What is bone marrow?
Bone marrow is the soft material that fills the central core of bones, especially long bones. It is the blood-forming tissue that produces the three major cell components of the blood.
What are the three major cell components of the blood?
- Erythrocytes (RBC)
- Leukocytes (WBC)
- Thrombocytes (platelets)
What is the absolute neutrophil count?
An important calculation which guides the care of a patient with bone marrow dysfunction. Once the ANC falls below 1500 cells/microliter, the risk for severe and potentially fatal infection rises dramatically.
What is considered mild neutropenia?
1000-1500 cells/microliter or 1-1.5
What is considered moderate neutropenia?
500-1000 cells/microliter or 0.5-1
What is considered severe neutropenia?
Fewer than 50 cells/microliter or <0.5
What are neutrophils?
What are bands?
What happens without neutrophils?
Neutrophils are the primary phagocytes within the immune system. Without these cells, the host defenses are severely impaired. Even with vigilant hygiene and housekeeping measures, the neutropenic patient is at risk for fatal infections even from their own body flora.
What kind of virus is HIV?
What is HAART?
Highly active anti-retroviral therapy.
Since HIV is a retrovirus, medical therapy utilizing a combination of antiviral medications is known as HAART. The goal of HAART is optimization of the CD4 T lymphocytes and a biral load that is undetectable (fewer than 50 or 400 viral copies per mL of blood, depending upon the sensitivity of the test)
What are risk factors for thrombocytopenia (bone marrow dysfunction)?
- Inherited platelet production (Fanconi's syndrome)
- Acquired Immune (Idiopathic thrombocytopenia)
- Acquired non Immune (HIT, drug induced)
What are risk factors of neutropenia (bone marrow dysfunction)?
- Drug-Induced Causes (chemo, antiinflammatories, psychotropics)
- Hematological Disorders (aplastic anemia, leukemia)
- Autoimmune Disorders (SLE, RA)
- Infections (Viral or Bacterial)
- Miscellaneous (Sepsis, BM infiltration, nutritional deficiencies)
Given common causes/risk factors of these types of bone marrow dysfunction, what can the RN do to promote bone marrow health?
Medications are a common cause of bone marrow dysfunction. The RN needs to know which medications are myelotoxic or myelosuppresive and monitor laboratory reports carefully. Examples include many chemotherapeutic agents. Pt. education is necessary.
What is thrombocytopenia?
A decreased number of platelets. Coagulation studies may remain normal.
What is a normal platelet count?
150,000-400,000 per microliter.
What is the average lifespan of a platelet?
What would platelet counts be from prolonged bleeding from trauma or injury?
platelet counts below 50,000
At what lab value does life threatening spontaneous bleeding occur?
platelet counts below 20,000
What other lab values may be seen in thrombocytopenic individuals?
Decreased Hbg and Hct due to bleeding
What are some dermatologic manifestations of thrombocytopenia?
Pinpoint microhemorrhages called petichiae, larger bruises known as purpura, or hemorrhages called ecchymoses which may be tender
Where can bleeding occur in patients with thrombocytopenia?
- Intraabdominal bleeding and overt hemorrhage
What is the medical treatment of thrombocytopenia?
- Transfusion of platelets
What is the surgical treatment of immune thrombocytopenia?
May consist of a splenectomy (the spleen sequesters platelets and coats them with antibodies that mark them for destruction by macrophages).
What medications are contraindicated in thrombocytopenic patients?
Aspirin and aspirin like products
What is a high priority nursing diagnosis for individuals with thrombocytopenia?
Risk for impaired tissue perfusion
What are the goals for individuals with thrombocytopenia?
The maintenance of vascular integrity and the absence of gross or occult bleeding
What is thrombocytopenia in children freqently caused by?
Viral infections such as:
- Chicken pox
What is thrombocytopenia most frequently cause by in adults?
What could failure to take antiretroviral medications as prescribed result in?
Failure to take atiretroviral medications as prescribed results in HIV mutations which are resistant to medications. Since resistance is more likely to develop when fewer than three of these medications are used, patients should be taught never to stop one of the medications and continue the others. If some are stopped, they should all be stopped temporarily. When mutations of HIV which are resistant to meds a patient is taking develop, these meds will no longer be effective in that person. In addition, these meds will not be effective for other people who contract these strains of HIV from that person.