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