HEMATOPOIETIC SYSTEM

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HEMATOPOIETIC SYSTEM

• Majuvy L. Sulse RN, MSN, CCRN

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Description

• Process of
• Formation development of blood cells
• Begins in early embryonic stage continuous thru
  life
• Occurs in bone marrow from common stem cell

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Functions

• Transport
• Gases
• Nutrients
• Hormones
• Waste products
• Regulate
• Fluid electrolyte balance
• Acid- Base balance
• Body temperature
• Protect
• Invasion of foreign substances
• Homeostasis of blood coagulation

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Components

• Plasma
• Red Blood Cells (RBCs)
• White Blood Cells (WBCs)
• Bone marrow
• Spleen
• Liver

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Plasma

• Liquid portion of blood 55 of blood
• Composed primarily of water
• Contains
• Proteins
• Albumin
• Globulin
• Prothrombin fibrinogen

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Red Blood Cells

• Flexible, biconcave shape cell membrane is thin
• Large molecules HEMOGLOBIN
• Heme (iron compound)
• Globin (simple protein)
• O2 carrying capacity of the blood
• Normal values for hemoglobin
• 14 16 grams/100mls of blood in males
• 12 14 grams/100mls of blood in females
• Less than 10 grams anemia.
• RBC production is called erythropoiesis
• Cellular oxygen requirements (hypoxia)
• General metabolic activity

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Red Blood Cells

• Controlled by hormone erythropoetin in kidneys
• Surface carry antigens which determine blood
  group
• Life span120 days
• Normal RBC values 5,500,000/mm3 of blood

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Important factors influencing RBC production

• Precursor cells
• Nutrition
• Protein
• Iron-Hb production accounts for 2/3 total iron
  (essential iron)
• Folic acid- formation maturation of RBCs
• Vit B12 (cyanocobalamine) -nervous system
  function
• Vit B2 ( Riboflavin)
• Vit B6 (pyridoxine)
• Traces of copper

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Hematocrit (HCT)

• Hematocrit- ratio of RBC mass to whole blood (3x
  Hgb)
• Levels are increased in dehydration, blood loss,
  polycythemia (increased production of RBCs)
• Levels are decreased in over hydration and low
  numbers of RBCs
• Normal Hematocrit value 35 - 45

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Leukocytes (WBCs)

• Classified according to presence or absence of
  granules and the staining characteristics of
  their cytoplasm
• Types
• Granulocytes,
• Agranulocytes

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Leukocytes (WBC)

• Granulocytes (polymorphonuclear leukocytes).
  Phagocytosis -engulfing/ ingesting/digesting/killi
  ng is the primary function of the granulocytes.
• Neutrophils-50-70 WBCs-primary phagocytic cells
• Segs- mature neutrophil
• Bands- immature neutrophil
• Eosinophils-2-4-allergic response
• Basophils-less than 2 of WBCs -no phagocytic
  activity. Secretes histamine in response to
  inflammatory and immune stimuli

Remember NNeutrophils N-fection
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WBCs

• Lymphocytes-agranular leukocytes-
• No granule nucleus has no lobes
• Smallest 2nd most numerous-20-40
• Monocytes-4-8 potent phagocytic cells
• Outside the bloodstream, enlarge mature and
  become tissue macrophages
• Lymphocytes are 3 types
• T lymphocytes-attack infected cell (cellular
  immunity)
• B lymphocytes-produce antibodies against specific
  antigens (humoral immunity)
• Natural killer cells

MMonocytes, monstrous, macrophages
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T cells Lymphocytes

• 70-80 of lymphocytes, develop in bone marrow,
  mature differentiate in thymus
• Responsible for cellular immunity
• Produce lymphokines that attack foreign cells
• Types Helper cells, Cytotoxic T cells,
  Suppressor T cells, Memory T cells

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B cells Lymphocytes

• 10-29 of lymphocytes
• Produce immunoglobulin responsible for humoral
  immunity
• Become plasma cells when activated

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Natural Killers Lymphocytes

• 10 of lymphocytes
• Involves in surveillance against tumors,
  parasites, and viruses
• Do not need prior exposure for activation

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Things that can Interfere with a WBC Count

• Splenectomy (spleen removal) have a persistent
  mild elevation of WBCs
• Certain drugs may increase WBC counts. They
  include epinephrine, allopurinol, aspirin,
  chloroform, heparin, quinine, corticosteroids.
• Other drugs that may decrease WBC counts include
  antibiotics, anticonvulsants, antihistamines,
  antithyroid drugs, arsenicals, barbiturates,
  chemotherapeutic agents, diuretics, and
  sulfonamides

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Leukopenia vs. Leukocytosis

• Leukopenia
• Bone-marrow failure (due to granuloma, tumor, or
  fibrosis).
• Presence of cytotoxic substances.
• Collagen-vascular diseases (lupus
  erythematosus).
• Disease of the liver or spleen.
• Radiation

• Leukocytosis
• Infectious diseases.
• Inflammatory diseases (rheumatoid arthritis or
  allergies).
• Leukemia.
• Severe emotional or physical stress.
• Tissue damage (burns).

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Thrombocytes (Platelets)

• Haemostatic function
• Occlusion of small openings in blood vessels
• Thromboplastic function
• Provision of chemical components that helps in
  the coagulation process
• N140-400k/mm3
• Life span is 9-12 days

• 
  
  
  
• Fragments of megakaryocytes
• Regulated by thrombopoetin-
• 2 functions hemostatic thromboplastic
• 3 types Tcells, B cells, natural killer cells

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Hemostasis

• Process by which platelets, plasma, and
  coagulation factors interact to control bleeding.
• Platelet aggregation
• Blood clotting cascade
• Intrinsic factors
• Extrinsic factors
• Fibrin clot formation
• Fibrinolysis

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Components/Phases of Hemostatic Mechanism

• Vascular Response (blood vessels)
• Vasoconstriction
• Reduces blood leakage
• Enhances wall thickness
• Platelet Response
• Formation of plug then aggregates to form
  thrombus
• Coagulation factors- formation of fibrin clot
• Activation of intrinsic/extrinsic factors
• Extrinsic factor pathway results in release of
  Thromboplastin which initiates the clotting
  cascade to form factor X

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Clotting Cascade

• Called a cascade because events are sequential
• Each event is initiated by the previous event
• Platelets come into contact with damaged vessel
• Release thrombokinase

• Thrombin converts fibrinogen to fiber
• Fibrin forms a meshwork clot over wound that
  controls bleeding
• Thrombokinase converts prothrombin to thrombin

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Blood Clotting Pathway

• Intrinsic activation through damaged surface
• Extrinsic activation through trauma
• Both pathways converge and ultimately lead to
  cleavage of fibrinogen to give insoluble fibrous
  clot.

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Anticoagulants

• Keeps blood in its fluid state by
• Antithrombins-counteracts thrombin (powerful
  coagulant).
• Fibrinolysis-dissolution of fibrin
• Plasminogin converted to plasmin attacks
• Fibrin or fibrinogen-FSPs/FDPs become byproducts
• Platelet Inhibitors prevent platelets from
  becoming active or activated platelets from
  clumping together

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Other Components

• Bone marrow
• One of the largest organs of the body
• Functions to
• store RBCs WBCs
• Produce antibody as secondary immune response
• Transform undifferentiated lymphocytes to mature
  B cells
• Envoironment fordifferentiation maturation of
  cells
• Has 2 parts
• Red-mass of cells surrounding hematopoietic cells
• Yellow-adipose cells, inactive except in severe
  blood loss or hypoxia

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Other Components/Players

• Spleen
• Involved in humoral activity
• Stimulates B cell activity to produce
  immunoglobulins
• Stores releases RBCs into the circulation
• Filters destroys damaged RBCs
• Filters traps bacteria, viruses other foreign
  bodies
• Stores releases platelets destroys damaged
  worn out platelets

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Other Components/Players

• Liver
• Filters blood as it comes from GI tract
• Kupffer cells help filter bacterial cells that
  are present in the peripheral blood
• Removes damaged old RBCs from the circulation
• Detoxifies toxic substances
• Synthesizes plasma proteins and clotting factors
• Breaks down HB into bilirubin
• Stores iron in the form of ferritin

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Other Components

• Thymus
• Located below the thyroid gland
• Packed with lymphocytes
• Site of maturation distribution of T
  lymphocytes
• Secretes thymosin, a hormone that stimulates
  immune function

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Other Components

• Lymphatics System
• Consists of
• lymph fluids (pale yellow)
• capillaries-thin walled without valves
• Ducts
• nodes- filters bacteria and foreign materials
  from lymph
• Carries fluid from interstitial spaces to the
  blood preventing edema
• Contains lymphocytes, PMNs, enzymes and antibodies

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Assessment of the Hematopoietic System

• Patients history
• Physical assessment
• Laboratory and diagnostic test

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Assessment

• Past health/medical history
• Prescribed OTC meds, vitamins, nutritional
  supplements
• Previous transfusions and radiation treatment
• Dietary pattern nutritional deficiencies (Folic
  acid, iron, B12)
• Family history
• Blood lymph node disorders
• Cancers involving the blood or lymph system

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Assessment

• History of present Illness
• s/s of lethargy. anorexia, fatigue, bleeding
  gums, bruising, dyspnea, aching bones joints,
  tarry stools, swollen/tender lymph nodes
• Social history
• Ethnic background race
• Use of cigarettes, alcohol, recreational drugs
• Occupational or household exposure to radiation
  or chemicals

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Physical Assessment

• Inspection
• General appearance, mental status
• Skin color, bruising, dyspnea, lesions,
  petechiae, swelling of lymph nodes
• Size color of tongue
• Abdominal girth
• Auscultation
• Heart sounds
• Bowel sounds, bruit, friction rubs, venous hums

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Physical assessment

• Palpation
• Lymph nodes
• Abdomen for ascites, enlarged organ, or
  tenderness
• Percussion
• Liver spleen to estimate signs
• Site location of other abdominal organs

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Assessment by System

• Health perception-Management pattern
• Cognitive level
• Values beliefs
• Activity- Exercise
• Nutritional- metabolic pattern
• Elimination Pattern
• Sleep- Rest patterns
• Self perception Coping mechanism

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Diagnostic Studies

• CBC (Complete Blood Count)
• Radiologic Studies
• Biopsies

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CBC

• Hemoglobin (Hb)-
• Normal value Men 14-18grams/dl women-12-16
  grams/dl
• Decreased in Anemia, hemorrhage, hemodilution
• Increased in polycythemia or dehydration
• Hematocrit (Hct)-
• N40-52 in males 35-47 for women
• RBC- no. of circulating RBC
• MCV-Mean corpuscular Volume- indicates size
• MCHC-Mean corpuscular Hb concentration
• MCH-Mean cell Hb-indicates weight of Hb color

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CBC

• Platelet Count- decreased in SLE, HIV, ITP
• N150,000-400,000/mm3 below 80, 000 is
  Thrombocytopenia
• ESR-(erythrocyte sedimentation rate)- cell
  destruction increased in acute chronic
  inflammatory conditions, malignancy, MI, ESRD.

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WBCs

• Neutrophils 50-70 gt in ifection lt in bone
  marrow depression
• Eosinophils-2-4 increased in allergic
  reactions,leukemia, autoimmune disorders,
  parasitic infection decreased in stress, SLE,
  adrenocortical stimulation
• Basophils-0-2 elevated in allergic conditions,
  inflammatory processes, graft rejection, acute
  leukemia, recent splenectomy
• Lymphocytes-20-40 elevated in CLL, chronic
  infections decreased in AIDS, SLE, steroids,
  Leukemia

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Coagulation Studies

• Bleeding Time-N1-4min-evaluates platelet
  function
• PT-Prothrombin Time-used to monitor coumadin
  therapy N12-15 sec, evaluates extrinsic factor
• INR- International Normalized Ratio-used with Pt
  to monitor Coumadin therapy
• PTT-Partial Thromboplastin time-N60-70sec
  evaluates the intrinsic factor
• APTT- Activated Partial Thromboplastin Time- used
  to monitor heparin therapy
• FDP or FSP-Fibrin Degradation Products/ Fibrin
  Split Products-detect DIC N0-10

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Radiologic Studies

• CT-preferred method to evaluate lymph nodes
• MRI- liver, spleen, lymph nodes
• Nursing care-
• Allergy/sensitivity to Iodine
• Remove all metal objects
• History of insertion of plates, staples/ other
  metal appliances
• Radioisotope studies- injection of radioisotope
  IV
• Bone Scans

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Biopsies

• Bone Marrow-
• Lymph Node biopsy
• Nursing responsibilities
• Explain procedure allay fears (consent)
• Analgesics
• Position comfort
• Assess site for bleeding