nemato|ogy

Aerob|c Metabo||sm process of creaLlng A1 ln Lhe presence of C2

3638 A1 per 1 glucose molecule + C2

Anaerob|c Metabo||sm 2 A1
CreaLed 8y Crganelle MltocbooJtlo
SkeleLal muscle Llssue needs more A1 Lherefore Lhey have more MlLochondrla
Same wlLh Lhe PearL so lL depends on whlch parL of Lhe were Lalklng abouL

ma[or organs for oxygenat|on
8esplraLory
PearL
vascular SysLem
PemaLologlc SysLem
88C

oy JlsotJet offectloq tbese systems wlll offect oxyqeootloo
1 coose of motblJlty ooJ mottollty cotJlo voscolot Jlseose

|ood
1 lormed elemenLs 43 + lasma 33
2 App 90 waLer and 10 SoluLes
3 normal blood volume 33 L (adulL)

ftet ceottlfoqe
lasma
8uffy coaLW8C plaLeleLs
LryLhrocyLes


nct|on of 8lood
1 uellvery of subsLances needed for cellular meLabollsm ln Lhe Llssues
2 uefense agalnsL lnvadlng mlcroorganlsms and ln[ury
3 Acld8ase 8alance

|asma and p|asma prote|ns
Complex aqueous llquld conLalnlng several organlc and lnorganlc elemenLs waLer elecLrolyLes
roLelns gases nuLrlenLs and wasLe producLs
ConcenLraLlon depends on dleL and meLabollsm
etom plosmo LhaL has been alLered Lo remove flbrlnogen or some oLher elemenLs
lasma proLelns domlnanL elemenLs by welghL

ma[or p|asma prote|ns
1 Albumln (4g/dl) produced by Lhe llver
a CncoLlc pressure LhaL regulaLes Lhe passage of waLer and soluLes
b Carrler molecule (drugs)
ocotlc ltessote lolls
nyJtostotlc ptessote losbes
Jepoote lbomlo lo tbe blooJ ollows ocotlc ptessote to poll excess lotetstltlol flolJ loto tbe blooJ
vessel so lt Joes occomolote
lvet Jomoqe os lo llvet etosls cooses o Jecteose lo lbomlo wblcb bloJets tbe oocotlc ptessote oeeJeJ
to poll tbe lotetstltlol flolJ loto tbe blooJ vessel coosloq Jemo
*lbomlofoooJ lo eqq wbltes (6 pet Joy)

Immnog|ob||n (ant|bod|es)
a manufacLured by plasma cells ln lymph nodes
llosmo cells creaLe Clobulln
lvet CreaLe lmmunoglobulln
3 CloLLlng facLors (llbrlnogen)
a mosL abundanL
b precursor of Lhe flbrln cloL

ther p|asma prote|ns and e|ements
complemenL proLeln
plasma llplds
elecLrolyLes

A Lrythrocytes (k)
a mosL abundanL cells of Lhe blood
b 48 of blood volume ln men
c 42 of blood volume ln women
d 120 day llfe span
e cyLoplasm conLalns mosLly hemoglobln and elecLrolyLes
f lacks cyLoplasmlc organelles
g can'L synLheslze proLeln
g can'L carry ouL oxldaLlve reacLlons
h can'L undergo mlLoLlc dlvlslon (120 day llfe)

ropert|es of k#s
8lconcave
8everslble deformablllLy (can change lnLo Lorpldo llke shape Lo squeeze Lhrough Lhe small caplllarles)
*SmallesL blood vessel 2 mlcrons
*88C's average slze 8 mlcrons
Also releases nlLrlc Cxlde Causes vasodllaLlon
s k8s qe tbey bove less oblllty to cbooqe sbope

Leocytes (W)
uefenders
AcL prlmarlly ln Llssues buL are LransporLed ln Lhe clrculaLlon
Larger and more spherlcal Lhan 88Cs and less flexlble

Gran|ocytes
1 neuLrophlls 8acLerlal lnfecLlon 3070 (mosL abundanL)
2 8asophlls Allerglc reacLlons 01
3 Loslnophlles Allergles and paraslLlc lnfesLaLlon (Worm lnfesLaLlon) 24

Agran|ocytes
1 LymphocyLes 36 vlral lnfecLlon
2 Macrophages
*Can also be caLegorlzed as hagocyLes and lmmunocyLes (Cnly one lmmunocyLe LymphocyLe)


Natra| k|||er e||s
a 8esemble lymphocyLes
b kllls Lumor cells vlruslnfecLed cells

D |ate|ets
a 140000 340000/mm3 blood
b Not cells bot Jlsk sbopeJ cytoplosmlc ftoqmeots
c LssenLlal for blood coagulaLlon and conLrol of bleedlng
d no nucleus no unA
e lncapable of mlLoLlc dlvlslon
f cootolos cytoploosmlc qtoooles copoble of teleosloq blocbemlcol meJlotots wbeo stlmoloteJ by lojoty
to o blooJ vessel
g 10 day llfespan
h AddlLlonal 1/3 ln reserve pool ln spleen

reat|on of |ate|ets
Meqokotyocyte eoJomltosls ltoqmeototloo plotelets

I Lympho|d rgans
AggregaLes of lymphold Llssue

|ass|f|cat|on
a r|mary |ympho|d organs

thyms degress wlLh age
Cver acLlve Lhymus 1hymoma myasLhenla gravls
8one Marrowall produced ln bone marrow
lllac reglon of Lhe elvls conLalns Lhe mosL bone marrow nexL slLe Lhe sLernum
8ed acLlvely produclng cells
?ellowlnacLlve fllled wlLh faL
b Secondary |ympho|d organs

Sp|een (wlLhouL a spleen predlsposed Lo cerLaln lnfecLlons pnumococcl lnfecLlons)
|ymph node
tons||s
eyer#s patches (1yphold fever causes Lhem Lo become lnflamed and can even cause perlLonlLls)
(*lympbolJ otqoos llok tbe bemotoloqlc ooJ lmmooe systems)


IIII Mononc|earhagocyte System (MS)
A llne of cells LhaL orlglnaLes ln Lhe bone marrow LransporLed by bloodsLream dlfferenLlaLe lnLo
monocyLes seLLle ln varlous Llssues as maLure macrophages
MosLly ln llver and spleen

Macrophage enLer Lhe llve kuppfer cells

mlctoqllol cells CnS
Mesooqlol cells kldney
steoclosts bone
ueoJtltlc cells skln

II o|on st|m|at|ng factors
soluble medlaLors secreLed by cells for cell Lo cell communlcaLlon
conLrol producLlon maLuraLlon fxn of granulocyLes and monocyLes
Macrophages and developmenL of blood cells
Lx LryLhropoleLln !CA sLlmulaLes bone marrow Lo creaLe 88C
CMCSl (granulocyLe monocyLe colony sLlmulaLlng facLor)
* PemaLopolesls blood cell producLlon occurs ln Lhe llver and spleen of feLus afLer blrLh ln bone marrow
(Medullary PemaLopolesls)
WhaL Lhe body needs Lhe bone marrow wlll provlde

@wo mojot stem cells MyelolJ ooJ ympbolJ stem cells

nemog|ob|n Synthes|s
1 Cxygen carrylng proLeln
2 Approx 90 of cells dry wL
3 CyLoplasm conLalns 300 hgb molecules
4 Lnables blood Lo LransporL 100x more oxygen (1han could be LransporLed dlssolved ln plasma alone)
Pemo nemog|ob|n globln


lron (lerous 1ype le2++) and roLoporphyrln 2Alpha and 28eLa
lerrlc (le3++)MeLhemoglobln

1ypes of nemog|ob|n

nb A (a2 82) ma[or adulL haemoglobln
nb A1c( a2)(8nPglucose) (ClycosylaLed hgb) wlll show glucose conLrol for Lhe prevlous 34 monLhs
(noL more LhaL 7 of Lhe LoLal hemoglobln) 7 of adulL Pgb lncrease ln dlabeLes (more Lhan 7 you
have noL been able Lo conLrol glucose )

nb A (A2 Cama 2) 2 of adulL Pb lncrease ln 82Lhalassemla
nbMa[or feLal Pgb from 3 9 mos ACC
romoLes C2 Lransfer across placenLa lncrease 8 may cause Lhalassemla

(oftet 120 Joys tbe k8c wlll qo to spleeo ooJ tbe moctopboqes wlll klll tbem)

nemeg|ob||n
Peme 88C lron wlll be used roLoporphysn 8y producL of 88C deaLh 8lllrubln
Clobulln AA

PemolyLlc anemlas !aundlce due Lo lncrease ln blllrubln

Mechan|sm of nemostas|s
ArresL of bleedlng
malnLenance of relaLlvely sLeady sLaLe of blood volume pressure and flow Lhrough ln[ured blood
vessels

nemostas|s
ttest of bleeJloq
|mportant anatom|c compartments of hemostas|s
1 laLeleLs
2 8lood proLelns (cloLLlng facLors)
3 vasculaLure

Iasc|ar damage and b|eed|ng

1 vasoconsLrlcLlon (vasospasm)

2 formaLlon of plaLeleL plug

3 AcLlvaLlon of Lhe coagulaLlon cascade

4 formaLlon of blood cloL (w/ln 43 mlns of vessel ln[ury)

3 CloL reLracLlon of cloL dlssoluLlon (flbrlnolysls)

Cnce heald plosmlooqeo plasmln by LA wlll eaL Lhe blood cloL (flbrlnolysls)
1lssue plasmlnogen AcLlvaLor can also be used for arLery revasculllzaLlon

oag|at|on ascade serles of enzymaLlc recaLlons among Lhe cloLLlng facLors
each coagulaLlon facLor ls converLed Lo lLs acLlve form by Lhe precedlng facLor
In|t|ated throgh
1 1he |ntr|ns|c pathwayPageman facLor (xll) ln plasma comes lnLo conLacL wlLh subendoLhellal
subsLances exposed Lo vascular ln[ury
2 1he extr|ns|c pathwayacLlvaLed when Llssue LhromboplasLln released from endoLhella cells conLacLs
wlLh oLher cloLLlng facLors
3 llnal common paLhway ls acLlvaLed facLor x (sLuarLprower facLor)

*11 (arLlal 1hrombln 1lme)lnLrlnslc
*1 (roLhrombln 1lme)LxLrlnslc

ontro| of nemostat|c Mechan|sms

propert|es of the vasc|ar endothe||m to prevent c|ott|ng

1 SmooLh LexLure of Lhe endoLhellal llnlng (revenLs adherence of plaLeleLs)
2 negaLlve charge of proLeln ln Lhe endoLhellal cells (repels neg Charged plaLeleLs and cloLLlng facLors)
damage Lo endoLhellum desLroys boLh Lhese properLles
SIII |ood grop and typ|ng A

ls lnherlLed as an auLosomal LralL
1yped accordlng Lo Lhe anLlgens
otlqeos foooJ lo tbe top loyet of tbe k8c otlboJles foooJ lo tbe etom

2 Mojot ootlqeos ooJ 8
unlversal donor Lype C
8eclplenLs blood aLLacks wlLh AnLlbody
rlncess Lo donaLe Lo Lrvln
tvlo type ltlocess @ype 8
AnLlgen A AnLlgen 8
AnLlbody 8 AnLlbody A

AnLlbody 8 wlll aLLack anLlgen 8 whlch wlll cause PemolyLlc 8xn( Pemolyses) ln Lhe blood of Lrvln

kn
8P + u anLlgen
1
sL
baby no effecL
2
nd
baby be effecLed (LryLhroblasLosls leLalls)
revenLlon by ln[ecLlon of 8hogam afLer 1
sL
blrLh wlLh each blrLh LhaL has Lhe same lssue
lndlrecL 8oomb's LesL Lo deLecL lf moLher has anLlbodles agalns Lhe blood


Spec|a| rocedres
|ood 1ransfs|onglven Lo replace needed blood componenLs because of hemorrhage anemla cloLLlng
dlsorder or blood deflclencles

Anem|a88C Lransfuslon
ulotetlcs fot flolJ ovetlooJ loslcsloop Jlotetlcs

1 Whole 8loodCells and plasma
2 acked 88C
3 lresh lrozen lasmafor bleedlng problems (Pemophllla) lack of cloLLlng facLors
4 laLeleLsfasL drlp
3 CryopreclplLaLe
6 CranulocyLescommon allerglc reacLlons (anaphylaxls)

Nrs|ng respons|b|||t|es
1 re ConsenL ls Lhe mosL lmporLanL
Intra
a Lypes of blood reacLlons (sLarL slowly and waLch for reacLlon ln Lhe flrsL 13 mlnuLes)
PemolyLlc 8eacLlons (backace ollgurla uC8 chesL paln
lebrlle reacLlon (MosL common reacLlon)
Allerglc 8eacLlon (8ashes prurlLls)
8acLerlal 1ransfuslon (lever)
clrculaLory overload
1ransfuslon assoclaLed CvPu graph vs hosL dlsease can occur monLhs and years laLer
ost
Cnly use laln nSS use Lhe largesL gage (18) no more Lhan 4 hours)
lf Lhere ls reacLlon sLop and open Lhe maln llne Lo prevenL cloL and check v/S and refer Lo Lhe u8 And
reLurn blood back Lo Lhe lab
lndepend Lhen dependend care always
you sLlll have Lo monlLor for delayed reacLlons

one Marrow Asp|rat|on and b|opsy
osLerlor lllac cresL
Lo assess and ldenLlfy mosL blood dlsorders
LxamlnaLlon of Lhe 8M reveals Lhe number slze and shape of Lhe 88C W8C and laLeleL
osLerlor lllac cresLmosL common slLe An alLernaLlve slLe ls Lhe sLernum

Steps
1 Lxplaln Lhe procedure
2 ConsenL
3 oslLlon (slde lylng feLal(slms) suplne)
4 AnLlsepLlc soluLlonbeLadlne
3 cc wlll be Laken
Apply dlrecLlon pressure Lo prevenL bleedlng
MosL common compllcaLlon ls bleedlng

Anemias, PIateIets and CIoting factors.


D|sorders Affect|ng ked |ood e||s

Anem|as
a reducLlon ln red blood cells whlch ln Lurn decreases Lhe oxygen carrylng capaclLy of blood
noL a dlsease ln lLself buL reflecLs an abnormallLy ln 88C number sLrucLure of funcLlon
2 ttotcbes to ltoo compooeot of boemoqloblo

lot ooemlc potleots u\ ctlvlty lotoletooce

Anemla ls a manlfesLaLlon of a dlsease
4 c/ossificotions of onemio
1 Normocytic nypochromic 4nemio k8c slze ls ootmol bot tbe colot ls pole
x 8ecoose of cbtoolc blooJ loss
2 Microcytic nypochromic 4nemio moll ooJ pole
ex ltoo Jeflcleocy ooemlo (lu)
l Mocrocytic 4nemio 8lq
x vlt 812 ooJ follc clJ yoo oeeJ tbem to motote ( lmmotote tbc blq motote smoll)
45ick/e 4nemio loq llke

lron ueficiency 4nemio
Most commoo
ssocloteJ wltb eltbet looJepoote obsotptloo ot excesslve loss of ltoo
cbtoolc mlctocytlc bypocbtomlc ooemlo
cooseJ by looJepoote sopply of ltoo oeeJeJ so syotbeslze boemoqloblo (ltoo ls esseotlol to tbe 2
cottyloq fooctloo of beme wltboot lt tbe mottow ptoJoces k8cs tbot ote Jeflcleot lo boemoqloblo
cooceottotloo

isk loctors
1 cbtoolc blooJ loss ( meoses lo womeo Cl bleeJloq lo meo)
2 losofflcleot lotoke of ltoo
J lmpolteJ obsotptloo of ltoo
4 xcesslve JemooJs fot k8c ptoJoctloo

lood
lotetool otqoos leofy qteeo veqetobles

Pothophysio/oqy
1 ockloq bemoqloblo Jecteose ptoJoctloo of k8c
2 lmpolteJ 2 ttoospott
J looJepoote 2 to tlssoe (bypoxlo)
4 lollot (especlolly ooteJ ot polm lloes ooll beJs coojooctlvo cltcomotol oteos)
cbelloslsctocks ot tbe cotoet of tbe mootb
kollooycblo spooo sbopeJ floqetoolls
bottoess of 8teotb
uyspoeo oo exettloo
lolpotloos
lotlqoe
nypoteoslooespeclolly lf tbe clleot bos lost o lot of blooJ

@be most commoo coose of bypoxlo ls lscbemlo

Lob findinq
1 bqb low os 6 q/Jl
2 MoJetotely teJoceJ totol k8 cooot totely Jtopploq below J mll cells/mmJ
J low setom ltooJecteoseJ to 10 mq/Jl (Nv010mq/Jl)

Medico/ Monoqement
1 2 tbetopy
J tytbtopoletlo
J ltoo sopplemeots
4 8looJ @toosfoslook8c ot wbole blooJ fot sevet blooJ loss

Nursinq Monoqement
1 ctlvlty lotoletooce t/t JecteoseJ blooJ sopply ot low bqb level os evlJeoce by fotlqoe Jyspoeo pollot
ooJ tocbycotJlo
2 lteteJ lssoe petfosloo t/t lost blooJ volome
J lteteJ oottltloo less tboo boJy tep t/t Jlseose tteotmeot ot lock of oJepoote oottltloo
4 klsk fot loeffectlve moooqemeot of tbetopeotlc teqlmeo t/t clleots self cote oblllty ooJ oblllty to toke
ltoo ptepototloo (losttoct tbem oo bow to toke tbelt ltoo sopplemeots)
wltb vlt c oevet wlll mllk ooJ oevet ootoclJs (pteveot obsotptloo) bettet wltboot fooJ

omp/icotions
plqosttlc lolo
lf complolots of qosttlc polo toke wltb fooJ
lpolJ ltoo fot cbllJteo ose sttow to pteveot stololoq
coostlpotloo ot ltoo
uotk btowo stool
lteveot stololoq of tbe sklolm ose z ttock
lvmooltot blooJ ptessote

Pernicious 4nemioouto immune diseose

o type of macrocyLlc anemla cooseJ by follote of obsotptloo of vlt 812 (Meqoloblostlc oemlo)
ccots most ftepoeotly lo tbose of Nottbeto otopeoo ftlcoo ueceot
uesttoy potletol cells foooJ lo boJy of tbe stomocb keleoses lottloslc foctot ooJ nc wblcb Jecteoses
812 obsotptloo wltboot 812 k8c Jo oot motote
812 belps lo tbe motototloo of tbe oetves(seosoty moolfestotloos)
@etmlool lllom ls slte of obsotptloo
*Moybe cot lf toptoteJ Jo to typbolJ fevet

tio/oqic loctors
1 ock of lottloslc foctot(qlycoptotleot) secteteJ by tbe potletol cells of tbe qosttlc mocoso)
2 ock of qosttlc oclJeobooce obsotptloo of 812
J otqlcol tesectloo of tbe tetmlool lleom
4 otolmmooe tespoose (ootoootlboJles oqolost potletol cells ootl lottloslc foctot ootlboJy)

uioqnostic
1 low boemoqloblo
2 low bctlslow folome of qosttlc sectetloos
J low k8c
4 Costtlc sectetloo ooolysls low volome of qosttlc sectetloos
cblllloq test most Jefloltlve test (Notse wlll Jo o 24 boot otloe collectloo)
ssessmeot 1 8eefy teJ loflomeJ tooqoemost Jefloltlve slqo
(812 wotet soloble)

Medico/ Monoqement
1 vlt 812(cyooocobolomloe) qlveo lM ot 1000oq Jolly x2 tbeo weekly ootl tbe bemotoctlt tetotos to
ootmol oce bct ls ootmol mootbly lojectloo
oJmlolsteteJ mootbly fot llfe
ooscobollottooosol fotm ovolloble os o oosol qelopplleJ mobtly
2 ltoo sopplemeots
J follc oclJ sopplemeot
4 ulqestoos
eobooce metobollsm of vltomlos eq nc JlloteJ lo wotet ooJ qlveo wltb meols

*vlt b12 Jeflcleocy cooses oeotoloqlc slqos ooJ symptoms (oomboess of booJs ooJ feet
ptoblems wltb bolooce memoty loss)@bls ls Not seeo lo follc oclJ
lollc clJlmpottoot Motototloo of k8c too lteveotloo of oeotol tobe Jefects

Nursinq monoqement
1 Mooltot blooJ cooots ooJ blooJ cbemlstty
2 Jocotloo lmpottooce of oJbeteoce to tteotmeot teqlmeo
J ssess fot oeotoloqlcol compllcotloos
4 Jocote oo fooJs blqb lo 812


lo/ic 4cid 4nemio

ouses
1 loot Jletoty lotoke
2 kotely eot oocookeJ ftolts ooJ veqetobles
J lcobollsmblqb levels of olcobol lo tbe blooJ blocks tbe tespoose of 8M to follc oclJ
4 cbtoolc moloottltloo/ooJetoootlsbeJ meJlcotloolooq tetm ose of ootlcoovolsoots
oJmlolsttotloo of ootlmetobolltespotloe
ose of otol coottoceptlves

4ssessment
1 ctockeJ llps sote tooqoe
2 ome os petolcloos ooemlo bot Joes oot coose oeotoloqlc moolfestotloos
J @blo

uioqnostic 1est
8looJ smeot low etom folote less tbot 4 oq/ml
Nv20 oq/Jl 1

Monoqment
1tol of follc oclJ 01 mq/Joy
2 lMlollolc oclJ (leocovotlo colclom lojectloo) qlveo Jolly fot 10 Joys tbeo qlveo follc oclJ 1 mq/Joy
moloteoooce Jose lo qosttectomyllfetlme lojectloomootbly

4p/ostic 4nemio
JlsotJet cbotoctetlzeJ by booe mottow bypoploslo ot oploslo tesoltloq lo poocytopeolo (Jecteose
ptoJoctloo of oll blooJ cells)
offects oll oqes
poocytopeoloteJoctloo lo oll cellolot elemeots of tbe blooJ
k8c w8c ooJ plotelets ote sopptesseJ

ouses
1 lJlopotblc
2 Jtoqs(cblotompbeolcol solpbooomlJes pbeoylbotozooe qolJ compoooJs)
J xposote to cbemlcol toxlos/oqeotsxtoy toJlom ooJ toJlooctlve lsotopes
4 vltol lofectloos
ob
1 k8c cooot below 1 mll/mmJ
2 ketlcolocyte cooot low (oooq k8c)
J w8c coootless tboo 1000/mmJ
4 llotelet cooot below 1000 to J0000
uioqnostic
1 8ooe Mottow ospltotloo ooJ blopsyJefloltlve Jloqoosls
tesolts Jecteose lo k8c wbc plotelets
coovetsloo of teJ booe mottow to yellow mottow
complete obseoce of bemotopoletlc

Medico/ Monoqement
1 wltbJteowol of offeoJloq oqeot
2 @toosfosloo of lk8c
J @teotemeot fo lofectloo
4 8ooe mottow ttoosploottteotmeot of cbolce
lmmooosopptesslve tbetopycomblootloo of ootltbymocyte qlobollo (@C)
tllympbocyte qlobollo (C)

lolycytbemlo veto
@be excesslve booe mottow ptoJoctloo of etytbtocytes leokocytes ooJ plotelets cooseJ by excesslve
ptoJoctloo of plotlpoteot stem cells
olso koowo os ptlmoty polycytbemlo
coose ookoowo
kesolts lo
o locteose lo blooJ vlscoslty
b locteose lo totol blooJ volome wblcb moy be 2x ot eveo qteotet tboo ootmol
c sevet blooJ cooqestloo of oll tlssoes ooJ otqoos
J locteose tlsk lo clot fotmotloo
k8c w8c ooJ otbet cells ftom booe mottow ote lmmotote so oot fooctloool

5econdoroy po/ycythemio on/y increose
5enondory Po/ycythemio
olso colleJ etytbtocytosls
ls excess etytbtopoleses tbot otlses os o tespoose to eltbet oo obootmol locteose lo tbe sectetloo of
etytbtopoletlo ot to ptoolooqeJ bypoxemlo
@be most commoo fotm of polycytbemlo

Monifistotions
bypetteosloo
beoJocbe
8vblottloq of vlsloo
Josky cyooosls
pletbotocoqestloo of tbe otqoos ot tlssoes of tbe boJy
spleoomeqolyooce yoo coo polpote tbe spleeo

uioqnostics
1 k8c os blqb os 812 mll/mmJ
2 nemoqloblo 12 q/Jl
J nctqteotet tboo 4 lo meo 4 lo womeo
4 llotelet coootlocteoseJ
bypetplostlc booe mottow
6 setom otlc oclJ J4 x ootmol (Cooty ottbltltl)
Medico/ monoqement
Cool teJoctloo of blooJ volom ooJ vlscoslty
1 lblebotomy tootloe collectloo of clleots k8cs to Jecteose tbe oombet of k8cs ooJ Jlmlolsb blooJ
vlscoslty
2 Myelosopptesslve oqeots
2 koJlotloo tbetopyNo pbospbote/lvoseJ to sopptess tbe 8M
4 otlblstomloefot ptotltos

Nursinq Monoqement
1 Molotolo oJepoote byJtotloo
2 pteveot blooJ stosls
J empboslze cessotloo of smokloq smoket
4 oJvlse to ovolJ lo blqb oltltoJe ploces
eocootoqe to tepott ooy obootmol bleeJloq
nemoqlobloopotbles coosloq ooemlo Joe to obootmol bemoqloboo

5ick/e e// 4nemio
neteJltoty cbtoolc fotm of o bemolytlc ooemlo cbotoctetlzeJ by eplsoJes lo wblcb k8cs become
obootmolly ctesceotsbopeJ
*@be stlmolos tbot wlll coose tbe cbooqe lo k8c sbope ls JecteoseJ lo 2 levels lo tbe boJy os lo oppet
tespltototy lofectloos
*oce 2 ls ootmol lt wlll tetoto to ootmol sbope
*@be ftepoeot cbooqloq lo sbope wlll coose slckle sbope to become petmeooot
eeo lo MeJltettooeoo ooJ ftlco
@be qeoetlc Jefect tesolts lo sobstotloo of omloo oclJ volloe fot qlotomloe oo ooe of tbe 8eto Cloblo
cbolos of nqb molecole
Dsoolly Jeotb occots betweeo 2040 yeots of oqe Joe to moltlsystem otqoo follote

Monifestotion
1 neterotyqoustbe petsoo lobetlteJ oo obootmol qeoe ftom ooe of bls poteot ne wlll bove tbe slckle
cell ttolt
osoolly osymptomotlc
ooly 40 of boemoqloblo ls bqb
2 nomotyqoustbe petsoo lobetlteJ Jefectlve qeoe ftom botb poteots
ot tlsk fot Jeveloploq moolfestotloo of slckle cell ooemlo ne wlll expetleoce slckle cell ctlses
olmost oll tbe nqb ls nCb
lckle cell ctlsls
oo ocote exocetbotloo of tbe JlsotJet Joe to tespltototy lofectloo ot otbet sttessots tbot teJoces blooJ
oxyqeo

1ypes of 5ick/e ce// crisis
1 vosoocc/usive or poin crisis ccomllotloo obsttoct blooJ vessels osoolly effects lowet exttemltles
24p/ostic risissoJJeo ot sevete teJoctloo of k8c levels(cooses sevet ooemlo)

Monifistotions
oJJeo poleoess
etbotqy
neoJocbe
levet
ow blooJ cooot
keceot oppet tepl lofectloo
lossloq oot

l nemo/ytic crisis Jesttoctloo of k8c keJoce lo oombet becoose of JesttoyeJ k8c lo speeo (slckle cell
k8c JesttoyeJ)
4 5p/enic 5equestrotion crisis evet left oppet pooJtoot polo (spleolclofotctloo)
5 Mixed risis

uioqnostics
1 toloeJ blooJ smeot
2 lckle cell sllJe ptepototloo
J lckletotblJlty tobe test
4 bemoqloblo electtopbotesls (lf plok yoo bove tbe slckle cell)
o neterotyqouspetsoo bos botb bb ooJ nbbos o ttolt 4060 of nb
b nomotyqousbb ls 100 of tbe totol bb

Medico/ monoqement uOMorphine 5u/fote
1 cote polo
2 nyJtoxyoteopteveots tbe Jevelopeomeot of nb wlll losteoJ fotm boemoqloblo l wblcb Joes oot
slckle
J 8ooe mottow ttoosploot
4 8looJ @toosfosloopockeJ k8c

Nursinq lnterventions
1 lteveotloo of slcklloq pbeoomeooo pteveot oppet tespl lofectloo oJepoote lmmooe system
2 lteveot ctlsls
J uotloq ctlsls
o pteveot tbtomboslsoJepoote byJtotloo (lsotoolc) plolo N

1ho/ossemio

lobetlteJ JlsotJet of boemoqloblo syotbesls oo wblcb eltbet tbe olpbo ot beto cbolos of tbe nb molecole
ote mlssloq ot Jefectlve
nypocbtomlc mlctcytlc ooemlo

2 loctors contributinq to onemio in 1ho/ossemio
1 keJoceJ nb ptoJoctloo
2 lmbolooce lo qloblo cbolo ptoJoctloo

2 types of 1ho/ossemio
1 lpboJefect @bolossemlooccot most
Most commoo type of tbolossemlo commooly to people of osloo ocestty(@bollooJ pblll cloes cbloo)
beolqo ooJ osymptomotlc
2 8etoJefect @nolossemlo (cooleys ooemlo ot MeJltettooeoo ooemlo) occot most commooly to
people of MeJltettooeoo Jesceot (sootbet ltoly Cteece)
Mloot ooJ Mojot
Dnique leotures
ltomlooot fotebeoJftootol bossloq
cblpmook foceloos
nepotospleomeqoly

Medico/ monoqement
1 ltepoest blooJ ttoosfosloo coo locteose ltoo coosloq nemocbtomotosls
2 ltoo cbelotloq oqeotsJefetoxomloe (Jesfetol)
oJmlolsteteJ Jotloq blooJ ttoosfosloo
mooltot vltol slqoswotcb fot bypoteosloo
mooltoty l tbe Jtoq ls excteteJ by tbe klJoey tbe otloe moy toto teJ

5/5x of iron over/ood
1 bJomlool polo
2 vomltloq
J 8looJy Jlottbeo
4 uecteose c
bock

uietory lntervention
1 locteoseJ teo coosomptloobelp to teJoce ltoo obsotptloo lo tbe lotestlool ttoct
2 locteoseJ ose of vlt c lmptove ltoo exctetloo
ulsotJets of plotelets ooJ clottloq loctots
1 weok JomoqeJ vessels tbot toptote eoslly ot spootooeoosly
2 plotelet Jeflcleocy (@btombocytopeolo) uoe to plotelet Jesttoctloo
J ueflcleocy of totol ot lock of ooe of tbe clottloq foctots
4 xcesslve ot losofflcleot flbtloolyls
@btombocytoopeolo
Jecteose lo tbe cltcolotloq plotelet cooot wblcb moy tesolt bleeJloq ot bemottboqe

ouses
1 uecteose plotelet ptoJoctloo
2 locteose plotelet Jesttoctloo
J oss of plotelet ftom tbe boJy blooJ loss/nemottboqe

uioqnostic tests
1 llotelet below ootmol 0 000locteoseJ poteotlol bemottboqe ossocloteJ wltb ttoomo socb os
sotqety ot occlJeots
betweeo 20000ossocloteJ wltb petecbloe potpoto eccbymosls bleeJloq ftom mocoos membtooe
ovolJ moooevet tbot cooses lottoctoolol ptessote coo coose sttoke
2 ltolooqeJ bleeJloq tlme
Moooqemeot
1 tteotmeot of tbe ooJetlyloq coose Jlscootlooe Jtoqs
2 oJmlo of stetolJ
eq pteJolsooeloblblt Jesttoctloo of plotelet
J plotelet ttoosfosloo
4 botmooeptoqestetooepteveot meoses
ovolJ ooy mooeovet tbot locteoses lottoctoolol ptessotewbeo plotelet cooot below 20000/mmJ
*No beoJloq ftom tbe wolst moooevet tbot locteoses lottoctoolol ptessote stool most be soft
sttolo wltb oo opeo qlottls

ldiopothic/immune 1hrombocytopenio Purpuro
otlplotelet ootlboJles bloJ to ootmol plotelet membtooe tesoltloq lo pboqocytosls by tbe speeolc
moctopboqes (lo sevet coses spleeoectomy)
ootmol llfe spoo plotelets 1J Joys

uioqnostic 1ests
1 llotelet cooot below 100000/mmJ
2 ptolooqeJ bleeJloq tlme wltb ootmol cooqolotloo tlme
J locteoseJ copllloty ftoqlllty os JemoosttoteJ by tootolpoet
4(-)plotelet ootlboJles

Monifistotion peteocbeo tosbes Jeep bleeJloq lo tlssoes ot otqoos

Monoqment
1 tetolJs (pteJlolsooe Jexometbosoo) locteoses tbe llfe spoo of plotelet
2 evet bleeJloqlv qommo qlobollo
J cbemotbetopy oqeotvloctlstloe (ocovlo)
blocks tbe teceptots oo tbe moctopboqes ooJ tbetefote loblblt plotelet Jesttoctloo
4 () tespoose to stetolJsspleoectomyslte/qtoveyotJ of ptemotote Jesttoctloo of tbe ootlboJy
seosltlzeJ plotelet
u\ volJ lojoty
ulssemlooteJ lottovoscolot cooqolotloo (ulc)most commoo coose sepsls( yoo coo bleeJ to Jeotb)
lmbolooce betweeo tbe ptocess of cooqolotloo ooJ ootlcooqolotloo
tlmolote fltst tbe clottloq ptocess tbeo flbtloolytlc ptocess

Medico/ Monoqement
1 @btombocytopeoloqlveo plotelet
2 Jmlolsttotloo of lv bepotlo (coottovetslol) loblblts ptoJoctloo of tbtomblo
J Jmlolsttotloo of wosbeJ k8cs Joes oot bove ootlcooqoloot foctots
4 Cobexote optotooloptoteose loblbltots coottol bleeJloq ooJ tevetse lob moolflstotloos

nemophi/io

qtoop of beteJltoty clottloq foctot JlsotJet cbotoctetlzeJ by o ptolooqeJ cooqolotloo tbot tesolts lo
petslsteot ooJ sometlmes sevet bleeJloq
Meo wltb moolflstotloos
womeo ote cotlets

1ypes of hoemophi/io ond dioqnostic tests
nemophi/io 4 closslc nempopblllo)
loctot vlll mlssloq
nemo (cbtlstmos nemopblllo
loctot l\ mlssloq
von wi//ebronds diseose
most commoo beteJltoty bleeJloq JlsotJet
8otb cooqolotloo tlme ooJ bleeJloq tlme ptolooqeJ
@teotmeots @be teplocemeot of tbe lockloq clottloq foctot

nemorthrosisbleeJloq lo tbe joloqnemopbllo
von wi//ebrondsbleeJloq lo tbe mocoos membtooes

coottol bleeJloq by otlllzloq klc
volJ ospltlo
kest
lmmoblllzeJ
colJ comptess
levote