LECTURE BY: Asst. Prof. Margaret M. Natividad, Ed.D.

, RN CARE OF CLIENT WITH HEMATOLOGIC CONDITION

HEMATOLOGIC SYSTEM NOTE:

● The blood and the blood forming sites, including the bone ● Thrombocytosis - increase in platelets → can lead to
marrow and the reticuloendothelial system thrombus clots (platelets are coagulants that cause
clotting)
BLOOD COMPONENTS
1. Plasma - the fluid ERYTHROCYTE INDICES
2. Blood Cells ● MCV
a. Leukocyte: WBC→ 5-10,000/cu.mm. (or 6-11,000) ● MCH
● Granular and agranular leukocytes ● MCHC
○ Leukocytes Eosinophil
○
COAGULATION STUDIES
○ Neutrophil Basophil
○
○ Monocyte Lymphocyte:
○ Bleeding time 3-8 mins
T-lymphocyte and
Prothrombin time (PT) 11-16 secs
B-lymphocyte
Clotting time 9-12 mins
b. Erythrocyte: RBC → 4-6 million; most numerous
c. Thrombocyte: Platelets → 150,000-450,000
● You need Prothrombin to form the fibrin for the clot to form
● Blood cells are always assessed when a patient is
● Prolonged PT (e.g. liver cirrhosis) → less time to clot → prone
confined especially if they will undergo surgery
to bleeding
because there may be some blood disorder
○ Complete Blood Count - to assess and BONE MARROW ASPIRATION
diagnose hematologic/blood disorders ● To diagnose blood dyscrasias
HEMATOPOIESIS
● Tests different blood cells
● For bone marrow pathology
● Hematopoiesis - production of blood cells in the red bone
● Important test for bone marrow cancer, multiple myeloma,
marrow esp. RBC
leukemia
○ Erythropoietin - an enzyme produced by the kidney;
stimulates hematopoiesis and specifically helps in ANEMIA
erythropoiesis ● Lower-than-normal hemoglobin or erythrocytes are signs of
○ Erythropoiesis - production of RBC an underlying disorder
● Common blood disorder: Anemia (caused by a lot of factors) ● Decreased availability of oxygen to the tissues
● A patient with chronic renal failure may experience anemia
● Anemia can also be a sign of cancer (early sign)
○ Epogen or Epoetin - mimics erythropoietin; injected
○ Due to blood loss secondary to a malignancy (internal,
subcutaneously’ very expensive, usual administration is
colon or abdominal organ malignancy)
once a week
○ Chronic bleeding
Laboratory and Diagnostic Tests ○ Some bleeding cannot be actually seen (e.g. some blood
spills in the GI → occult (hidden) blood → loss of blood
COMPLETE BLOOD COUNT → anemia)
RBC 4-5.5 M / cu.mm ● Hypoproliferative: defect in production of RBCs
WBC 5,000 -10,000 / cu. mm ○ Due to iron, vit. B12 (cyanocobalamin) or folate
deficiency, decreased erythropoietin production (due to
Platelets 150,000-450,000 / cu. mm
renal failure) and cancer
Hgb 12-17 g/dL ○ Vit B12 helps in maturation of the RBC; absorbed by the
Hct 38-52 vol. % intrinsic factors, produced by parietal cells
DIFFERENTIAL COUNT ○ Decreased intrinsic factors (may be due to parietal cell
loss, gastric cancer or exogenous sources causing
Neutrophils 60-70%
changes in stomach) → Vit B12 can’t be absorbed →
Eosinophils 0-5% RBC won’t mature → pernicious anemia (lack of Vit B12)
Basophils 0-3% → give vitamin B12 (lifetime)
Lymphocytes 30-40% ● Hemolytic: excess destruction of RBCs
Monocytes 0-5% ○ Due to altered erythropoiesis, or other causes such as
hypersplenism (spleen as the site of destruction),
drug-induced or autoimmune hemolytic processes,
Blood Component Increased Decreased
mechanical heart valves
RBC Polycythemia Anemia ○ Destruction of RBC → heme and globin (separation) →
WBC Leukocytosis Leukopenia release of bilirubin → prone to Hyperbilirubinemia →
Platelet Thrombocytosis Thrombocytopenia jaundice (skin or eye sclera)

1 FRIAS | SACRAMENTO | SALUD | SAMANIEGO | SANTOS, A | SANTOS, C | SANTOS, R | SANTOS, Z | SANZ | SAPALO | SAPITAN | SAUL | SERRANO | SIENA | SILANGCRUZ | SOLLANO | SORIANO | SUMABAT
LECTURE BY: Asst. Prof. Margaret M. Natividad, Ed.D., RN CARE OF CLIENT WITH HEMATOLOGIC CONDITION

■ Not all jaundice is associated with liver disease; can

COMMON CLINICAL MANIFESTATIONS
also be due to blood transfusion mismatch
● Pallor ● Tachycardia / Palpitations
○ Can be caused by blood transfusion: when the nurse
● Easy fatigability ● Syncope - may faint in severe
gives mismatched blood
● Weakness cases
○ Blood transfusion → can cause destruction of RBC due
● Anorexia ● Brittle hair and nails
to blood mismatch
● Weight loss ● Paresthesia
○ Universal recipient: AB
○ Universal donor: O ● SOB ● Cold sensitivity
○ RH positive (+) is dominant, very few has RH negative ● Headache / Dizziness ● Amenorrhea
● May also be due to blood loss
○ Usually in surgeries Iron Deficiency Anemia
○ Extreme blood loss secondary to trauma, cesarians and ● Microcytic, hypochromic anemia
surgery → fresh whole blood ASSESSMENT
○ Anemia → packed RBC ● Vinson - Plummer’s Syndrome (SAD)
○ Hemophilia → cryoprecipitate (contains clotting factors ○ Stomatitis
8 & 9) ○ Atrophic glossitis (smooth, sore tongue)
■ Carrier is the mother → affects the son
○ Dysphagia
■ Common in males
● Cheilosis
MANIFESTATIONS ● Pica (clay, laundry starch, ice)
● Fatigue, weakness, and malaise - in all kinds of anemia ● Tinnitus
● Pallor ● Cardiovascular symptoms (Hgb = 7.5 g/dl)
● Cardiac and respiratory symptoms ○ Increased PR, chest pain, SOB, CHF
○ DOB / SOB - difficulty of breathing/shortness of breath ○ Palpitations, tachycardia, may lead to cardiac problems
○ Has inadequate oxygen → altered tissue perfusion
MEDICAL MANAGEMENT
because of the decreased RBC delivery
1. Iron Supplement
● Tongue changes - glossitis
● Oral
● Nail changes
○ Ferrous Sulfate
● Angular cheilosis (changes in lips and the tongue)
○ Ferrous Gluconate
● Pica - eating/craving non-food
○ Ferrous Fumarate
NOTE: NOTE: Stool becomes black - normal
● Nursing diagnosis: Activity intolerance ● Parenteral: Iron Dextran (Imferon)
○ Due to the main manifestation: fatigue ○ In severe cases
● Goal: to increase RBC by providing what is lacking ○ Oral iron should be given p.c.
○ Oral liquid iron to be administered with straw - to
KINDS OF ANEMIA
prevent staining of the teeth
● Iron deficiency anemia
○ Vitamin C increases iron absorption
● Folate deficiency anemia
○ Don’t administer with milk, antacid
● Aplastic anemia (Pancytopenia)
○ Imferon: Z-track (deep IM)
○ Cell production insufficiency
■ Do not massage to prevent leakage, staining
○ Hypoplasia of the bone marrow → pancytopenia (all
and drug stays in the tissue only
blood cells are decreased)
○ Iron salts change color of stool to dark green or
■ No cell will cause oxygenation, clotting and
protection from infection black
■ Just like leukemia’s manifestations 2. Oxygen therapy for patients with difficulty of breathing
● Pernicious anemia - lack of vit. B12 3. Blood transfusion as needed
● Hemolytic anemia - hemolysis; excess destruction of RBCs NOTE: If symptoms persist, consult doctor. If hemoglobin or RBC
levels are very low, BT may be given to prepare patients for
CAUSES OF ANEMIA
surgery
● Acute / chronic blood loss - trauma or surgery
● Inadequate dietary intake of vitamins / minerals needed for NURSING INTERVENTIONS
RBC production ● Promote rest - if fatigued; rest in between activities
● Decreased RBC production by the bone marrow (hypoplasia ● Provide good oral care - for the tongue, mouth and lips
of the bone marrow) ● Provide good skin care
● Increased destruction of RBC ● Diet: Iron - rich foods
● Increased demands of vitamins/minerals needed for RBC ○ Organ meats ○ Green, leafy vegetables
production ○ Beans ○ Raisins

2 FRIAS | SACRAMENTO | SALUD | SAMANIEGO | SANTOS, A | SANTOS, C | SANTOS, R | SANTOS, Z | SANZ | SAPALO | SAPITAN | SAUL | SERRANO | SIENA | SILANGCRUZ | SOLLANO | SORIANO | SUMABAT
LECTURE BY: Asst. Prof. Margaret M. Natividad, Ed.D., RN CARE OF CLIENT WITH HEMATOLOGIC CONDITION

Folate Deficiency ● Urine Specimen Test- to test for the presence hydrochloric
acid
CAUSES
○ Parietal cells secrete hydrochloric acid and intrinsic
● Poor dietary intake
factor
● Rarely eat uncooked (raw) fruits and vegetables
○ No presence of hydrochloric acid = parietal cells are not
● Alcoholism
secreting at all
● Chronic Malnutrition
● Schilling’s Test
● Pregnancy
○ Most definitive diagnostic test
● Anorexia nervosa - not eating enough
○ Oral radioactive Vitamin B12
● Malabsorption
○ IM nonradioactive Vitamin B12
● Malignancy
○ Collect 24-hour urine specimen
● Prolonged TPN
○ Decreased excretion of Vitamin B12 in the urine
● Chronic hemodialysis
○ (+) Pernicious Anemia
ASSESSMENT
● Cracked lips MANIFESTATIONS
● Sore tongue ● Beefy red, inflamed tongue
● Same as pernicious anemia ● Neurologic manifestation → paresthesia (tingling sensation,
numbness; may be due to alteration in the nerve integrity
COLLABORATIVE MANAGEMENT
caused by vit B12 deficiency)
● Well-balanced diet
● Folic acid 1 mg/day MANAGEMENT
● Vitamin B12 IM
Pernicious Anemia
○ Daily = 7 days
● Macrocytic, hyperchromic anemia ○ Weekly = 10 weeks
CAUSES ○ Monthly - LIFETIME 100 mg/Mo - esp after gastrectomy
● Gastric Surgery because parietal cells are removed
● Crohn’s Disease - inflammatory bowel disease → inability to ● Hydrochloric acid p.o. for 1 week
absorb vit B12 ○ Achlorhydria - decreased HCl due to low intrinsic factor;
can lead to gastric cancer
PATHOPHYSIOLOGY
● Iron therapy
● Blood transfusion as needed
● Physical examination every six months
● At risk for Gastric Cancer

Aplastic Anemia (Pancytopenia)

● Hypoplasia of the bone marrow
○ The bone marrow is not producing adequate RBC
● Due to lack of intrinsic factor (released by parietal cells in the ● Fat replaces bone marrow
stomach) → decrease vit B12 absorption → decrease ● PANCYTOPENIA - all blood cells are down → manifestations
maturation of RBC of blood deficiency are present (similar to leukemia)
● Megaloblastic anemia (due to the formation of megaloblastic ○ Anemia - fatigue
cells) → impairment on the integrity of the cells in the GI ○ Leukopenia - risk for infection
tract and nervous system (vit B12 is good for the nerve so it ○ Thrombocytopenia - bleeding
affects the neural or axons of neuron)
CAUSES
○ Can be caused by anything that decreases parietal
cells like gastric surgery ● Congenital
● One of the complications of gastrectomy is pernicious ● Acquired
anemia → given Vit B12 via IM ● Idiopathic - unknown cause; usually autoimmune → you
cannot cure it, the management is symptomatic
DIAGNOSTIC TEST ● Infections
● Tubeless Gastric Analysis ● Medications
● Heavy metals
● Hepatitis
● Chemotherapy and radiotherapy - affect the rapid dividing
cells → all blood cells are down after management →
fatigue, risk for infection, immunocompromised, bleeding

3 FRIAS | SACRAMENTO | SALUD | SAMANIEGO | SANTOS, A | SANTOS, C | SANTOS, R | SANTOS, Z | SANZ | SAPALO | SAPITAN | SAUL | SERRANO | SIENA | SILANGCRUZ | SOLLANO | SORIANO | SUMABAT
LECTURE BY: Asst. Prof. Margaret M. Natividad, Ed.D., RN CARE OF CLIENT WITH HEMATOLOGIC CONDITION

DIAGNOSTIC TESTS PATHOPHYSIOLOGY

● Bone marrow aspiration / biopsy - to assess the different
blood cells in the bone marrow
○ Adult
■ Posterior iliac crest - common site
■ Prone position
■ Brief, sharp pain - invasive, obtain consent
○ Child
■ Tibia
■ Side-lying position

MEDICAL MANAGEMENT ● Many blood cells → increased blood viscosity (malapot) →

● Bone marrow transplant prone to production of thrombus → embolism
● Immunosuppressive therapy ● Organ infiltration → can lead to organ enlargement
○ Central line 7-10 days (hepatomegaly and splenomegaly), arthralgia (joint pain),
● Blood transfusion as necessary cerebral hypoxia (CVA) or thrombotic stroke
● Capillary overdistention → rupture of BV → bleeding →
● Stool softener; high-fiber diet
hypovolemia → clot formation
● Assess for signs and symptoms of infections, tissue hypoxia
● Thromboembolism caused by clotting → common
and bleeding
complication is stroke
○ Prevent infection (leukocytopenia), prevent bleeding
(thrombocytopenia), provide rest (anemia) SIGNS AND SYMPTOMS
○ Symptomatic management for decreased blood cells ● Ruddy complexion - maroon color of the skin
● Frequent rest periods ● Headache
● Good oral care ● Dizziness
● Use soft - bristled toothbrush / soft swabs - bleeding in the ● Fatigue
mouth ● Blurred vision
● Male clients ● Hepatomegaly & Splenomegaly
○ Use electric razor → they are prone to bleeding, less ● See pic: overproduction of blood cells
trauma compared to the traditional razors → crowding → viscous → clotting →
● No ASA Administration embolism (travels) → stroke
● Reverse/Protective Isolation
MANAGEMENT
● Practice asepsis
● Increase fluid intake to prevent viscosity
● No Fresh fruits / fresh flowers in the patient’s unit
● Monitor for signs and symptoms of bleeding
● Limit visitors
○ Especially for hepatomegaly and splenomegaly
● Don’t allow persons with signs and symptoms of infection to
● Monitor signs and symptoms of thromboembolism
visit (e.g. COVID)
○ Angina (heart)
POLYCYTHEMIA ○ Claudication (pain in the legs)
● Increased RBC and Hgb production ○ Thrombophlebitis (extremities)
● Compensatory response to chronic hypoxia (e.g. TOF and ○ Pruritus (extremities)
COPD) - body tries to adapt to decreased oxygen by ● Administer analgesic as ordered
increasing RBC ● Administer antihistamine to decrease pruritus
● Hypoxia → increased erythropoietin production by the ● Therapeutic phlebotomy - drawing of blood para hindi
kidneys → stimulation of the bone marrow to increase RBC dumami and para hindi malapot
production ● Chemotherapy - to suppress the formation of too much
● RBC can also increase due to change in altitude (high blood cells
altitude) ● Radiation therapy - to suppress the formation of too much
blood cells
Polycythemia Vera
● Patient teaching: Avoid high altitude to prevent increased
● Hyperplasia of the bone marrow production of RBC
● Hypoplasia → pancytopenia, hyperplasia → polycythemia
● Polycythemia - increased RBC; Polycythemia vera - increase LEUKEMIA
of ALL blood cells ● Hematopoietic malignancy with unregulated proliferation of
● Increased RBC (erythrocytosis), increased WBC leukocytes
(leukocytosis), increased platelets (thrombocytosis) ● Neoplasm forming in the bone marrow & lymph node;
● Cause is unknown; associated with genetics affects WBC

4 FRIAS | SACRAMENTO | SALUD | SAMANIEGO | SANTOS, A | SANTOS, C | SANTOS, R | SANTOS, Z | SANZ | SAPALO | SAPITAN | SAUL | SERRANO | SIENA | SILANGCRUZ | SOLLANO | SORIANO | SUMABAT
LECTURE BY: Asst. Prof. Margaret M. Natividad, Ed.D., RN CARE OF CLIENT WITH HEMATOLOGIC CONDITION

● Cancer of the blood, may be acute or chronic TREATMENT

● Proliferation of blood cells (WBC) → increased leukocytes ● Aggressive chemotherapy
(leukemia) ● BMT (bone marrow transplant)
● Embryonic WBC (immature pero madami) don’t serve any
purpose that’s why patient is prone to infection → patient Chronic Myeloid Leukemia (CML)
may die of infection (immunosuppressed due to decreased ● Mutation in myeloid stem cell with uncontrolled proliferation
WBC) of cells: Philadelphia chromosome
○ WBC are not working at all bc they are immature ● Stages: Chronic phase, transformational phase, blast crisis
● Hypertrophy of bone marrow → bone pain ● Uncommon in people under 20
● Organ infiltration → hepatomegaly and splenomegaly, ○ Incidence increases with age
kidney failure, hyperuricemia, arthralgia, increased ICP ○ Mean age is 55-60 years
when meninges are infiltrated ● Life expectancy is 3-5 years
● Common denominator: decreased RBC, WBC and platelets
MANIFESTATIONS (initially may be asymptomatic)
CAUSE ● Malaise ● SOB due to leukostasis
● Idiopathic (unknown) ● Anorexia ● Enlarged, tender spleen
● Viral ● Weight loss ● Enlarged liver
● Genetic ● Confusion
● Chemotherapy & radiotherapy - causing high levels of
abnormal cells TREATMENT
● Imatinib mesylate (Gleevec) blocks signals in leukemic cells
TYPES
that express BCR-ABL protein
● Acute myeloid leukemia (AML)
● Chemotherapy
● Chronic myeloid leukemia (CML)
● BMT
● Acute lymphocytic leukemia (ALL) - common in children;
● PBSCT (Peripheral blood stem cell transplant)
usually starting from 5 y/o
● Chronic lymphocytic leukemia (CLL) Acute Lymphocytic Leukemia (ALL)
CLINICAL MANIFESTATIONS ● Uncontrolled proliferation of immature cells from lymphoid
● Patient is lethargic, pale, headache, disoriented, altered LOC, stem cell
fever, infection ● Most common in young children, boys more often than girls
● 80% event-free after 5 years, but survival drops with
increased age

MANIFESTATION
● Leukemic cell infiltration is more common with this leukemia
with symptoms of meningeal involvement and liver, spleen,
and bone marrow pain

TREATMENT
● Chemotherapy
● BMT

Chronic Lymphocytic Leukemia (CLL)

● Malignant B lymphocytes, most of which are mature, may
escape apoptosis, resulting in excessive accumulation of
Acute Myeloid Leukemia (AML)
cells.
● Defect in the stem cells that differentiate into all myeloid
● Most common form of leukemia
cells: monocytes, granulocytes, erythrocytes, and platelets
● More common in older adults and affects men more often
● Most common nonlymphocytic leukemia
than women
● Affects all ages with peak incidence at age 60
● Survival varies from 2 to 14 years depending upon stage
MANIFESTATIONS
MANIFESTATIONS
● fever and infection ● hyperplasia of gums
● Lymphadenopathy, hepatomegaly, splenomegaly
● weakness and fatigue ● bone pain (due to
● In later stages, anemias and thrombocytopenia
● bleeding tendencies hyperproliferation of the blood
● Autoimmune complications with RES destroying RBCs and
● pain from enlarged cells in the bone marrow)
platelets may occur
liver or spleen
● B symptoms include fever, sweats, and weight loss

5 FRIAS | SACRAMENTO | SALUD | SAMANIEGO | SANTOS, A | SANTOS, C | SANTOS, R | SANTOS, Z | SANZ | SAPALO | SAPITAN | SAUL | SERRANO | SIENA | SILANGCRUZ | SOLLANO | SORIANO | SUMABAT
LECTURE BY: Asst. Prof. Margaret M. Natividad, Ed.D., RN CARE OF CLIENT WITH HEMATOLOGIC CONDITION

TREATMENT
Non-Hodgkin’s Lymphoma
● Early stage may require no treatment, chemotherapy or
● Lymphoid tissues become infiltrated with
monoclonal antibody therapy
malignant cells that spread unpredictably
● Interventions related to risk of infection and bleeding
● Incidence increases with age; the average
○ Usually they die due to infection
age of onset is 50-60
● Mucositis
● Treatment: interferon, chemotherapy,
○ Frequent, gentle oral hygiene
and/or radiation therapy
○ Soft toothbrush, or if counts are low, sponge-tipped
applicators MULTIPLE MYELOMA
○ Rinse only with NS, Ns, and baking soda or prescribed ● Cancer of the bone marrow
solutions ● Malignant disease of plasma cells in the bone marrow with
○ Perineal and rectal care destruction of bone
● Administer analgesics before meals ○ Plasma cells in the bone marrow increase with the
● Provide appropriate treatment of nausea destruction of the bone → manifestation: bone pain
● Provide small, frequent feedings with soft foods that are ● M protein and Bence-Jones protein
moderate intemperature ● Median survival is 3 to 5 years; there is no cure - there is
● Provide a low-microbial diet remission with chemotherapy, radiotherapy and BMT
MEDICAL MANAGEMENT MANIFESTATION
● Chemotherapy ● Bone pain
● Bone Marrow Transplantation ● Osteoporosis - bone is destroyed → calcium is released from
● Blood Transfusion the bone → osteoporosis → pathologic fractures
NURSING INTERVENTIONS ● Fractures - due to destruction of the bone
● Protect from infection ● Elevated serum proteins
○ Reverse / protective isolation ● Renal damage
○ Practice asepsis ● Renal failure
○ Limit visitors ● Symptoms of anemia: Fatigue, Weakness
○ Don’t allow people with infections to visit ● Increased serum viscosity
○ No fresh fruits / fresh flowers in the unit ● Increased risk for bleeding and infection
● Prevent trauma and bleeding TREATMENT
○ Minimize parenteral injections ● Chemotherapy
○ Use small gauge needle ● Corticosteroids
○ Apply pressure at injection site for 5 minutes ● Radiation therapy
○ Support / handle body parts gently ● Bisphosphonates
○ Use soft-bristled toothbrush / soft swabs ● BMT (Bone Marrow Transplantation) - may provide a long
○ Use electric razors remission but patient will undergo another therapy
○ Don’t administer ASA
● Conserve Energy / Increase Oxygen Supply
○ Adequate rest
○ Oxygen supply

LYMPHOMA
● Tumor of the lymphatics
● Neoplasm of lymph origin

TYPES
● Abnormal plasma cells proliferate in the bone marrow →
● Hodgkin’s lymphoma
destruction of bones → osteoporosis → fracture → bone
● Non-Hodgkin’s lymphoma
pain
Hodgkin’s Lymphoma BLEEDING DISORDERS
● Reed - sternberg cell ● Primary thrombocythemia
● Suspected viral etiology; familial pattern ● Thrombocytopenia
● Incidence occurs in early 20s and again after age 50 ● Idiopathic thrombocytopenic purpura (ITP)
● Manifestations: painless lymph node enlargement; pruritus; ● Hemophilia - lack of factor 8 or 9 that happens in males
B symptoms such as fever, sweats, and weight loss carried by the mother
● Treatment: chemotherapy and/or radiation therapy

6 FRIAS | SACRAMENTO | SALUD | SAMANIEGO | SANTOS, A | SANTOS, C | SANTOS, R | SANTOS, Z | SANZ | SAPALO | SAPITAN | SAUL | SERRANO | SIENA | SILANGCRUZ | SOLLANO | SORIANO | SUMABAT
LECTURE BY: Asst. Prof. Margaret M. Natividad, Ed.D., RN CARE OF CLIENT WITH HEMATOLOGIC CONDITION

● Acquired coagulation disorders: liver disease, anticoagulants, ○ Before BT, blood typing and cross matching should be
and vitamin K deficiency done to prevent transfusion reaction that may cause
● Disseminated intravascular coagulation (DIC) hemolysis of the blood
○ Prepare blood (get from blood bank), BT set (has filter
Disseminated Intravascular Coagulation (DIC) unlike IV set), large bore needle
● Not a disease but a sign of an underlying disorder ○ Infuse saline solution - before and after BT
● Severity is variable; may be life threatening ○ The donor’s name is not indicated, only the serial
● Triggers may include sepsis, trauma, shock, cancer, abruptio number
placenta, toxins, and allergic reactions ● Procedure to identify patient and blood product
● Altered hemostasis mechanism causes massive clotting in ○ To prevent errors and mismatch bloods
microcirculation; as clotting factors are consumed, bleeding ○ Blood checked by at least 2 nurses to prevent errors
occurs; symptoms are related to tissue ischemia and ○ NI: Check the blood type, Rh, serial number
bleeding ● VS (before, during and after transfusion)
○ Hemostasis - stopping bleeding
COMPLICATIONS
○ Clotting comes before bleeding
● Febrile nonhemolytic reaction → fever
● Abnormal reaction of the body (patient may show signs of
● Acute hemolytic reaction → jaundice
shock due to profuse bleeding) due to trauma or surgery
● Allergic reaction → urticaria or hives
● Initially, body tries to coagulate to prevent bleeding →
● Circulatory overload → dyspnea, crackles, anxiety due to IV
there’s a period that all clotting factors are consumed and
and BT running together
used up → bleeding is profuse → patient will die or tissue will
● Bacterial contamination → sepsis → shock
become ischemic
● Transfusion-related acute lung injury
● Not easy to assess
● An oncologic emergency - a common complication of ● Delayed hemolytic reaction → jaundice
pancreatic cancer due to hemorrhage ● Disease acquisition → acquisition of Hepa B

TREATMENT
● Treat underlying cause
● Correct tissue ischemia
● Replace fluid and electrolytes
● Maintain BP
● Replace coagulation factors
● Heparin

THERAPIES FOR BLOOD DISORDERS

● Anticoagulant therapy - anticoagulant drugs if prone to
clotting
● Splenectomy - spleen is the destruction site of RBCs
● Therapeutic apheresis - removing some portion from the
blood
● Therapeutic phlebotomy - (e.g. polycythemia vera) to
remove many blood cells because they cause viscosity,
clotting and thromboembolism
● Blood component therapy - packed RBC, platelets, plasma,
cryoprecipitate etc.

Blood Transfusion
● Review patient history including history of transfusion and
transfusion reactions; note concurrent health problems and
obtain baseline assessment and VS
● Perform patient teaching and obtain consent
○ Do not force the patient to take blood transfusion (may
be because of culture, religion, etc.) - doctor will still
explain to the pt; if still refuses → honor patient’s
decision and sign a waiver (for proof that they do not
consent to blood transfusion)
● Equipment: IV (18 gauge or greater for PRBCs), appropriate
tubing, and normal saline solution

7 FRIAS | SACRAMENTO | SALUD | SAMANIEGO | SANTOS, A | SANTOS, C | SANTOS, R | SANTOS, Z | SANZ | SAPALO | SAPITAN | SAUL | SERRANO | SIENA | SILANGCRUZ | SOLLANO | SORIANO | SUMABAT