2. Secondary Polycythemia

7/20/2014 3
Primary Polycythemia
Or Polycythemia Vera also known as
erythremia.
Myeloproliferative disorder
develops in clients > 50 y/o
Splenomegaly
7/20/2014 4
Secondary Polycythemia
Causes chronic hypoxia

7/20/2014 5
Clinical Manifestations and
Complications

HPN
Subjective complaints: Headache, vertigo,
dizziness, tinnitus and visual
disturbances.
experience angina, CHF, intermittent
claudication and thrombophlebitis
Stroke
Generalized pruritus
7/20/2014 6
Hemmorhage
ecchymoses, epistaxis or GI bleeding
Splenomegaly and hepatomegaly-
complaints of satiety and fullness
experience pain from peptic ulcer
Plethora
Hyperuricemia

7/20/2014 7
Diagnostic Studies

1. Elevated hgb and RBC count;
2. Elevated WBC count with basophilia;
3. Elevated platelets (thrombocytosis) and
platelet dysfunction;
4. Elevated leukocyte alkaline phosphatase,
uric acid and cobalamin levels; and
5. Elevated histamine levels. Splenomegaly
is found in 90% clients with primary
polycythemia but does not accompany
secondary polycythemia.

7/20/2014 8
Collaborative Care

Phlebotomy
Hydration therapy
Myelosuppressive agents (busulfan
(Myleran), hydroxyurea (Hydrea))
Allopurinol (Purinol)
Antiplatelet agents (aspirin and
dipyridamole (Persantine))
7/20/2014 9
Nursing Management :
Polycythemia Vera

maintaining adequate oxygenation may
prevent problems
controlling chronic pulmonary disease,
stopping smoking, and avoiding high
altitudes
the nurse may either assist with or perform
the phlebotomy
Fluid intake and output must be evaluated
7/20/2014 10
myelosuppressive agents are used,
observe the client, and teach the client
about the med side effect.
Assessments of the clients nutritional
status
Activities
Active or passive leg exercises and
ambulation
Phlebotomy may need to be done every 2
or 3 months
nurse must evaluate the client for the
development of complications.

7/20/2014 11
Problems of Hemostasis

The homoestatic process involves the
vascular endothelium, platelets and
coagulation factors, which normally
function together to arrest hemorrhage
and repair vascular injury. Disruption in
any of these components may result in
bleeding or thrombotic disorders.

7/20/2014 12
3 major disorders of hemostasis:

Thrombocytopenia (low platelet count)
Hemophilia and von Willebrands disease
(inherited disorders of specific clotting
factors) and
Disseminated intravascular coagulation
(DIC).

7/20/2014 13

7/20/2014 14

7/20/2014 15

7/20/2014 16