CH 41: Hematological Assessment (Per Amendolair)

Assessment of
Chapter 41 the
Hematologic
System
Anatomy and Physiology Review
• Bone marrow
• Blood components
• Red blood cells (erythrocytes)
• White blood cells (leukocytes)
• Platelets
• Accessory organs of hematopoiesis
• Spleen
• Liver
• Plasma
• Proteins
• Albumins
• Globulins
• Fibinogen
• Water
• Platelets
• Leukocytes
• Erythrocytes
Figure 19-8. Hematopoiesis. Hematopoiesis from the stem cell pool; activity
mainly in the bone marrow and in the peripheral blood.

Modified from Harmening DM, editor: Clinical hematology and fundamentals of hemostasis, ed 3, Philadelphia, 1997, FA Davis
Erythrocyte
growth pathway
Platelet growth
pathway.
Blood Components: Plasma
Figure 19-13. Iron cycle. Iron (Fe) released from gastrointestinal epithelial cells circulates in the bloodstream associated with its
plasma carrier, transferrin. It is delivered to erythroblasts in bone marrow, where most of it is incorporated into hemoglobin. Mature
erythrocytes circulate for approximately 120 days, after which they become senescent and are removed by mononuclear phagocyte
Figure 19-14. Role of
erythropoietin regulation of red
blood cell production and
delivery of oxygen. In addition to
decreased oxygen in the
atmosphere, other stimulators of
erythropoietin release include
anemia or decreased population
of mature red blood cells (RBCs),
decreased hemoglobin
synthesis, decreased blood flow,
and hemorrhage or excessive
bleeding. In response to
decreased blood oxygen, the
kidneys release erythropoietin,
which stimulates erythrocyte
production in the bone marrow.
From Thibodeau GA, Patton KT: Anatomy & physiology, ed
5, St Louis, 2003, Mosby

Figure 19-15. Metabolism of bilirubin released by heme breakdown. MPS, Mononuclear phagocyte system.
Hemostasis/Blood Clotting
• Platelet aggregation
• Blood clotting cascade
• Intrinsic factors
• Extrinsic factors
• Fibrin clot formation
• Fibrinolysis
Clotting Factors (Table 41-2)
I. Fibrinogen
II. Prothrombin
III. Tissue thromboplastin
IV. Calcium
V. Proaccelerin
VI. Discovered to ba an artifact
VII.Proconvertin
VIII.Antibemophilic factor
IX. Plasma thromboplastin component
X. Stuart-Prower factor
XI. Plasma thromboplastin antecedent
XII.Hageman factor
XIII.Fibrin-stabilizing factor
Figure 19-19. The "cascade" theory of
coagulation. Recent changes in the cascade theory
are shown in blue

Drugs (table 42-3, p 877)
• Anticoagulants: interfere with steps in blood

clotting. Limit or prevent extension of clots and
prevent new clots
• Fibrinolytics: selectively degrade fibrin threads in
the formed blood clot
• Platelet Inhibitors: prevent platelets from
becoming active or activated platelets from
clumping together
Elsevier items and derived items © 2006 by
Elsevier Inc.
Assessment
• Gordon’s Functional Health Patterns
• Demographic data
• Age and Gender
• Personal history
• Diet history
• Liver function
• Known immunological or hematological disorders
• Occupation
• Drugs
• Prolong use of antibiotics (clotting problems, bone marrow
suppression)
• Blood thinners
• NSAID
• Anticoagulant
• Fibrinolytic durgs
• Platelet inhibitors (Aspirin)
Assessment
• Family history and genetic risk
• Hemophilia
• Recurrent nosebleeds, postpartum hemorrhage
• Sickle cell
• Current health status
• Women – menorrhagia
• Fatigue
Physical Assessment
• Skin – pallor; jaundice; petechia; bruising
• Respiratory – capillary fill, breathing difficulties
• Cardiovascular – BP; heart sounds, signs of phlibitis
• Renal and urinary – hematuria; increase urine proteins
• Musculoskeletal – rib/sternal tenderness, limit ROM
• Abdominal – enlarged spleen, enlarge liver
• Central nervous system – change in neurological

degeneration, tremors
• Psychosocial – effects of chronic illness

Diagnostic Assessment:
Tests of cell number and function:
• Complete blood count

• RBC, WBC, HCT, HgB; size, shape and proportions of different cell
types (e.i. sickle cell)
• Reticulocyte count
• determine bone marrow function
• Hemoglobin electrophoresis
• detect abnormal form of hemoglobin (e.i. sickle cell)
Diagnostic Assessment:
Tests of cell number and function:
• Leukocyte alkaline phosphatase

• Increase during episode of infection or stress
• Coombs’ test
• Detects antibodies against RBC
• Presence of antibodies cause hemolytic anemia
• Serum ferritin, transferrin, and total iron-binding
capacity
• Increase in TIBC and iron levels = hematologic problems (iron
deficiency anemia
• Transferrin
Diagnostic Test
Tests Measuring Bleeding and Coagulation
• Capillary fragility test

• Petechiae
• Bleeding time test
• Normal bleeding – 1 to 9 minutes
• Prothrombin time
• Clotting time
• Reflect how much clotting factors II, V, VII, and X
• PT = 11 to 13 sec
Diagnostic Test
Tests Measuring Bleeding and Coagulation
• International normalized ratio (INR)
• Establishes the normal mean
• INR = 0.7 to 1.8
• Pt on anticoagulant therapy (warfin) INR – 2.0 to 3.0
• Partial thromboplastin time
• Intrinsic clotting cascade and action of clotting factors II,
V, VII, IX, XI and XII.
• Platelet agglutination/aggregation
• Ability of platelets to clump
Other Tests
• Radiographic examinations
• Isotopes to evaluate bone marrow function
• Standard X-rays
• Bone destruction
• Enlargement of spleen and liver
• Bone marrow aspiration and biopsy
• Patient preparation
• Procedure
• Followup
Follow-up Care
• Give client education.

• Cover with dressing; observe for 24 hours.
• Administer mild analgesic.
• Apply ice pack.
• Avoid contact sports or any activity that might
result in trauma to the area.

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Assessment of

mainly in the bone marrow and in the peripheral blood.

erythropoietin regulation of red

blood cell production and

delivery of oxygen. In addition to

decreased oxygen in the

atmosphere, other stimulators of

erythropoietin release include

anemia or decreased population

of mature red blood cells (RBCs),

synthesis, decreased blood flow,

and hemorrhage or excessive

decreased blood oxygen, the

kidneys release erythropoietin,

which stimulates erythrocyte

production in the bone marrow.

From Thibodeau GA, Patton KT: Anatomy & physiology, ed

5, St Louis, 2003, Mosby

coagulation. Recent changes in the cascade theory

are shown in blue

• Anticoagulants: interfere with steps in blood

Elsevier items and derived items © 2006 by

• Respiratory – capillary fill, breathing difficulties

• Cardiovascular – BP; heart sounds, signs of phlibitis

• Renal and urinary – hematuria; increase urine proteins

• Musculoskeletal – rib/sternal tenderness, limit ROM

• Abdominal – enlarged spleen, enlarge liver

• Central nervous system – change in neurological

• Psychosocial – effects of chronic illness

• Complete blood count

• Leukocyte alkaline phosphatase

• Capillary fragility test

• Give client education.

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