Hematology is: 

The study of blood and blood - forming tissues

which includes the bone marrow, blood, spleen, and

lymph system 

Assessment of the hematologic system is based on:

the pt's health history, physical exam, and results of diagnostic tests 

hematopoiesis is: 

the blood cell production that occurs within the bone marrow 

Bone marrow is: 

the soft material that fills the central core of bones

There are two types of bone marrow: 

Yellow (adipose)

and

Red (hematopoietic)

The marrow that actively produces blood cells is: 

The red marrow 

There are three types of blood cells: 

RBCs, WBCs, and platelets 

The stem cell is: 

a nondifferentiated immature blood cell found in the bone marrow 

Blood is considered what type of tissue? 

Connective tissue 

Blood has three major functions: 

transportation, regulation, and protection 

Blood transports: 

oxygen, nutrients, hormones, and waste products around the body 

Blood regulates: 

fluid, electrolytes, and acid-base balance 

Blood protects the body in:

 its ability to clot and combat infections

There are two major components of blood: 

plasma and blood cells 

Approximately 55% of blood is? 

plasma 

Leukocytes are? 

White blood cells (WBCs) 

Leukocytes originate from the? 

stem cells within the bone marrow 

There are 5 different types of Leukocytes: 

Lymphocytes

Monocytes

Basophils

Eosinophils

Neutrophils 

The only two mononuclear cells are: 

Lymphocytes and Monocytes 

Basophils, Neutrophils, and Eosinophils are also known as: 

Polymorphonuclear leukocytes or granulocytes 

The primary function of a granulocyte is: 

phagocytosis which is the process by which WBCs

ingest or engulf any unwanted organism and then

digest and kill it

The most common type of granulocyte is: 

The neutrophil (making up 50-70% of all WBCs) 

Neutrophils are the primary phagocytic cells involved in: 

Acute inflammatory responses

A mature neutrophil is called a: 

Segmented neutrophil or a "Seg" or polysegmented

neutrophil because the nucleus is segmented into

2 - 5 lobes connected by strands 

An immature neutrophil is called a: 

Band (for the band appearance of the nucleus) 

Eosinophils account for: 

2-4% of all WBCs and have a reduced ability for phagocytosis 

Primary function of the Eosinophil is: 

to engulf antigen-antibody complexes formed during an allergic response

The are also able to defend against parasitic infections 

Basophils make up less than: 

2% of all leukocytes and have a limited roll in phagocytosis 

Basophils have: 

cytoplasmic granules that contain heparin, serotonin, and histamine

this cell is used for the allergic and inflammatory reactions 

Lymphocytes are agranular and make up: 

20-40% of the WBCs 

Lymphocytes form the basis of the: 

cellular and humoral immune responses

Two lymphocyte subtypes are:

B cells and T cells 

T cells originate in the _____________

and migrate to the _________________. 

bone marrow

and

thymus gland 

Monocytes are the other agranular leukocytes that make up: 

4-8% of the total WBCs

they are potent phagocytic cells and can ingest small or large masses of matter such as bacteria, dead cells, tissue debris, and old or defective RBCs

These cells are only present in the blood for a short time then migrate into the tissues and become macrophages 

Resident macrophages around the body are called: 

Kupffer cells (in the liver)

Osteoclasts (in the bone)

Alveolar macrophages (in the lungs)

these macrophages protect the body from pathogens at there respective entry points and are more phagocytic than monocytes 

Macrophages also interact with lymphocytes to facilitate: 

the humoral and cellular immune responses 

Iron 

obtained thru food and dietary supplements and absorbed in the duodenum and upper jejunum

only 5-10% of ingested iron is absorbed 

As part of normal iron metabolism, iron is recycled after: 

macrophages in the liver and spleen phagocytize, or ingest and destroy old and damaged RBCs 

1/3 of iron is stored as ferritin and hemosiderin (a degraded form of ferritin) in the: 

bone marrow, spleen, liver, and macrophages

when the stored iron is not replaced, hemoglobin production is reduced 

Hemostasis is: 

the blood clotting process 

4 components contribute to normal hemostasis: 

1-vascular response

2-platelet plug formation

3-the development of the fibrin clot on the platelet plug by plasma clotting factors

4-the ultimate lysis of the clot 

Fibrinolysis is: 

the process resulting in the dissolution of the fibrin clot

If fibrinolysis is excessive: 

the pt will be predisposed to bleeding 

The spleen has 4 major functions: 

hematopoietic, filtration, immunologic, and storage

Hematopoietic function is : 

manifested by the spleen's ability to produce RBCs during fetal development

Filtration function is: 

demonstrated by the spleen's ability to remove old and defective RBCs from the circulation by the mononuclear phagocyte system

Filtration also involves the reuse of iron

It also filters circulating bacteria, especially encapsulated organisms such as gram-positive cocci 

Immunologic function of the spleen is by way of: 

The spleen's rich supply of lymphocytes, monocytes, and stored immunoglobulins 

The storage function of the spleen is reflected in: 

its role as storage site for the RBCs and platelets

Approx. 30% of the platelet mass is stored in the spleen 

The lymph system consists of: 

lymph fluid, lymphatic capillaries, ducts, and lymph nodes

it carries fluid from the interstitial spaces to the blood

it also returns excess interstitial fluid to the blood 

Lymph fluid is: 

pale yellow interstitial fluid that diffused thru lymphatic capillary walls 

When too much interstitial fluid develops or when something interferes with the reabsorption of lymph _________________ develops. 

lymphedema 

The lymphedema that may occur as a complication of mastectomy or lumpectomy with dissection of axillary nodes is often caused by: 

the obstruction of lymph flow from the removal of lymph nodes 

lymphatic capillaries are thin-walled vessels and larger than blood capillaries, and do not contain_______________? 

valves 

The liver functions as a? 

Filter, it also produces all the procoagulants that are essential to hemostasis and blood coagulation

The liver also stores iron that is in excess of tissue needs 

GERONTOLOGIC CONSIDERATIONS OF THE HEMOTOLOGIC SYSTEM: 

Red marrow and the amt of stem cells decrease

Stem cells are replaced with nonfunctioning fat cells 

Hemoglobin decreases in men and women

Iron absorption is not impaired

Nutritional intake of iron may be impaired

Osmotic fragility of RBCs is increased

Platelets are unaffected

MCV have slight increase

MCHC have a slight decrease

The spleen can be found in what area of the abdomen? 

The LUQ

the spleen produces Lymphocytes and monocytes

Destroys old RBCs

Forms bilirubin

Not a vital organ 

The thymus

Found below the thyroid gland in front of trachea

Produces t-cells nad hormones that mature the immune system 

Effects of aging: 

Decreased amt of red bone marrow and stem cell production

RBCs are produced slower

Less effective immune system

Delayed clotting 

Pancytopenia is: 

a marked decrease in:

RBCs

WBCs

Platelets

The pt's care is directed towards the mgmt of anemia, infection, and hemorrhage 

Shift to the left means: 

immature bands of neutrophils 

A bone marrow examination consists of:

puncture site over the iliac crest, use of lidocaine at puncture site, aspiration of 0.2 - 0.5 ml of bone marrow 

the site is covered with a sterile pressure dressing

The pt should lie on that side for 30-60 mins to maintain pressure on the site

Open needle biopsy:

an incision is made and the lymph node and surrounding tissue are dissected (excised) whenever possible

performed in OR or procedure area under local or general anesthesia 

Closed needle biopsy:

(aka fine needle aspiration)

performed to analyze lymph tissue, performed by physician at the bedside or in an outpt area

Sterile technique is essential thru out procedure

extremely small needle is used to reduce risk of tracking malignant cells thru normal subQ tissue 

Bence Jones Protein test 

nsg responsibility:

Acquire random urine specimen 

negative finding is normal

used to detect multiple myeloma 

Bone, Liver, or Spleen scan: 

radioactive dye is used with the CT scan

It evaluates the structures

nsg responsibility:

keep pt well hydrated for excretion of dye thru urination

pt is not a source of radioactivity 

Noninvasive procedures: 

Liver, spleen, or abdominal ultrasound

CT computed tomography

MRI magnetic resonance imaging

Radioisotope studies: 

Liver/spleen scan - radioisotope is injected IV

Bone scan - same procedure as for the spleen scan 

When palpating the lymph nodes be aware of: 

enlarged, palpable, and tenderness

be aware of the degree of fixation (movable or fixed)

texture

Size in centimeters

Symmetrical in location 

Thrombocytes are:

Leukopenia is:

Neutropenia is: 

Platelets

abnormal decrease in # of WBCs

abnormal decrease in # of neutrophils 

Shift to the left is important in: 

neutrophil count, the existence of many immature neutrophils is termed "shift to the left" 

Epistaxis is:

Petechiae are:

Arthralgia is: 

Nose bleed

small purplish lesions

joint pain 

Lymph nodes that are enlarged and tender are usually associated with: 

an acute infection 

There are approximately _______lymph nodes in the

body  with the greatest number in the__________.

200

abdominal area surrounding the GI tract

Lymph nodes are found both superficially and deep

Superficial lymph nodes can be palpated, deep nodes require radiologic examinations 

Normally both the liver and the spleen ________ palpable. 

ARE NOT

when they are enlarged they may be detectable by percussion and palpation

The degree of enlargement of the liver is measured by the # of fingerwidths it extends below the rib border 

Lymph nodes should be small, mobile, firm, and nontender

however : 

tender nodes are usually a result of inflammation

hard or fixed nodes suggest malignancy

Petechiae is:

Eccymosis is:

Spider nevus is: 

small purplish-red lesions

bruising

a form of telangiectasia