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Chapter 41
Assessment of the
Hematologic System
Anatomy and Physiology Review
• Bone marrow is the source of all blood cells,
including immune system cells
• Red blood cells (erythrocytes)
• White blood cells (leukocytes)
• Platelets smallest of blood cells. They stick to
injured blood vessel walls and form platelet
plugs that can stop the flow of blod from the
injured site. They produce substances
important to coagulation (clotting) They
perform most of their job by aggregation
(clumping)
Accessory Organs of Blood Formation
• They help regulate growth of blood cells & form factors that
ensure proper blood clotting.
• SPLEEN: under the diaphragm to the left of the stomach. It
has 3 types of tissue WHITE PULP: filled with WBC and
major site of antibody production. RED PULP: contains
enlarged blood vessels that store RBC’s and platelets.
MARGINAL PULP contains the ends of many arteries and
other blood vessels. It’s main function is to destroy old &
imperfect RBC’s break down the hemoglobin from bad cells
, stores platelets and filters antigens. A patient can live
without their spleen has a reduced immune system and
prone to infection.
• KNOW THIS SLIDE
Accessory Organs of Blood Formation
• LIVER: Site for producing prothrombin and most of the blood
clotting factors. Produce bile forms vitamin K in the intestinal
tract which is needed to produce blood clotting factors VII,
IX, X & prothrombin. Large quantities of whole blood cells
and whole blood can be stored in the liver. Also stores iron
and converts bilirubin to bile.
• KNOW THIS SLIDE
Hemostasis/Blood Clotting
• Platelet aggregation
• Blood clotting cascade
• Intrinsic factors: problems directly in the blood
itself that make platlet clump and then clot.
• Extrinsic factors: outside of the cell that can also
induce platelet plugs to form usually due to
changes in the blood vessels rather than in the
blood Ex trauma
• Fibrin clot formation: Last Phase of blood clotting,
protein made in the liver, that helps make
threadlike mesh to form a clot.
Platelets and Blood Clotting
Anticlotting Forces
Assessment
• Patient history
• WHAT WOULD YOU ASK?
• WHAT WOULD YOU LOOK FOR?
Drugs
• Anticoagulants—interfere with steps in blood
clotting; limit or prevent extension of clots
and prevent new clots CAN YOU NAME ANY?
• Fibrinolytics also know as Thrombolytic
drugs—selectively degrade fibrin threads in
the formed blood clot. Best seen in clots for
MI, or clot strokes.
• Platelet Inhibitors—prevent platelets from
becoming active or activated platelets from
clumping together (NSAIDS)
Assessment
• Nutritional status
• Family history and genetic risk
• Current health problems
Physical Assessment
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Skin
Head and neck
Respiratory
Cardiovascular
Renal and urinary
Musculoskeletal
Abdominal
Central nervous system
Psychosocial
Diagnostic Assessment
• Tests of cell number and function:
• Complete blood count
• Reticulocyte count
• Hemoglobin electrophoresis
• Leukocyte alkaline phosphatase
• Coombs’ test
• Serum ferritin, transferrin, and total ironbinding capacity
Tests Measuring Bleeding and
Coagulation
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Capillary fragility test
Bleeding time test
Prothrombin time
International normalized ratio
Partial thromboplastin time
Platelet agglutination/aggregation
Other Tests
• Radiographic examinations
• Bone marrow aspiration and biopsy
Bone Marrow Aspiration and Biopsy
• Patient preparation
• Procedure
• Follow-up care
NCLEX TIME
Question 1
A nurse interviews an older female patient
who is complaining of progressive fatigue,
shortness of breath, and headaches.
What question should the nurse ask
first to collect more data surrounding the
possible cause of the patient’s symptoms?
A. “Do you have a history of cardiovascular
disease?”
B. “Can you tell me about your diet?”
C. “Have you been feeling depressed lately?”
D. “What medications do you routinely take?”
Question 2
The patient’s hematologic assessment results are:
Red blood cell count: 3.8 million/mm3
Total iron binding capacity: 225 mcg/dL
Iron: 50 mcg/dL
Hemoglobin: 10 g/dL
Hematocrit: 35%
These results suggest that the patient may be experiencing:
A.
B.
C.
D.
Chronic hypoxia
A malignancy
A liver disorder
Hemorrhage
Question 3
The patient is complaining of increased fatigue,
bleeding gums, and frequent “chills.” What is the
most appropriate initial nursing intervention?
A.
B.
C.
D.
Notify the physician of the patient’s complaints.
Review the laboratory analysis for signs and
symptoms of bone marrow suppression.
Review the laboratory analysis for signs and
symptoms of infection.
Administer the prescribed antibiotics to manage
the patient’s current infection.
Question 4
The patient was transitioning from IV heparin
therapy to oral warfarin. Therapeutic
anticoagulation of the patient is best
assessed by:
A. Partial thromboplastin time of 24.3
seconds
B. Prothrombin time of 18 seconds
C. International normalized ratio of 2.5
D. Bleeding time of 5 minutes
Question 5
After obtaining a patient’s blood pressure, you notice
petechiae upon removal of the blood pressure
cuff. What should be the nurse’s priority
intervention?
A.
B.
C.
D.
Obtain a blood sample to assess the patient’s
coagulation status.
Ask the patient about a history of bleeding
disorders.
Ask the patient about medications he is currently
taking.
Ask the patient if he is experiencing bone,
sternum, or rib pain.