Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 9
Hematology
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 9
Hematology
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Anatomy, Physiology, and
Pathophysiology
General Assessment and
Management
Managing Specific Patient
Problems
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hematology
The Study of Blood and Blood-
Forming Organs
– Includes study of blood disorders:
Red blood cell disorders
White blood cell disorders
Platelet disorders
Coagulation problems
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy, Physiology,
and Pathophysiology
Components
– Blood, bone marrow, liver, spleen,
kidneys
Hematopoiesis
– Pluripotent stem cell
– Erythropoietin
Blood Volume
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of Blood
(1 of 6)
Plasma
– Water
90–92% by volume
– Proteins
6–7% by volume
– Other
2–3% by volume
Fats, carbohydrates, electrolytes, gases,
and chemical messengers
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of Blood
(2 of 6)
Red Blood Cells
– Hemoglobin
– Oxygen transport
– Bohr effect
– 2,3 DPG
– Oxygen–
hemoglobin
dissociation curve
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of Blood
(3 of 6)
Red Blood Cells
– Production
Erythropoiesis
Hemolysis
Sequestration
– Laboratory
analysis of red
blood cells
Red blood cell
count
Hematocrit
Hemoglobin
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of Blood
(4 of 6)
White Blood Cells
– Margination
– Phagocytosis
– White blood cell count
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of Blood
(5 of 6)
White Blood Cells
– Leukopoiesis
Granulocytes
Neutrophil
Basophil
Eosinophil
Lymphocytes
Monocytes
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of Blood
(6 of 6)
White Blood Cells
– Immunity
Subpopulation of lymphocytes known
as T cells and B cells
T cells develop cellular immunity.
B cells produce humoral immunity.
– Autoimmune disease
– Alterations in the immune process
– Inflammatory process
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Immune Response
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Components of Blood
Platelets
– Megakaryocytes
– Thrombocytopenia
– Thrombocytosis
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hemostasis
(1 of 3)
Controlling Blood Loss
– Vascular spasms
– Platelet plugs
– Stable fibrin blood clots
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hemostasis
(2 of 3)
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hemostasis
(3 of 3)
Fibrinolysis
Thrombosis
– Fibrinolytics
– Medications
affecting clot
formation
Alter the
enzyme
on the platelet
Affect the
coagulation
cascade
Enhance clotting
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Blood Products and
Blood Typing
(1 of 2)
Blood Types
– Antigens
A, B, AB, O
– Universal donors
– Rh factor
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Blood Products and
Blood Typing
(2 of 2)
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Transfusion Reactions
(1 of 2)
Hemolytic Reactions
– Signs and Symptoms
Facial flushing, hyperventilation,
tachycardia, hives, chest pain,
wheezing, fever, chills, and cyanosis.
– Treatment
Stop transfusion, change all IV tubing,
and initiate IV therapy with normal
saline or lactated Ringer’s.
Consider furosemide, dopamine, and
diphenhydramine.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Transfusion Reactions
(2 of 2)
Febrile Nonhemolytic Reactions
– Signs and Symptoms
Headache, fever, and chills.
– Treatment
Stop transfusion, change all IV tubing,
and initiate IV therapy with normal
saline or lactated Ringer’s.
Consider diphenhydramine and an
antipyretic.
Observe closely to ensure reaction is
nonhemolytic.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment
and Management
(1 of 3)
Scene Size-up
Initial Assessment
Focused History and Physical
Exam
– SAMPLE history
Hematological disorders are rarely the
chief complaint.
– Physical exam
Evaluate nervous system function.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Physical exam
– Skin signs
– Lymphatic signs
– Gastrointestinal
signs
– Musculoskeletal
signs
– Cardiorespiratory
signs
– Genitourinary
signs
General Assessment
and Management
(2 of 3)
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment
and Management
(3 of 3)
General Treatment Guidelines
– Maintain ABCs.
Provide high-flow, high-concentration
oxygen or assist ventilations as indicated.
Consider volume replacement.
– Monitor cardiac rhythm and vital signs.
Treat rhythm disturbances.
– Provide reassurance, comfort care, and
transport.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Managing Specific
Patient Problems
Diseases of the Red Blood Cells
Diseases of the White Blood Cells
Diseases of the Platelets/Blood
Clotting Abnormalities
Other Hematopoietic Disorders
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the Red
Blood Cells
(1 of 4)
Anemias
– Anemia is a sign, not a separate
disease process.
Signs and symptoms may not be present
until the body is stressed.
Differentiate chronic anemia from acute
episode.
– Treat signs and symptoms.
Maximize oxygenation and limit blood loss.
Establish IV therapy if indicated.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the Red
Blood Cells
(2 of 4)
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the Red
Blood Cells
(3 of 4)
Sickle Cell Disease
– Sickle cell crises
Vaso-occlusive
Hematological
Infectious
– Management
Follow general treatment guidelines.
Consider analgesics.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the Red
Blood Cells
(4 of 4)
Polycythemia
– Overproduction of erythrocytes
– Occurs in patients >50 years old or
with secondary dehydration.
– Results in bleeding abnormalities
Epistaxis, spontaneous bruising, GI
bleeding
– Management
Follow general treatment guidelines.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the White
Blood Cells
(1 of 3)
Leukopenia/Neutropenia
– Too few white blood cells or neutrophils.
– Follow general treatment guidelines and
provide supportive care.
Leukocytosis
– An increase in the number of circulating
white blood cells, often due to infection.
Leukemoid reaction
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the White
Blood Cells
(2 of 3)
Leukemia
– Cancer of hematopoietic cells
– Initial presentation
Acutely ill, fatigued, febrile and weak,
anemic
Often have a secondary infection
– Management
Follow general treatment guidelines.
Utilize isolation techniques to limit risk of
infection.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the White
Blood Cells
(3 of 3)
Lymphomas
– Cancers of the lymphatic system
– Presentation
Swelling of the lymph nodes
Fever, night sweats, anorexia, weight
loss, fatigue, and pruritis
– Management
Follow general treatment guidelines.
Utilize isolation techniques to limit risk
of infection.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diseases of the Platelets
Thrombocytosis and
Thrombocytopenia
– Thrombocytosis
An abnormal increase in the number of
platelets
– Thrombocytopenia
An abnormal decrease in the number of
platelets
– Management
Provide supportive care and follow
general treatment guidelines.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Blood Clotting
Abnormalities
(1 of 2)
Hemophilia
–
Deficiency or absence of a blood clotting
factor
Deficiency of factor VIII causes hemophilia A.
Deficiency of factor IX causes hemophilia B.
Deficiency is a sex-linked, inherited disorder.
Defective gene is carried on the X chromosome.
–
Signs and Symptoms
Numerous bruises, deep muscle bleeding, and
joint bleeding.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Blood Clotting
Abnormalities
(2 of 2)
Hemophilia
– Management
Treat the patient similarly to others.
Administer supplemental oxygen.
Establish IV access.
Be alert for recurrent or prolonged bleeding,
and prevent additional trauma.
Von Willebrand’s Disease
– Deficient component of factor VIII
Generally results in excessive bleeding.
Generally is not serious; provide supportive
care.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Other Hematopoietic
Disorders
Disseminated Intravascular
Coagulation
– System activation of coagulation
cascade
– Results from sepsis, hypotension, OB
complications, severe tissue or brain
injury, cancer, and major hemolytic
reactions
Multiple Myeloma
– Cancerous disorder of plasma cells
– Pathologic fractures common
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Anatomy, Physiology, and
Pathophysiology
General Assessment and
Management
Managing Specific Patient
Problems