05 hematology

Dutchess Community College EMS

HematologyHematology


SectionsSections

Anatomy, Physiology, and Anatomy, Physiology, and PathophysiologyPathophysiology

General Assessment and General Assessment and ManagementManagement

Managing Specific Patient Managing Specific Patient ProblemsProblems



The Study of Blood and Blood-The Study of Blood and Blood-Forming OrgansForming Organs Includes study of blood disorders.Includes study of blood disorders.

Red blood cell disordersRed blood cell disorders White blood cell disordersWhite blood cell disorders Platelet disordersPlatelet disorders Coagulation problemsCoagulation problems


Anatomy, Physiology, Anatomy, Physiology, and Pathophysiologyand Pathophysiology


BloodBlood

Viscosity greater than that of waterViscosity greater than that of water Temperature, 38Temperature, 3800C (100.4'F)C (100.4'F) pH of 7.35 to 7.45.pH of 7.35 to 7.45.


ComponentsComponents Red Blood CellsRed Blood Cells White Blood CellsWhite Blood Cells PlateletsPlatelets

HematopoiesisHematopoiesis Pluripotent stem cellPluripotent stem cell ErythropoietinErythropoietin

BloodBlood


Components of BloodComponents of Blood

PlasmaPlasma WaterWater

90–92% by volume90–92% by volume ProteinsProteins

6–7% by volume6–7% by volume OtherOther

2–3% by volume2–3% by volume Fats, carbohydrates, electrolytes, gases, Fats, carbohydrates, electrolytes, gases,

and chemical messengersand chemical messengers



Red Blood CellsRed Blood Cells HemoglobinHemoglobin Oxygen Oxygen

transporttransport Bohr effectBohr effect 2,3 DPG2,3 DPG Oxygen–Oxygen–

hemoglobin hemoglobin dissociation dissociation curvecurve


Red Blood CellsRed Blood Cells

Average life-span of Red Blood Cells ~120 Average life-span of Red Blood Cells ~120 days days Due to wear and tear on plasma membranes Due to wear and tear on plasma membranes

as they squeeze through capillaries. as they squeeze through capillaries. A healthy male has about 5.4 million A healthy male has about 5.4 million

RBC’s/mmRBC’s/mm3 3

A healthy female has about 4.8 A healthy female has about 4.8 million/mmmillion/mm33..


Red Blood CellsRed Blood Cells

Red blood cell productionRed blood cell production ErythropoiesisErythropoiesis HemolysisHemolysis SequestrationSequestration


Erythropoietin

Kidney and Liver form:

More Less

RBC production (Hemopoiesis) in Bone Marrow

Blood Oxygen levels down

increases decreases

stimulationinhibition

Blood Oxygen levels up

MORE RBC

FEWER RBC



Laboratory analysis Laboratory analysis of red blood cellsof red blood cells

Red blood cell countRed blood cell count HematocritHematocrit HemoglobinHemoglobin



White Blood CellsWhite Blood Cells MarginationMargination PhagocytosisPhagocytosis White blood cell countWhite blood cell count


PhagocytosisPhagocytosis


White Blood White Blood CellsCells

LeukopoiesisLeukopoiesis GranulocytesGranulocytes

NeutrophilNeutrophil BasophilBasophil EosinophilEosinophil

LymphocytesLymphocytes MonocytesMonocytes


White Blood CellsWhite Blood Cells

ImmunityImmunity Subpopulation of lymphocytes known as Subpopulation of lymphocytes known as

T cells and T cells and

B cellsB cells T cells develop cellular immunity.T cells develop cellular immunity. B cells produce humoral immunity.B cells produce humoral immunity.

Autoimmune diseaseAutoimmune disease Alterations in the immune processAlterations in the immune process Inflammatory processInflammatory process



PlateletsPlatelets MegakaryocytesMegakaryocytes ThrombocytopeniaThrombocytopenia ThrombocytosisThrombocytosis


Blood Forming OrgansBlood Forming Organs

Bone marrowBone marrow LiverLiver SpleenSpleen


HemostasisHemostasis

Controlling Blood LossControlling Blood Loss Vascular spasmsVascular spasms Platelet plugsPlatelet plugs Stable fibrin blood clotsStable fibrin blood clots


HemostasisHemostasis

FibrinolysisFibrinolysis ThrombosisThrombosis

ThrombolyticsThrombolytics Medications affecting clot formationMedications affecting clot formation

Alter the enzyme Alter the enzyme on the platelet.on the platelet.

Affect the coagulation cascade.Affect the coagulation cascade. Enhance clotting.Enhance clotting.


Blood TypesBlood Types AntigensAntigens

A, B, AB, OA, B, AB, O Universal Universal

donorsdonors Rh factorRh factor

Blood Products and Blood Products and Blood TypingBlood Typing


Transfusion ReactionsTransfusion ReactionsDonor’s RBC and Recipient’s Donor’s RBC and Recipient’s

PlasmaPlasmaRecipient

Donor - RBC

Type A A antigens B antibodies

Type B B antigens A antibodies

Type AB A+B antigens O antibodies

Type O O antigens A+B antibodies

Type A A antigens B antibodies

No reaction Major reaction

Minor reaction

Major reaction

Type B B antigens A antibodies

Major reaction

No reaction Minor reaction

Major reaction

Type AB A+B antigens O antibodies

Major reaction

Major reaction

No reaction Major reaction

Type O O antigens A+B antibodies

Minor reaction

Minor reaction

Minor reaction

No reaction

.


Blood ProductsBlood Products


Transfusion ReactionsTransfusion Reactions

Hemolytic ReactionsHemolytic Reactions Signs & SymptomsSigns & Symptoms

Facial flushing, hyperventilation, Facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, tachycardia, hives, chest pain, wheezing, fever, chills, and cyanosisfever, chills, and cyanosis

TreatmentTreatment Stop transfusion, change all IV tubing, and Stop transfusion, change all IV tubing, and

initiate IV therapy with normal saline or initiate IV therapy with normal saline or lactated Ringer’s.lactated Ringer’s.

Consider furosemide, dopamine, and Consider furosemide, dopamine, and diphenhydramine.diphenhydramine.


Transfusion ReactionsTransfusion Reactions

Febrile Nonhemolytic ReactionsFebrile Nonhemolytic Reactions Signs & SymptomsSigns & Symptoms

Headache, fever, and chillsHeadache, fever, and chills TreatmentTreatment

Stop transfusion, change all IV tubing, and Stop transfusion, change all IV tubing, and initiate IV therapy with normal saline or initiate IV therapy with normal saline or lactated Ringer’s.lactated Ringer’s.

Consider diphenhydramine and an Consider diphenhydramine and an antipyretic.antipyretic.

Observe closely to ensure reaction is Observe closely to ensure reaction is nonhemolytic.nonhemolytic.


Scene Size-upScene Size-up Initial AssessmentInitial Assessment Focused History and Physical Focused History and Physical

ExamExam SAMPLE historySAMPLE history

Hematological disorders are rarely the Hematological disorders are rarely the chief complaint.chief complaint.

Physical examPhysical exam Evaluate nervous system function.Evaluate nervous system function.

General Assessment General Assessment and Managementand Management


Detailed Physical Detailed Physical ExaminationExamination

Levels of Levels of consciousnessconsciousness VertigoVertigo FatigueFatigue Syncopal episode(s)Syncopal episode(s)

SkinSkin Prolonged bleedingProlonged bleeding BruisingBruising ItchingItching PallorPallor JaundiceJaundice



Visual disturbancesVisual disturbances GastrointestinalGastrointestinal

EpistaxisEpistaxis Bleeding gums / Infections of the gumsBleeding gums / Infections of the gums UlcerationsUlcerations MelenaMelena Liver diseaseLiver disease PainPain

SkeletalSkeletal ArthralgiaArthralgia Nuchal rigidityNuchal rigidity



CardiorespiratoryCardiorespiratory DyspneaDyspnea Chest painChest pain HemoptysisHemoptysis TachycardiaTachycardia

GenitourinaryGenitourinary HematuriaHematuria MenorrhagiaMenorrhagia InfectionsInfections


General Treatment GuidelinesGeneral Treatment Guidelines Maintain ABCs.Maintain ABCs.

High-flow oxygen High-flow oxygen Assist ventilations as indicatedAssist ventilations as indicated Consider volume replacement.Consider volume replacement. Monitor cardiac rhythm and vital signs.Monitor cardiac rhythm and vital signs. Treat rhythm disturbances.Treat rhythm disturbances.

General ManagementGeneral Management


General ManagementGeneral Management PharmacologicalPharmacological

OxygenOxygen Platelet aggregate inhibitorPlatelet aggregate inhibitor Alkalinizing agentsAlkalinizing agents Narcotic/ analgesicNarcotic/ analgesic DiureticDiuretic

Non-pharmacological Non-pharmacological Provide reassurance, comfort care, and Provide reassurance, comfort care, and

transport.transport. Transport considerationsTransport considerations

Appropriate mode / facilityAppropriate mode / facility


Diseases of the Red Blood CellsDiseases of the Red Blood Cells Diseases of the White Blood CellsDiseases of the White Blood Cells Diseases of the Platelets/Blood Diseases of the Platelets/Blood

Clotting AbnormalitiesClotting Abnormalities Other Hematopoietic DisordersOther Hematopoietic Disorders

Managing Specific Managing Specific Patient ProblemsPatient Problems


EpidemiologyEpidemiology Reduction below normal levels of Reduction below normal levels of

hemoglobin or erythrocytes, and is a hemoglobin or erythrocytes, and is a symptom of an underlying disease symptom of an underlying disease processprocess

AnemiasAnemias


AnemiasAnemias

PathophysiologyPathophysiology Morbidity/ mortalityMorbidity/ mortality

Can be self-limiting diseaseCan be self-limiting disease Must be confirmed by laboratory diagnosisMust be confirmed by laboratory diagnosis

Precipitating causesPrecipitating causes Blood loss (acute or chronic)Blood loss (acute or chronic) Decreased production of erythrocytesDecreased production of erythrocytes Increased destruction of erythrocytesIncreased destruction of erythrocytes


AnemiasAnemias

Pathophysiology cont.Pathophysiology cont. HemolyticHemolytic

HereditaryHereditary Sickle cellSickle cell ThalassemiaThalassemia Glucose-6-phosphate dehydrogenase Glucose-6-phosphate dehydrogenase

deficiencydeficiency AcquiredAcquired

ImmuneImmune DrugDrug


AnemiasAnemias

Signs and symptoms may not be Signs and symptoms may not be present until the body is stressed.present until the body is stressed.

Treat signs and symptoms.Treat signs and symptoms. Maximize oxygenation and limit blood Maximize oxygenation and limit blood

loss.loss. Establish IV therapy if indicated.Establish IV therapy if indicated.


AnemiasAnemias Initial assessment findingsInitial assessment findings

Airway/ breathingAirway/ breathing Labored breathing may or may not be Labored breathing may or may not be

presentpresent CirculationCirculation

Peripheral pulsesPeripheral pulses QualityQuality RhythmRhythm

Changes in skinChanges in skin ColorColor TemperatureTemperature MoistureMoisture


AnemiasAnemias Focused History ComplaintsFocused History Complaints

Complaints secondary to anemiaComplaints secondary to anemia FatigueFatigue LethargyLethargy HypoxiaHypoxia DyspneaDyspnea


AnemiasAnemias

Focused History ComplaintsFocused History Complaints Complaints secondary to leukopeniaComplaints secondary to leukopenia

InfectionsInfections FeversFevers

Complaints secondary to Complaints secondary to thrombocytopeniathrombocytopenia

Cutaneous bleedingCutaneous bleeding Bleeding from mucous membranesBleeding from mucous membranes


AnemiasAnemias

ManagementManagement Airway and ventilationAirway and ventilation Circulatory supportCirculatory support PharmacologicalPharmacological

AnalgesicsAnalgesics Fluid volume replacementFluid volume replacement Control of bleeding Control of bleeding

Non-pharmacologicalNon-pharmacological Position of comfortPosition of comfort


AnemiasAnemias

Transport considerationsTransport considerations Appropriate modeAppropriate mode

Indications for rapid transportIndications for rapid transport Significant changes in LOCSignificant changes in LOC Hypotension/ hypoperfusionHypotension/ hypoperfusion

Appropriate facilityAppropriate facility Support and communication strategiesSupport and communication strategies

Explanation for patient, family, significant Explanation for patient, family, significant othersothers

Communications and transfer of data to the Communications and transfer of data to the physicianphysician


Types of AnemiaTypes of Anemia


Sickle Cell DiseaseSickle Cell Disease


Sickle Cell DiseaseSickle Cell Disease EpidemiologyEpidemiology

Highest incidence in blacks, Puerto Highest incidence in blacks, Puerto Ricans and persons of Spanish, French, Ricans and persons of Spanish, French, Italian, Greek and Turkish originItalian, Greek and Turkish origin

PathophysiologyPathophysiology A congenital hemolytic anemiaA congenital hemolytic anemia A chemical defect within the hemoglobin A chemical defect within the hemoglobin

of red blood cellsof red blood cells Morbidity/ mortalityMorbidity/ mortality

SepsisSepsis ShockShock DeathDeath



Initial assessment findingsInitial assessment findings Levels of consciousnessLevels of consciousness Airway/ breathingAirway/ breathing CirculationCirculation

Peripheral pulsesPeripheral pulses Changes in skinChanges in skin

Pallor, Cool, ClammyPallor, Cool, Clammy Hypotension/ hypoperfusionHypotension/ hypoperfusion



Focused historyFocused history Chief complaintChief complaint

Sudden onset develops into a Sudden onset develops into a condition called “crisis”condition called “crisis”

Thrombotic crisis (painful)Thrombotic crisis (painful) AplasticAplastic HemolyticHemolytic



Detailed physical examDetailed physical exam Airway / Breath soundsAirway / Breath sounds CirculationCirculation

SkinSkin As aboveAs above Temperature may varyTemperature may vary

ECG findingsECG findings TachycardiaTachycardia EctopyEctopy


Sickle Cell DiseaseSickle Cell Disease Detailed physical exam continuedDetailed physical exam continued

Increased weaknessIncreased weakness AchingAching Chest painChest pain Sudden, severe abdominal painSudden, severe abdominal pain Bony deformitiesBony deformities Icteric scleraIcteric sclera Abdominal painAbdominal pain FeverFever ArthralgiaArthralgia


Sickle Cell DiseaseSickle Cell Disease ManagementManagement

Position of comfortPosition of comfort PharmacologicalPharmacological

AnalgesiaAnalgesia Fluid volume replacementFluid volume replacement

Transport for reperfusionTransport for reperfusion Indications for no transportIndications for no transport RefusalRefusal

Support and communication strategiesSupport and communication strategies Explanation for patient, family, significant others Explanation for patient, family, significant others Communications and transfer of data to the Communications and transfer of data to the

physicianphysician


PolycythemiaPolycythemia

EpidemiologyEpidemiology Overabundant production of red blood Overabundant production of red blood

cells, white blood cells and plateletscells, white blood cells and platelets Rare disorder seen in persons over 50 Rare disorder seen in persons over 50

years of ageyears of age PathophysiologyPathophysiology

ThrombosisThrombosis Death from thrombosisDeath from thrombosis



Initial assessment findingsInitial assessment findings Levels of consciousnessLevels of consciousness Airway/ breathingAirway/ breathing

Labored breathing is commonLabored breathing is common CirculationCirculation

Peripheral pulsesPeripheral pulses QualityQuality TachycardiaTachycardia

Changes in skinChanges in skin Color - red-purple complexionColor - red-purple complexion Red hands and feetRed hands and feet PruriticPruritic


PolycythemiaPolycythemia Focused historyFocused history

DyspneaDyspnea Generalized pruritusGeneralized pruritus

Detailed physical examDetailed physical exam Airway / Breath soundsAirway / Breath sounds CirculationCirculation

SkinSkin As aboveAs above Temperature may varyTemperature may vary

ECG findingsECG findings TachycardiaTachycardia



ManagementManagement Position of comfortPosition of comfort PharmacologicalPharmacological

AnalgesiaAnalgesia Increase or decrease heart rateIncrease or decrease heart rate

Non-pharmacologicalNon-pharmacological PhlebotomyPhlebotomy



TransportTransport Indications for no transportIndications for no transport

RefusalRefusal Referral Referral

Support and communication strategiesSupport and communication strategies Explanation for patient, family, significant Explanation for patient, family, significant

othersothers Communications and transfer of data to Communications and transfer of data to

the physicianthe physician


Leukopenia/NeutropeniaLeukopenia/Neutropenia Too few white blood cells or neutrophils.Too few white blood cells or neutrophils. Follow general treatment guidelines and Follow general treatment guidelines and

provide supportive care.provide supportive care. LeukocytosisLeukocytosis

An increase in the number of circulating An increase in the number of circulating white blood cells, often due to infection.white blood cells, often due to infection.

Leukemoid reactionLeukemoid reaction

Diseases of the White Diseases of the White Blood CellsBlood Cells


LeukemiaLeukemia


Blood lossBlood loss DeathDeath

Neoplastic diseaseNeoplastic disease Acute versus chronicAcute versus chronic

Precipitating causes Precipitating causes Radiation exposureRadiation exposure Viral infectionsViral infections ChemicalsChemicals Immune defectsImmune defects Chromosomal changesChromosomal changes


LeukemiaLeukemia Initial assessment findingsInitial assessment findings

Levels of consciousnessLevels of consciousness Airway/ breathingAirway/ breathing

Labored breathing may or may not be Labored breathing may or may not be presentpresent

CirculationCirculation Peripheral pulsesPeripheral pulses

QualityQuality TachycardiaTachycardia

Changes in skinChanges in skin ColorColor TemperatureTemperature MoistureMoisture


LeukemiaLeukemia Focused historyFocused history

ComplaintsComplaints Fatigue, bone pain, diaphoresis Fatigue, bone pain, diaphoresis Elevated body temperature Elevated body temperature Sternal tendernessSternal tenderness Heat intoleranceHeat intolerance Abdominal fullnessAbdominal fullness BleedingBleeding

Contributing historyContributing history Recurrent bleedingRecurrent bleeding Increasing frequency and/ or duration Increasing frequency and/ or duration


LeukemiaLeukemia

Detailed physical examDetailed physical exam Airway Airway Breath soundsBreath sounds CirculationCirculation

SkinSkin Blood pressure may lowBlood pressure may low ECG findingsECG findings TachycardiaTachycardia Ectopic Ectopic


LeukemiaLeukemia


AnalgesiaAnalgesia Increase or decrease heart rateIncrease or decrease heart rate Fluid volume replacementFluid volume replacement

ElectricalElectrical Constant ECG monitoringConstant ECG monitoring


LeukemiaLeukemia

TransportTransport Criteria for rapid transportCriteria for rapid transport

No relief with medicationsNo relief with medications Hypotension/ hypoperfusionHypotension/ hypoperfusion Significant changes in ECGSignificant changes in ECG

Indications for no transport Indications for no transport RefusalRefusal ReferralReferral


LymphomasLymphomas

EpidemiologyEpidemiology Hyperplasia of the lymphoreticular Hyperplasia of the lymphoreticular

systemsystem PathophysiologyPathophysiology

Morbidity/ mortalityMorbidity/ mortality Blood lossBlood loss PainPain DeathDeath


LymphomasLymphomas Initial assessment findingsInitial assessment findings

Levels of consciousnessLevels of consciousness Airway/ BreathingAirway/ Breathing CirculationCirculation

Focused historyFocused history ComplaintsComplaints

FeverFever Night sweatsNight sweats Generalized pruritusGeneralized pruritus AnorexiaAnorexia Weight lossWeight loss Fatigue, bone pain, diaphoresisFatigue, bone pain, diaphoresis


LymphomasLymphomas Detailed physical examDetailed physical exam

Airway / Breath soundsAirway / Breath sounds May be clear to auscultation May be clear to auscultation Congestion in bases may be presentCongestion in bases may be present

CirculationCirculation SkinSkin

Pallor during the episodePallor during the episode Temperature may varyTemperature may vary Diaphoresis is usually present Diaphoresis is usually present

Blood pressure may lowBlood pressure may low ECG findingsECG findings

TachycardiaTachycardia EctopyEctopy


LymphomasLymphomas



ElectricalElectrical Constant ECG monitoringConstant ECG monitoring


LymphomasLymphomas

TransportTransport Criteria for rapid transportCriteria for rapid transport

No relief with medicationsNo relief with medications Hypotension/ hypoperfusionHypotension/ hypoperfusion Significant changes in ECGSignificant changes in ECG


Diseases of the Diseases of the PlateletsPlatelets

Thrombocytosis and Thrombocytosis and ThrombocytopeniaThrombocytopenia ThrombocytosisThrombocytosis

An abnormal increase in the number of An abnormal increase in the number of plateletsplatelets

ThrombocytopeniaThrombocytopenia An abnormal decrease in the number of An abnormal decrease in the number of

plateletsplatelets ManagementManagement

Provide supportive care and follow general Provide supportive care and follow general treatment guidelines.treatment guidelines.


HemophiliaHemophilia

EpidemiologyEpidemiology A hereditary disorder transmitted by the A hereditary disorder transmitted by the

female to the male female to the male In true hemophilia A factor VIII is nearly In true hemophilia A factor VIII is nearly

absent absent In hemophilia B there is a deficiency in In hemophilia B there is a deficiency in

factor IX factor IX The ability to produce thrombin is The ability to produce thrombin is

severely impaired by deficiency or severely impaired by deficiency or absence of these factorsabsence of these factors




Uncontrolled bleedingUncontrolled bleeding ShockShock DeathDeath



Initial assessment findingsInitial assessment findings Levels of consciousnessLevels of consciousness Airway/ breathingAirway/ breathing


Peripheral pulsesPeripheral pulses Weak and threadyWeak and thready

TachycardiaTachycardia



Changes in skinChanges in skin Pallor, Cool, clammyPallor, Cool, clammy Bleeding Bleeding

From body orificesFrom body orifices Knees, Wrists, ElbowsKnees, Wrists, Elbows HematuriaHematuria EpistaxisEpistaxis HemoptysisHemoptysis HematemesisHematemesis MelenaMelena

Hypotension/ hypoperfusionHypotension/ hypoperfusion



Focused historyFocused history DyspneaDyspnea BleedingBleeding

Detailed physical examDetailed physical exam Airway / Breath soundsAirway / Breath sounds

May be clear to auscultation May be clear to auscultation Congestion in bases may be presentCongestion in bases may be present

CirculationCirculation ECG findingsECG findings TachycardiaTachycardia Ectopy Ectopy





Transport for reperfusionTransport for reperfusion Indications for no transportIndications for no transport

RefusalRefusal


Blood Clotting Blood Clotting AbnormalitiesAbnormalities

Von Willebrand’s DiseaseVon Willebrand’s Disease Deficient component of factor VIIIDeficient component of factor VIII

Generally results in excessive bleeding.Generally results in excessive bleeding. Generally is not serious; provide supportive Generally is not serious; provide supportive

care.care.


Multiple MyelomaMultiple Myeloma Cancerous disorder of plasma cells.Cancerous disorder of plasma cells. Pathologic fractures are common.Pathologic fractures are common.

Other Hematopoietic Other Hematopoietic DisordersDisorders


Disseminated Disseminated Intravascular Intravascular Coagulopathy Coagulopathy

EpidemiologyEpidemiology A complication of severe injury, trauma A complication of severe injury, trauma

or disease; acute bleeding disorder or disease; acute bleeding disorder resulting from defibrinationresulting from defibrination

First phase characterized by free First phase characterized by free thrombin in the blood, fibrin deposits thrombin in the blood, fibrin deposits and aggregation of plateletsand aggregation of platelets

Phase two is hemorrhage caused by Phase two is hemorrhage caused by depletion of clotting factorsdepletion of clotting factors


Disseminated Disseminated Intravascular Intravascular CoagulopathyCoagulopathy


Uncontrolled bleedingUncontrolled bleeding ShockShock DeathDeath



Initial assessment findingsInitial assessment findings Airway/ breathingAirway/ breathing


Peripheral pulses are weak and threadyPeripheral pulses are weak and thready TachycardiaTachycardia

Changes in skinChanges in skin PallorPallor Purpura over chest and abdomenPurpura over chest and abdomen Cool, clammyCool, clammy Bleeding Bleeding Hypotension/ hypoperfusionHypotension/ hypoperfusion




DyspneaDyspnea BleedingBleeding



Detailed physical examDetailed physical exam Airway / Breath soundsAirway / Breath sounds

May be clear to auscultation May be clear to auscultation Congestion in bases may be presentCongestion in bases may be present

CirculationCirculation SkinSkin

As aboveAs above Temperature may varyTemperature may vary







others others Communications and transfer of data to the Communications and transfer of data to the

physicianphysician


Multiple MyelomaMultiple Myeloma

EpidemiologyEpidemiology A plasma cell dyscrasia characterized by A plasma cell dyscrasia characterized by

neoplastic cells that infiltrate bone marrowneoplastic cells that infiltrate bone marrow Eventually plasma cells become malignant Eventually plasma cells become malignant

leading to tumor formation within the boneleading to tumor formation within the bone PathophysiologyPathophysiology

Morbidity/ mortalityMorbidity/ mortality FracturesFractures BleedingBleeding ShockShock DeathDeath


Multiple MyelomaMultiple Myeloma Initial assessment findingsInitial assessment findings

Levels of consciousnessLevels of consciousness Airway/ breathingAirway/ breathing


Peripheral pulsesPeripheral pulses Weak and threadyWeak and thready TachycardiaTachycardia

Changes in skinChanges in skin Pallor, Cool, clammyPallor, Cool, clammy

Bleeding Bleeding Hypotension/ hypoperfusionHypotension/ hypoperfusion


Multiple MyelomaMultiple Myeloma


WeaknessWeakness Skeletal painSkeletal pain HemorrhageHemorrhage HematuriaHematuria LethargyLethargy Weight lossWeight loss Frequent fracturesFrequent fractures


Multiple MyelomaMultiple Myeloma Detailed physical examDetailed physical exam

Airway / Breath soundsAirway / Breath sounds CirculationCirculation


Increased weaknessIncreased weakness AchingAching Chest painChest pain Sudden severe abdominal painSudden severe abdominal pain Bony deformitiesBony deformities ArthralgiaArthralgia


Multiple MyelomaMultiple Myeloma ManagementManagement

Position of comfortPosition of comfort PharmacologicalPharmacological


Transport for reperfusionTransport for reperfusion Indications for no transportIndications for no transport RefusalRefusal


others others Communications and transfer of data to the Communications and transfer of data to the

physicianphysician



Anatomy, Physiology, and Anatomy, Physiology, and PathophysiologyPathophysiology

General Assessment and General Assessment and ManagementManagement

Managing Specific Patient ProblemsManaging Specific Patient Problems

05 hematology

Health & Medicine

study of blood disorders

blood viscosity greater

b cells t cells

antibodies type ab

liver form

cellular immunity

humoral immunity

normal saline