Hematologic Disorders 2 PDF

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Hematologic disorders...

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---------------------------------------------------------Forming Clots--------------------------------------------------------------Slide 5.

Lymphocytes

Monocytes/ macrophages (3-8 %) - Macrophage is a mature monocyte - They engulf quantities of foreign tissue(known for phagocytosis) -Important role in immune response by engulfing foreign antigens and presenting them to other cells Eosinophils (1-3%) & Basophils (0.3-0.5%) (The smallest percentage) -Implicated in the allergic response a.) When eosinophils and basophils are elevated→ we tend to think it is an allergic response Slide 6. Hemostasis - Thrombosis: too much coagulation or too much platelet activity→ person forms clots (the inappropriate formation of clots within the vascular system) - Bleeding: too little coagulation→ person at risk for bleeding uncontrollably (Failure of blood to clot in the response to appropriate stimulus) • •

There needs to be a balance in bleeding and pro-clotting Hemostasis needs to be a process in which there is clot formation and clot retraction or dissolution [balance between pro-clotting and breathing]

Slide 7. Five stages of Hemostasis 1. Vessel spasm a.) you get a cut on finger or a cut in artery of the heart→ initially there will be a vessel spasm to try and control the bleeding -Because it is vascular smooth muscle contraction, it causes endothelial injury * Endothelial injury sets the stage for inflammation and healing (dangerous when there is an injury to the coronary artery) 2. Formation of the platelet plug - When there is endothelial damage these local humoral mechanisms get released form the endothelium and cause the platelets to do two things” 1)aggregate- platelets clumps together( form little spikes that help them form together) 2)activate- the more activated the platelet becomes, they release chemical mediators{cytokines}that lead to further platelets being activated to come to the site of injury 3. Blood coagulation or development of an insoluble fibrin clot a.) “The clotting cascade”- The end result of the clotting cascade I to cover fibrinogen to fibrin [crossed

linked fibrin molecule]→ this is going to stabilize the platelet plug *Clotting cascade activated by injury or trauma (intrinsic and extrinsic pathway) 4.) Clot retraction - Actin and myosin will cause the clot to contract, pull, and shrink 5.) Clot dissolution/ lysis [plasmin] Slide 13. ** In addition to clot formation, there must be regulation of blood coagulation which is regulated by the liver a.) If someone had liver disease→ They would easily bleed [because the person does not have efficient clotting factors] Blood Clotting Process Requires: -Many of the clotting factors are dependent on vitamin K - Antithrombin lll inactivates thrombin *Thrombin converts fibrinogen to fibrin -Protein C is a plasma protein that inactivates factors V (five) and Vlll (eight) - Plasmin responsible for breaking down fibrin[this is an anticoagulant] a.) Synthetic plasmin can be given when a person has a clot Slide 15. Hypercoagulability -Produces an environment that predisposes someone to forming clots - Having conditions that 1.) increase platelet function[platelets become very aggregated or 2.)conditions in which theres accelerated caoagulation[clotting cascade is working at a faster rate than it ordinarily works] Increased Platelet Function -Atherosclerosis (acuumulationof fat or lipids in your arteries) -Diabetes -Smoking -Elevated blood lipids and cholesterol (more fat) -Increased platelet levels a.) If a person had diabetes and they smoked→ higher risk for person to develop clots Accelerated Coagulation/ Activity -Sometimes inherited disorder -Sometime acquired disorder -Pregnancy -Oral contraception[estrogen and hormones play a role in accelerating the coagulation response] -Surgery or bed rest→ can have venastasis[when blood is sluggish]→This blood tends to clot -Immobility -Postsurgical state a.) This is why a person is given compression stockings or SCD(sequential compression devices)

b.)Person given medication to prevent clots from forming if we know they are at high risk (long surgery, orthopedic patients, bed ridden patients.) **Medications: blood thinner -Malignant Diseases -Congestive heart failure **An older woman over 35 who used oral contraceptives, smoked and had diabetes→ PERSON AT RISK FOR CLOTS ^As a nurse you must educate the patient Slide 16 Hypercoagulability Associated with Increased Platelet Function -Hypercoagulability results platelet adhesions and aggregation and platelet clots (more prone to platelets activating and clumping together with other platelets) -Thrombus(clot)→ when clot travels, the clot is called an emboli Arterial Thrombi -Associated with turbulent blood flow (accelerated blood flow and conditions in which there is platelet aggregation) -Can form in both small and large blood vessels -Major concern: When Thrombi form in vessels of the heart or brain ^This thrombi can form an occlusion ^blockage or closing of a blood vessel or hollow organ ^with complete occlusion, can lead to ischemic blood flow→infarction→and tissue can become necrotic→ NECROSIS IS NOT REVERSIBLE [DEAD IS DEAD] -Concern with arterial thrombi forming in: coronary arteries & the brain Venous Thrombi -Associated with conditions of stasis of blood flow (increase in the tendency to clot) 3 Elements that predispose someone to form a Venous Thrombi 1.) Stasis of blood flow [sluggish or stagnant blood flow] (ex. Postsurgical, comatose, paraplegic) 2.) Endothelial injury (ex. Atherosclerosis, smoking, diabetes→ damage the lining of blood vessels) 3.) Hypercoagulability (clotting cascade is accelerated; ex. Pregnancy, oral contraceptives, surgery) *Venous Thrombi in the lower extremities can lead to a pulmonary embolism [clot travels to right ventricle and gets logged in the lung] a.) A person at risk for clotting will be on DVT (Deep Vein Thrombosis) precautions → Want to get patient out of bed as soon as possible; ambulation b.) Give person compression stocking or SCD (Sequential compression device) c.) Give person range of motion exercises

Slide 17 **Normal Platelet count is 150,000 - 400,000 Thrombocytosis *-THROMBO means platelets *-CYTOSIS means abnormal increase Thrombocytosis is increase number of platelets Elevation in platelet count...