Caring For Patients With Hematologic Disorders
Caring For Patients With Hematologic Disorders
Caring For Patients With Hematologic Disorders
HEMATOLOGIC DISORDERS
RBC DISORDERS
Reduced production of RBCs results in anemia,
of WBCs results in infections, and
of platelets results in bleeding.
• RBC disorders include anemias and poly cythemia vera.
• Anemia is a common hematopoietic disorder in which the
client has a decreased number of RBCs and a low hemo
globin level.
CRITICAL THINKING
How are the symptoms of iron deficiency anemia related to a
decreased red blood cell count and decreased hemoglobin?
Medical management
• An oral iron preparation, usually ferrous sulfate is
ordered.
• These preparations are not given with food or milk
because they interfere with iron absorption.
• The administration of iron with orange juice or
vitamin C–rich drinks increases iron absorption.
Diet
A diet high in iron is encouraged.
An increase of vitamin C in the diet assists in the
absorption of iron.
Iron pills should not be taken within 2 hours of antacids or
tetracycline or at the same time as foods high in caffeine
(coffee, tea, and chocolate).
If the client has a loss of appetite, small frequent snacks
are tolerated better than three large meals.
Activity: Space daily activities to provide rest periods
between times of exercise.
Iron-rich Foods
Red meats
Fish
Liver
Raisins
Apricots
Dried fruits
Dark green vegetables
Dried beans, lentils, chick peas
Egg yolks
Iron-enriched whole-grain breads and cereals
APLASTIC ANEMIA
• The bone marrow decreases or stops functioning in a client
with aplastic anemia.
• The client with aplastic anemia has pancytopenia, a decrease
in the number of RBCs, WBCs, and platelets.
• In most cases the cause is unknown, but genetic factors
are suspected.
• Secondary aplastic anemia is caused by exposure to viruses,
chemicals (benzene or airplane glue), radiation, or
medications.
• Some medications that cause aplastic anemia are
chloramphenicol (Chloromycetin), mephenytoin
(Mesantoin), trimethadione (Tridione), mechlorethamine or
nitrogen mustard (Mustargen), methotrexate (Folex PFS), 6-
mercaptopurine or 6-MP (Purinethol), and phenylbutazone
(Butazolidin).
Symptoms in APLASTIC ANAEMIA
fatigue,
weakness,
palpita tions,
headaches,
fever,
mouth ulcers,
petechiae
gingival bleeding, and epistaxis.
These clients are extremely ill.
Diagnosis is confirmed by a bone marrow aspiration
Medical Management
• The cause of aplastic anemia is removed if possible.
• Immunosuppressive therapy with antithymocyte
globulin or ATG (Atgam) and cyclosporine is given to
suppress the reaction causing the aplastic anemia and to
allow the client’s bone marrow to recover.
• A client who has a good response will improve in 3 to
6 months.
• Transfusions of packed red cells and platelets are given
as needed.
SURGICAL MANAGEMENT
• A bone marrow transplant is performed if the client’s
bone marrow fails to respond to treatment.
• Cyclosporine (Sandim mune), an immunosuppressant, is
given for a bone marrow transplant to decrease the graft
rejection.
• The best response occurs in a young client who has not
previously had a transfusion because transfusions increase
bone marrow graft rejection.
• Bone marrow transplants from a human leukocyte
antigen- (HLA-)matched sibling donor are the treatment
of choice for clients younger than 30 years of age.
Surgical management
• The spleen destroys RBCs. In severe cases of hemolytic
anemia, a splenectomy is performed in an attempt to
stop the destruction of RBCs.
Pharmacological management
• Corticosteroids are administered to decrease the
autoimmune response.
• Folic acid is given to increase the production of RBCs.
SICKLE CELL ANEMIA (INHERITED HEMOLYTIC
ANEMIA)
• Sickle cell anemia is also known as inherited hemolytic
anemia or sickle cell disease.
• This genetic disorder has abnormal hemoglobin S rather
than hemoglobin A in the RBCs.
• Sickle cell anemia is caused by a recessive gene or genes
that are passed through the generations’
• The client with one S gene has sickle cell trait (Hb
sA) and is asymptomatic but is a carrier of the
disease.
• The client with sickle cell anemia has two S genes
(Hb ss) and manifests symptoms.
• Sickle cell tests are done on infants to diagnose sickle cell
trait or disease.
• Clients experience
cerebrovascular accidents,
renal failure,
pulmonary infarction,
shock, and
priapism (a continuous, painful erection).
• Assess extremity circulation frequently by checking
capillary refill, peripheral pulses, and temperature.
• Application of warm compresses to painful areas relieves
pain.
• Encourage the client to avoid restrictive clothing and
anything that may restrict circulation.
• Teach clients to avoid high altitudes and have adequate
fluid intake.
CLIENT TEACHING IN SICKLE CELL ANAEMIA
Encourage client to avoid high altitudes and non pressurized
airplanes.
Encourage adequate fluid intake because dehydration causes a sickle cell
crisis.
Treat all infections promptly.
Encourage client to avoid tight-fitting, restrictive clothing, strenuous
exercise, smoking, and cold temperatures.
Encourage client to receive yearly flu vaccine and
pneumococcal vaccine.
Encourage client not to smoke.
Teach smoking cessation options.
Medical-Surgical Management
• Infections are treated promptly with antibiotics.
• Large amounts of oral and intravenous fluids (3 to 5 L/day) are
given to remove the by-products of broken RBCs.
• Oxygen is administered based on pulse oximetry and ABGs to
combat deoxygenation.
• Skin grafting is necessary for chronic leg ulcers.
• Genetic counseling is recommended for clients with sickle cell trait
and sickle cell anemia. There may be more openness to counseling
if the counselor is from the same com munity as the client.
• Pharmacological Hydroxyurea reduces the frequency of
painful crisis and the need for blood transfusions in adults.
• Folic acid or folate (Folvite) is administered daily to assist in
the production of RBCs.
• Pentoxifylline (Trental) reduces blood viscosity and increases
RBC flexibility.
• Blood transfusions are given during a crisis.
• Patient-controlled analgesia (PCA) with morphine is
effective during a crisis. The client is progressed from
narcotics to nonnarcotic analgesics as indicated.
Nursing Management
Assess weight, vital signs, apical and peripheral pulses,
breath sounds, color, abdominal tenderness, and signs of
bruising or jaundice.
Review client’s history for possible familial illnesses.
Encourage client to follow treatment regimen.
Monitor laboratory test results.
Administer blood products as ordered and monitor for a
possible reaction.
Keep immunization records current and administer vaccines
as needed, including Haemophilus influenzae, pneumococcal,
meningococcal, hepatitis B, and influenza.
POLYCYTHEMIA
• Polycythemia is a disease in which there is an increased
production of red blood cells. Usually the numbers of
WBCs and platelets are also increased.
• The increase in RBCs increases the blood volume and
viscosity and decreases the ability of the blood to circulate
freely.
Activity
• Activities of daily living are adjusted so the client can have
regular periods of rest to relieve fatigue.