Hema System

Hematologic System COURSE OUTLINE A. Review on Anatomy and Physiology 1. Organs of Hematologic System 2. Blood and Blood Components 3. Immunity 4. Blood Groups and Blood Typing B. Laboratory/Diagnostic Examination 1. Complete Blood Count 2. Coagulation Screening Test 3. Antiglobulin Tests 4. Bone Marrow Aspiration and Biopsy 5. Skin Tests C. Hematologic Disorders 1. Anemia a. Iron Deficiency b. Thalassemia c. Megaloblastic d. Pernicious e. Folic Acid Deficiency f. Aplastic Hemolytic g. Sickle Cell 2. Polycythemia Vera 3. Agranulocytosis 4. Multiple Myeloma 5. Idiopathic Thrombocythopenia Purpura 6. Hypoprothrombinemia 7. Disseminated Intravascular Coagulation 8. Hemophilia 9. Leukemia 10. Lymphomas 11. Infectious Mononucleosis HEMATOLOGIC SYSTEM Consists of the blood and the sites where blood is produced including the bone marrow and the reticuloendothelial system BLOOD • Specialized organ • Differs from other organs in that it exists in a fluid state • Composed of plasma,proteins and clotting factors such as FIBRINOGEN PLASMA: fluid portion of blood, occupies 55% of total blood volume FUNCTIONS OF BLOOD • Carries oxygen and nutrients to the body cells for cellular metabolism • Carries waste products • Carries hormones, antibodies • WHEN THERE IS DANGER(-._.-) • Intricate clotting mechanism is activated to seal any leak in the blood vessels • HEMOSTASIS: balance between clot formation and clot dissolution • BONE MARROW • Site of hematopoeisis • Highly vascular • Consists of islands of cellular components (RED MARROW) separated by fat (YELLOW MARROW) • CHILD: all skeletal muscles • ADULT: pelvis,ribs,vertebrae and sternum BLOOD CELLS • Normally make up 40-45% of total blood volume HEMATOPOEISIS: complex process of formation and maturation of blood cells

RED BLOOD CELLS • Erythrocytes unnucleated biconcave disks • Has thin membrane that enable gases such as oxygen and carbon dioxide to diffuse immediately • JOB: transports oxygen between lungs and tissues ERYTHROPOEISIS: process of formation of RBC’s LIFESPAN: 120 days GRANULOCYTES NEUTROPHIL: essential in preventing or limiting bacterial infection via phagocytosis AVRG LIFE SPAN: 2 to 4 hours EOSINOPHIL: involved in allergic reactions, neutralizes histamine; digests foreign proteins,phagocytosis of parasites BASOPHIL: contains histamine, integral part of hypersensitivity reactions AGRANULOCYTES MONOCYTES: enters tissue as macrophage;highly phagocytic especially against fungus; immune surveillance LYMPHOCYTES: A. T lymphocytes: cell mediated immunity, recognizes material as “foreign” B. B lymphocytes: humoral immunity, many mature into plasma cells to form antibodies PLATELETS • Thrombocytes • Granular fragments of giant cells in the bone marrow called MEGAKARYOCYTES • Production: regulated in part by hormone THROMBOPOEITIN • JOB: essential role in the control of bleeding • LIFE SPAN: 7 to 10 days PLASMA AND PLASMA PROTEINS • ALBUMIN: maintenance of fluid balance • Produced by liver • Has capacity to bind to several substances that are transported in the plasma GLOBULIN: • Alpha • Beta • Gamma RETICULOENDOTHELIAL SYSTEM • encompasses a range of cells capable of phagocytosis - macrophages and monocytes. • mononuclear phagocytic system • maybe freely circulating within the blood or fixed to various connective tissues. • Examples of the site of fixed cells includes pulmonary alveoli, liver sinusoids, skin, spleen and joints. FUNCTIONS: • remove senescent cells from circulation • provide phagocytic cells for both inflammatory and immune responses

PRIMARY HEMOSTASIS SECONDARY HEMOSTASIS Complete Blood Count • Includes the red blood cell (RBC) count, hemoglobin, hematocrit, RBC indices, WBC count with or without differential and platelet count RBC Count • Measure the number of RBCs in mm3 • Useful in verifying findings from other hematopoietic tests for diagnosis of anemia and polycythemia • Hemoglobin level • Used to evaluate the hemoglobin content (iron status and oxygen carrying capacity) of RBCs by measuring the number of grams of hemoglobin • Complete Blood Count Hematocrit Level • Measure the volume of RBCs in the whole blood expressed as a percentage • Roughly three times the hemoglobin concentration Red Blood Cell Indices • Measures of erythocyte size and hemoglobin content • 3 indices: Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, Mean Corpuscular Hemoglobin Concentration Platelet Count • Valuable in assessing the severity of thrombocytopenia and thrombocytosis • White blood cell count • Used to detect infection or inflammation and to monitor a client’s response to or adverse effects of chemotherapy or radiation therapy • White blood cell differential • Determines the proportion of each of the 5 types of WBC in a sample of 100 WBCs • Used in evaluating the body’s capacity to resist and overcome infections, in detecting and classifying leukemias, allergies, helminthic infections and other disorders Coagulation Screening Test • Performed to discern whether the bleeding problem is related to a platelet, coagulation or vascular defect Components Platelet count Prothrombin Time (PT) Partial Thromboplastin Time (PTT) Bleeding time Platelet Count Measures the number of circulating platelets in venous or arterial blood NV = 150,000 – 450,000/mm3 Low counts results in prolonged bleeding time and impaired clot retraction; diagnostic of thrombocytopenia Prothrombin Time • Determines activity and interaction of factors V, VII and X, prothrombin and fibrinogen; determines dosages of oral anticoagulant drugs • NV = 11-15 secs • INR = 2-3.5 • Prolonged PT is seen in clients receiving anticoagulant therapy; with low or deficiencies of fibrinogen, clotting factors II, V, VII and X, impaired prothrombin activity in the presence of circulating anticoagulants as seen in SLE Partial Thromboplastin Time • Complex method for testing the normalcy of intrinsic coagulation process; employed to identify deficiencies of coagulation factors,

prothrombin and fibrinogen; used to monitor heparin activity • NV = 25-38 secs • Prolongation of time indicates coagulation disorder that is related to deficiency of a coagulation factor; not diagnostic for platelet disorders Bleeding Time • Measure ability to stop bleeding after a small puncture wound • NV = 3-8 minutes in adults • Prolonged bleeding time in severe coagulation problems and therapeutic administration of heparin Antiglobulin test • Indirect Antiglobulin test identifies antibodies to erythrocyte antigens in the serum of clients who have a greater than normal chance of developing transfusion reactions • Direct Antiglobulin test (Coomb’s test) uses • Detect certain antigen-antibody reactions between serum antibodies and RBC antigens • Differentiate between various forms of hemolytic • Determine unusual blood types • Identify hemolytic disease in newborns Bone Marrow Aspiration and Biopsy • Used to assess and identify most blood dyscrasias • Reveals the number, size, shape of the RBCs, WBCs, and platelet precursors • Most commonly taken at the posterior iliac crest; 2nd common: sternum Preprocedure Care • Explain about the procedure and that there will be pain during the procedure • Obtain informed consent • Provide sedation as prescribed • Position client on side-lying position with the side from where the biopsy will be taken uppermost • Clean client’s skin with antiseptic solution • Applying ice to the contralateral side to reduce pain Postprocedure Care • Apply pressure until bleeding stops • Pressure dressing and sandbag may be applied • Clients may require a mild analgesic for discomfort or pain • Monitor site for bleeding Skin Test • Confirm sensitivity to a specific allergen and to detect presence of antibodies • Positive reaction indicate an antibody (B cell) response to a previous exposure to the antigen • Methods • Patch test • Scratch test • Intradermal allergy test Nursing Assessment of the Hematologic System • Assessment of Patients with Disorders of the Hematologic System • Health History • History of Present Illness • Easy bruising • Prolonged bleeding • Chronic fatigue • Past Medical History • Cancer or prior treatment to cancer – immunosuppression due to chemotherapy • HIV infection - immunosuppression Past Medical History • Liver disease – liver can also be used in production of blood cells in cases of bone marrow destruction, fibrosis or scarring; this process is called extramedullary hematopoiesis

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Kidney disease – kidney is responsible for the production of erythropoietin: a kidney hormone that tends to increase the number of RBCs and cut down the need for blood transfusions in cases of chronic anemia • Malabsorption disorder - malabsorption of certain nutrients like Vit.B12, iron and folate which are needed in the production of RBCs • Prolonged bleeding • History of blood transfusions • Current medications – aspirin and other NSAIDs may prolong bleeding Family History Blood disorders – sickle-cell disease, hemophilia Death at young age for reasons other than trauma Review of Systems • Integumentary • Change in skin color • Dryness • Pruritus • Brittle fingernails or toenails • Neurologic • Dizziness • Vertigo • Confusion • Pain • Headache – may indicate low RBC count • Mental status change – intracranial bleeding from low platelet count • Change in vision • Respiratory – symptoms of low RBC count: • Epistaxis • Hemoptysis • Dyspnea • Cardiovascular – symptoms of low RBC count: • Palpitations • Chest pain • Dizziness • Postural hypotension • Gastrointestinal • Change in eating habits • Nausea • Vomiting • Bleeding • Pain • Change in bowel habits/ blood in stool • Genitourinary • Blood in urine • Heavy menses in women • Musculoskeletal • Numbness or pain in bones or joints – may indicate bleeding has occurred in the joint • Endocrine • Fatigue • Cold intolerance • Functional Assessment • Occupation & Hobbies – know patient’s job and hobbies. For eg., someone who builds models for a hobby may be exposed to unusual glues or paints, which may affect blood count • Self-concept – change in appearance because of the disease may adversely affect patient’s self-concept • Activity & Exercise • Sleep & Rest Functional Assessment • Nutrition • Interpersonal Relationships • Coping & Stress • Perception on Health • Physical Examination • Vital Signs • Tachycardia • Tachypnea • Hypotension • Height and Weight

General Survey • Responsiveness • Mood • Expression • Posture • Skin • Color • Dryness • Brittle fingernails and toenails • Bruising • Petechiae • Purpura • Ecchymosis • Head and Neck • Bleeding • Cracking at the corners of the mouth • Thorax • Respiratory rate • Breath sounds • Heart rate • Abdomen • Liver enlargement • Petechiae • Purpura • Ecchymosis • Stool guaiac test Dipstick urine sample for blood Anemia Decreased availability of oxygen to the tissues Types of anemia • Iron Deficiency Anemia • Thalassemia • Folate Deficiency Anemia • Pernicious Anemia • Aplastic Anemia • Sickle Cell Anemia Causes of Anemia • Acute/chronic blood loss • Inadequate dietary intake of vitamins/minerals needed for RBC production • Decreased RBC production by the bone marrow • Increased destruction of RBC • Increased demands for vitamins/minerals needed for RBC production Common Manifestations • Pallor and syncope • Easy fatigability and Weakness • Anorexia and Weight loss • Shortness of breath • Headache/dizziness • Tachycardia/palpitations • Brittle hair and nails • Paresthesia • Cold sensitivity • Amenorrhea • Iron Deficiency Anemia • Microscopic, hypochromic anemia • Caused by inadequate intake or excessive loss of iron, which is essential to the oxygencarrying function of heme Clinical Manifestation • Vinson-Plummer syndrome (stomatitis, dysphagia, atrophic glossitis) • Cheilosis (cracks at the side of the lips) • Koilonychias (spoon-shaped/concave fingernails) • Pica (craving for non-edible substances) • Tinnitus • Cardiovascular symptoms (tachycardia, chest pain, shortness of breath) Medical Management • Iron supplements • Should be given with food or pc to prevent GI irritation

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Oral liquid iron to be administered with straw to prevent permanent staining of the teeth Vitamin C increases iron absorption Do not administer with milk, antacid Parenteral: administer through Z track (deep IM) Can change the color of stools Nursing Interventions Promote rest to reduce oxygen demand Provide good oral care to prevent stomatitis Provide good skin care to prevent pressure sore Diet: iron rich foods such as organ meats, green leafy vegetables, raisins and other dried fruits

Thalassemia • Inherited disorder of the RBCs that results in reduced rate of normal globin chains synthesis • Classification • Alpha – defective production of A globin • Beta – defective production of B globin (Cooley’s Anemia) • Beta Thalassemia major – defect on both B globin • Beta Thalassemia minor – defect on 1 B globin • Thalassemia Manifestations • Blood cells are vulnerable to mechanical injury and easily die Management • Blood transfusion • Bone marrow transplant • Chelating agents (eg. Deferoxamine) to prevent iron build up • Megaloblastic Anemia • Causes • Poor dietary intake (deficiency of Vitamin B12 and folic acid) • Rarely eat uncooked (raw) fruits and vegetables • Alcoholism • Chronic malnutrition • Pregnancy • Anorexia nervosa • Malabsorption • Malignancy • Prolonged Total Parenteral Nutrition • Chronic hemodialysis • Megaloblastic Anemia Assessment • Cracked lips, sore tongue • Same as Pernicious anemia Collaborative Management • Well-balanced diet • Folic acid 1mg/day • Eat food from animal sources Pernicious Anemia • Macrocytic, hyperchromic anemia • Decreased intrinsic factor production by the parietal cells of the stomach • DNA synthesis and cell replication are impaired Causes • Gastric surgery • Crohn’s disease • Diagnostic Tests • Tubeless Gastric Analysis • Checks for presence of HCl in urine • HCl and instrinsic factor are both produced by the parietal cells of the stomach Schilling’s Test • Most definitive diagnostic test for pernicious anemia • Oral radioactive Vitamin B12 is administered • Collect 24-hour urine specimen

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Decreased excretion of Vitamin B12 in the urine indicates (+) pernicious anemia Assessment • “beefy”, red inflamed tongue (most characteristic manifestation) • Achlorhydria • Tingling, numbness • Lack of balance, uncoordinated movements • Confusion • Paralysis • Depression, psychosis • Jaundice (faulty erythropoiesis) • Management • Vitamin B12 supplements • Hydrochloric acid • Iron therapy • Blood transfusion as needed • Physical examination every 6 months • Folic Acid Deficiency Anemia • Results from diet lacking in foods such as green leafy vegetables, liver, citrus fruits and yeast • Associated with use of alcohol, oral contraceptives, anticonvulsant medications, antimetabolites • Causes no neurologic manifestations • Management: Folic acid supplement, Vitamin C (to help in erythropoiesis) Aplastic Anemia • Hypoplasia of the bone marrow • Fat replaced bone marrow • Pancytopenia (Anemia, Leukopenia, Thrombocytopenia) Diagnostic tests: Bone marrow aspiration/biopsy • Causes • Congenital • Acquired • Idiopathic • Infections • Medications • Heavy metals • Hepatitis Medical Management • Bone marrow transplantation • Immunosuppressive therapy • Blood transfusion as necessary • Stool softeners, high-fiber diet to avoid constipation thereby prevent rectal bleeding Nursing Management • Assess for s/s of infection, tissue hypoxia, bleeding • Frequent rest periods to reduce oxygen demands of tissue • Good oral care • Use soft-bristled toothbrush/soft swabs to prevent gum bleeding • Avoid aspirin administration • Reverse/protective isolation • Practice asepsis • Avoid fresh fruits/flowers or raw foods in the client’s unit Sickle Cell Anemia • Inherited disorder of hemoglobin synthesis resulting in tissue hypoxia and obstruction of blood vessels • Primarily affects the Blacks because the abnormal hemoglobin is more resistant to the parasite that causes malaria in Africa • Sicke cell hemoglobin (Hb S) resumes a sickle or crescent shape when deoxygenated • Once RBC sickles, it becomes rigid and blood becomes more viscous and obstructs capillary blood flow leading to more sickling • Organs commonly affected: brain, kidneys, bone marrow and spleen

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Sickle cell crisis – acute exacerbation of the disorder due to respiratory infections or other stressors that reduce blood oxygen levels Manifestations • Usually manifested at 6 months old • Weakness and fatigue • Developmental delays and growth retardation • Sluggish circulation • Infarctions Sickle Cell Crisis • Cardiac systolic murmurs, dysrhythmias, heart enlargement • Dyspnea, chest pain, cyanosis • Sensorimotor manifestations of increased intracranial pressure due to cerebral hemorrhaging • Renal manifestations of uremia, such as decreased cardiac output and edema Diagnostic Findings • Stained blood smears • Sickle cell slide preparations – blood specimen is observed after deoxygenation of blood • Sickle-turbidity tube test – blood is mixed with a solution and observed for cloudiness • Hemoglobin electrophoresis – differentiates sickle cell anemia from sickle cell trait Management • Supportive care • Administration of packed RBC • Anticoagulants, steroids, cobalt treatments • Hydroxyurea and erythropoietin • Fluids to prevent dehydration • Provide rest periods • Avoid high altitudes • Client teaching on the possibility of being a carrier of the trait • Polycythemia Vera • Hyperplasia of the bone marrow • Increased RBC (erythrocytosis), increased WBC (leukocytosis), increased platelets (thrombocytosis) • Cause is unknown; associated with genetics Signs and Symptoms • Ruddy complexion • Headache • Dizziness • Fatigue • Blurred vision • Hepatosplenomegaly • Increased risk of CVA and MI due to thromboembolism Collaborative Management • Increase fluid intake to reduce blood viscosity • Monitor for signs and symptoms of bleeding • Monitor for signs and symptoms of thromboembolism • Angina • Claudication • Thrombophlebitis • pruritus Collaborative Management • Administer analgesics as ordered • Administer antihistamine to decrease pruritus • Therapeutic phlebotomy to reduce circulating volume • Chemotherapy to inhibit hyperactivity of the bone marrow • Radiation therapy • Avoid high altitude Agranulocytosis • Acute, potentially fatal blood dyscrasia characterized by profound neutropenia (decreased neutrophils) • More common in females • Associated with chemotherapy, radiation, aplastic anemia, drug toxicity, autoimmune diseases, hypersensitivity

Clinical Manifestations • Severe fatigue and weakness • Sore throat, ulcerations of oral mucosa • High fever and severe chills • Absence of granulocytes on bone marrow aspiration Leukopenia Specimen cultures that are positive for bacteria Management Elimination of potentially toxic agents Surveillance cultures of blood, throat, sputum, urine and stool Erythropoietin Granulocyte-stimulating factor Multiple Myeloma • B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells • Associated with heredity, radiation and occupational chemical exposures • Crowding of plasma cells in the bone marrow results to bone destruction, disruption of RBC, WBC and platelet production Manifestations • Backache or bone pain • Pathologic fractures with severe pain • Sternum and rib cage deformities • Osteoporosis • Diffuse bone lesions • Renal stones • Immobilized clients • Bence-Jones protein in the urine • Management • Aimed at early recognition and treatment of the complications • Chemotherapy • Palliative radiation • Bone marrow transplantation • Etidronate disodium (Didronel) or Gallium nitrate (Ganite) to decrease serum calcium levels • Increase oral fluids • Antiemetics, stool softeners as ordered • Idiopathic Thrombocytopenic Purpura • Autoimmune bleeding disorder characterized by the development of autoantibodies to one’s own platelets, the binding of autoantibodies to antigens and the destruction of platelets in the spleen Clinical Manifestations • Petechiae, ecchymosis, epistaxis • Bleeding gums and easy bruising • Heavy menses or bleeding between periods in women • Thrombocytopenia • Prolonged bleeding time • Bone marrow aspirate containing increased number of megakaryocytes • Complications • Cerebral hemorrhage • Severe hemorrhages from the nose, GIT and urinary system • Bleeding into the diaphragm • Nerve pain, paralysis, paresthesia • Management • Steroids to inhibit the macrophage ingestion of the antibody-coated platelets • Plasmapheresis • Splenectomy • Chemotherapy • IV gamma globulin to increase platelet count Hypoprothrombinemia • Deficiency in the amount of circulating prothrombin

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Develops from Vitamin K deficiency or liver damage or from overdose of coumadin and aspirin, prolonged antibiotic administration that sterilizes the bowel • Danger of bleeding or spontaneous hemorrhage occurs Clinical Manifestations • Ecchymosis • Epistaxis • Postoperative hemorrhage • Hematuria • GI bleeding • Prolonged bleeding from venipuncture Management • Treatment of underlying cause • Vitamin K supplement such as Phytoadione (Aquamephyton) or menadione (Synkayvite) • Stop anticoagulant therapy • Transfusion of prothrombin concentrates Disseminated Intravascular Coagulation • Complex syndrome of activated coagulation that results in bleeding and thrombosis • Imbalance between thrombin (causes thrombosis) and plasmin (causes lysis) that occur simultaneously • Causes: infection, introduction of tissue coagulation factors into the circulation, damage to vascular endothelium, stagnant blood flow Clinical Manifestations • Acute - hemorrhagic condition associated with excess plasmin formation • Subacute - not apparent initially but becomes severe as it progress • Thrombosis attributed to excessive formation of thrombin • Chronic- seen in clients with cancer or in women carrying dead fetus • thrombosis • Acute Manifestations (hemorrhagic) • Purpura, petechiae, ecchymoses • Prolonged bleeding from venipuncture • Severe, uncontrolled hemorrhage • Excessive bleeding from gums and nose • Intracerebral and GI bleeding • Renal hematuria • Tachycardia and hypotension • Dyspnea, hemoptysis, respiratory congestion Management • Identification and elimination of causative factor • Reinstitution of hemostasis by replacing missing blood components • Provision of supportive therapy • Antibiotics for infection • Monitor laboratory values Hemophilia • X-linked genetic disorder that results in a deficiency of coagulation factors that causes spontaneous bleeding • Forms • Hemophilia A (classic form) – due to deficiency in factor VIII • Hemophilia B (Christmas disease) – due to deficiency in factor IX • Von Willebrand’s disease –deficiency in factor VIII and defective platelet function Clinical Manifestations • Bleeding that usually presents at circumcision or at the beginning of ambulation or primary dentition • Hemarthrosis (bleeding into the joints) – hallmark of hemophilia

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All forms of bleeding (bleeding gums, hematuria, gastric hemorrhage, intracranial bleeding, etc.) Management • Stop topical bleeding asap • Supply the missing clotting factor causing the hemorrhage • Prevent complications leading to and caused by bleeding • Joint immobilization and ice pack for hemarthrosis • Analgesics and corticosteroids • Leukemia • Chronic or acute neoplasm of blood-forming cells in the one marrow and lymph nodes Causes • Idiopathic • Viral • Genetic • Radiation • Chemicals • Types of Leukemia • Acute Myelocytic Leukemia • Malignant disorder that affects monocytes, granulocytes, erythrocytes, platelets • Survival: 1-3years (with chemotherapy); 2-5 months (if untreated) Types of Leukemia Chronic Myelocytic Leukemia • Malignancy of the myeloid stem cells that leads to uncontrolled proliferation of granulocytes • Most common type of leukemia in adults • Characterized by the presence of Philadelphia chromosomes • Survival: 3-5 years (if without bone marrow transplantation) Acute Lymphocytic Leukemia • Malignant proliferation of lymphoblasts arising from a disorder of a single lymphoid stem cell • Most common type of leukemia among children • Survival: 5 years (with chemotherapy and radiation therapy) • 50% can be cured Chronic Lymphocytic Leukemia • Caused by a proliferation of small, abnormal Blymphocytes • Survival: 5-7 years Management • Chemotherapy • Bone marrow transplantation • Blood transfusion • Protect from infection • Prevent trauma and bleeding • Conserve energy/oxygen supply LYMPHOMAS • Malignant lymphomas • Neoplastic disorders • Lymph nodes • Spleen • Painless lymphadenpathy • Splenomegaly Types • Hodgkin’s disease (Lymphadenoma) • Lymphosarcoma • Burkitt’s Lymphoma (Stem cell lymphoma) Assessment • General malaise • Sweating • Fever • Fatigue • Weight loss Hodgkin’s Lymphoma • Cause: unknown • Common among males, adolescents, young adults Stages of Hodgkin’s Disease

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Stage 1 - involvement of a single lymph node Stage 2 – involvement of 2+ lymph node region on same side of diaphragm • Stage 3 – involvement of lymph node regions on both sides of diaphragm • Stage 4 – diffuse or disseminated involvement of 1+ extra lymphatic organs, with or without lymph node involvement (liver, lung, marrow, skin) Clinical Manifestation • Painless lymphadenopathy • Reed-Sternberg cells are the malignant cells • Pain (pressure on nerves) • Edema (obstruction of venous/lymph drainage) • Cough, dyspnea, dysphagia (enlarged mediastinal nodes) • Abdominal pain (splenomegaly) Management • Radiation therapy • Chemotherapy • MOPP (Nitrogen Mustard, Oncovin, Procarbazine, Prednisone) • Supportive Care • Protect client from infection • Splenectomy is done in advanced disease • INFECTIOUS MONONUCLEOSIS • Benign • Infectious • Lymphatic system is affected • Epstein Barr Virus (EBV) is the causative agent Assessment • Sore throat • Gingivitis • Headache • Fatigue • Anorexia • Body malaise • Fever Lymphadenopathy • Abdominal tenderness • Increased WBC • Self-limiting • High risk groups • Homosexual-anal intercourse • Bisexual males – anal intercourse • IV drug users • Infants: HIV-infected parents • Blood/blood products before 1985 Manifestations • Fever • Diarrhea • Muscle aches • Rashes • Weight loss • Night sweats • Persistent generalized lymphadenopathy • Management • Treatments are aimed at controlling the manifestations • Bed rest • Acetaminophen, TSB, fluids for fever • Warm saline for sore throat • Avoid aspirin • Avoid contact sports

Laboratory Normal Values CBC RBC

: (male) 4.6-6.2 M/cu. mm. (female)4.2-5.4 M/cu. mm.

WBC

: 5,000-10,000/cu. mm.

PLT

: 100,000-400,000/cu. mm.

HGB

: (male) 13-18 gm/dL (female)12-16 gm/dL

HCT

: (male) 42-50%. (female)40-48%

Differential Count Lymphocytes : Neutrophils : Monocytes : Eosinophils : Basophils : ABG pH paCO2 HCO3 PaO2 O2 Sat. :

20-40% 60-70% 2-8% 1-4% 0.5-2%

: 7.35-7.45 : 35-45 mmHg : 22-26 mmol/L : 80-100 mmHg 94-100% 90-110 : adequate 80-89 : mild hypoxia 70-79 : moderate hypoxia ↓69-69 : severe hypoxia

Urinalysis Color Sp. Gravity pH Glucose Sodium Potassium Chloride : Protein Osmolality

: yellow - straw : 1.010-1.030 : 5.0-8.0 : negative : 130-200 mEq/24h : 40-65 mEq/24h <8mEq/L : negative-trace : 270-380 mOsm/L

General Chemistry Sodium : Potassium : Calcium : Magnesium : Phosphate :

135-145 mEq/L 3.5-5.0 mEq/L 8.5-10.5 mg/dL 1.3-2.4 mEq/L 2.5-4.5 mg/d

Blood Coagulation PT : 9.5-12 sec. PTT : 20-45 sec. (activated) Bleeding Time ESR

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(male) : (female):

1-9 min. <15 mm/h [under50] <20 mm/h [under50]

BUN : 6-23 mg/dL Creatinine : 0.7-1.4 mg/dL Cholesterol : 150-200 mg/dL Glucose : 60-110 mg/dL Iron : 50-160/µg/dL Lactic Dehydrogenase:100-225 U/L Uric Acid : 2.5-8 mg/dL Zinc : 55-150 /µg/dL Lead : up to 40 µg/dL

Levels of Compensation: pH is Nº : Fully Compensated pH is Abº (look at opposite partner) Nº : Uncompensated Abº: Partial Compensation