• Disorders of the Hematopoietic System
○ Julie Mann, NP
○ N145
• Case #1
○ Mr. Jones has been on Heparin therapy as a
result of his recent atrial fibrillation
episode. He develops purple discolorations
of the skin.
○ What might be causing this?
• Bleeding into skin tissue, not clotting
well, therefore thrombocytopenia
• Thrombocytopenia
○ A decrease in the number of platelets
○ The greater the decrease the bigger the
risk of bleeding
○ Three causes:
• decreased production
• increased sequestration of platelets in
the spleen.
• decreased platelet survival
• Other types of thrombocytopenia
○ Drug-induced thrombocytopenia
• Produce and antigen-antibody response
(quinine, quinidine, some sulfa drugs)
○ Heparin-induced thrombocytopenia
(common in hospital)
• Immune reaction, antibody-platelet
complexes are made, activation of
other platelets, thrombosis.
○ Immune thrombocyticytopenic purpura
• Autoimmune platelet antibody
formation and excess destruction of
platelets.
○ thrombotic thrombocytopenic purpura
• A rare disorder, combo of
thrombocytopenia, hemolytic anemia,
renal failure, fever, and neuro
abnormalities. May result from platelet-
aggregating substances (molecular
substances that naturally occur).
○ For your info: Test - Platelet count,
anticipate an order to stop heparin and get
a bag o' platelets. May give lovenox. Avoid
needlesticks, leaving BP cuff on. Initiate
falls precautions, avoid injury.
• Case Study 2
○ Mr. Larson has a history of peptic ulcers
and hemorrhoids. He is a new vegetarian (9
months) and he complains of fatigue and
dyspnea. He also states he has periods
where he feels his heart racing.
• Fatigue and dyspnea, r/t decreased O2
from lack of iron.
• Higher risk r/t bleeding - peptic ulcers,
hemorrhoids.
○ Give Iron pills (don't give with calcium),
teach how to eat with iron,
• Anemia
○ abnormally low circulating RBC or
hemoglobin, or both
○ results in diminished oxygen-carrying
capacity
○ Related to:
• excessive bleeding
• destruction of RBC’s
• deficient production of RBC’s
• Types of Anemia’s
○ Blood Loss Anemia
 • Acute (not tolerated as well) or Chronic
○ Hemolytic Anemias: premature destruction
of RBC's.
• Transfusion reactions
• Mechanical injury
• Sickle Cell Disease
• Types of Anemias
○ Iron-Deficiency Anemia:
• Dietary deficiency, loss of iron in
bleeding, or increased demands. Iron is
component in heme, low levels
decrease hemoglobin synthesis, impair
O2 delivery.
○ Megaloblastic Anemias:
• Vitamin B-12 Anemia
 B12 is essential for RBC
maturation; deficiency leads to
large, immature RBC's with a short
life span.
• Folic Acid-Deficiency Anemia
 Folic acid is essential for RBC
maturation; deficiency leads to
large, immature RBC's with a short
life span.
○ Aplastic Anemia
• A disorder of the stem cells in the bone
marrow. Bone marrow can't replace the
RBC's.
• Case 3
○ Ms. Sally is receiving radiation and
chemotherapy for her Stage IV breast CA.
○ She has a CBC, why are these lab results
important?
• Chemo can alter RBC, WBC (don't want
infex)
• Considerations: Neutropenic diet (no
fresh fruits/vegies, must be cooked
well, pasteurized), no flowers, stimulate
WBC, universal precautions for nurses,
visitors, doctors, gowns.
• Neutropenia
○ decrease in the absolute number of
leukocytes in the blood
○ usually a decrease in the number of
neutrophils
○ Causes:
• decreased neutrophil production
• accelerated utilization or destruction
• shift from the blood to the tissue
compartments
• Acquired Neutropenia
○ Autoimmune Neutropenia
• Antibodies against the neutrophils or
the bone marrow. Can be primary
(childhood) or secondary (related to
other autoimmune process, RA, lupis).
○ Infection-Related Neutropenia
• Affect either auto-antibody production
or infects bone marrow and
splenomegaly. Common in AIDS.
○ Drug-Related Neutropenia
• Mostly seen with chemotherapy-
induced neutropenia.
• Clinical Course
○ Mild to Moderate
• Mild Skin Lesions
• Stomatitis (mouth sores)
 •Pharyngitis (inflammation of pharynx) • intermediate or fast growing: also have
• Diarrhea constitutional symptoms of fever, night
○ Severe sweats, or weight loss.
• malaise • Hodgkin Lymphoma
• fever ○ Reed-Sternberg cells multiplying in affected

• chills lymph node

• weakness
• fatigue
Cancers
• Lymphoma
○ malignancies that arise from the peripheral
lymph tissues
○ Both forms involve:
• uncontrolled lymph node and tissue
growth
• bone marrow involvement
• constitutional symptoms (fever,
fatigue, weight loss)
• Non-Hodgkin Lymphoma
○ cause is unknown
○ Either a T cell or B cell neoplasm
• Within each it is either fast growing
(notice lymph node enlargement, fever,
night sweats) or slow growing
(insidious, not noticed)
○ usually originates in the lymph nodes but
can originate in the lymph tissue
○ clinical manifestations depend on the type
of lymphoma
• slow growing: painless
lymphadenopathy
○ Usually arises in a single node or chain
○ cause is unknown, generally poor
prognosis.
○ painless enlargement of a node or group of
nodes
○ Usually occur above waist, often picked up
on Xray
○ other symptoms (fatigue, anemia) indicate
disease spread
• HIV
○ A retrovirus that destroys the body’s
immune cells, takes over and destroys the
CD4 T-cells (Thelper cells)
○ Transmission: sexual contact, blood-to-
blood contact, pregnancy perinatally.
○ HIV infected person is infectious even when
no symptoms are present. (window period)
• Phases of HIV Infections
○ Primary Infection Phase:
• An acute mono like illness. (fever,
fatigue, malaise, myalgias, sore throat,
night sweats, GI problems,
lymphadenopathy, maculopapular rash,
HA).
• Increased viral replication decreased
CD4 T-cell count. Appears 1-4 weeks
after exposure; lasts 7-10 days. Then
 CD4 count drops to lower level and
maintains for years.
• Try to catch at this point for more
chances to address illness.
○ Chronic Asymptomatic or latent phase:
• CD4 count drops gradually. Some
people have lymphadenopathy. This
phase lasts for about 10 years.
○ AIDS phase:
• CD4 count very low or the development
of an AIDS-defining illness. Without
treatment this phase will lead to death
in 2-3 years. High risk for opportunistic
infections.
• Clinical Course
○ Opportunistic Infections:
• May be fungal, bacterial, parasitic,
viral, etc.
○ Respiratory Manifestations
• P. jiroveci pneumonia (aka
• Clinical Manifestations
Pneumocystic carinii pneumonia)
 Inhaled pathogen from soil,
opportunistic (normally not an
issue with healthy individuals)
• Mycobacterium tuberculosis
 This is the leading cause of death
in HIV patients worldwide.
 Becoming resistant to treatment.
• Clinical Course
○ Gastrointestinal Manifestations
• Esophageal candidiasis, CMV infection,
herpes simplex virus. Also diarrhea and
gastroenteritis.
○ Nervous System Manifestations
• HIV associated neurocognitive
disorders
 Impaired attention and
concentration, slow mental speed
and agility, slow motor speed,
apathetic behavior.
• Toxoplasmosis (not as common now,
once was)
 Parasitic infection (opportunistic),
affects the CNS. (fever, HA,
confusion, lethargy, visual
disturbances, and seizures)
• Progressive Multifocal
Leukoencephalopathy
 Demyelinating disease of the white
matter of the brain. Caused by a
virus. (progressive limb weakness,
subtle changes in mental status,
hemiparesis, ataxia, diplopia, and
seizures)
○ Cancers and Malignancies
• Kaposi Sarcoma
 Malignancy of the endothelial lining
of the small blood vessels. Lesions
in the skin, lungs, and GI tract
• Non-Hodgkin Lymphoma
• Noninvasive cervical and anal
carcinoma: HPV
○ Wasting Syndrome
• Involuntary weight loss >10%, diarrhea
>2x's a day, chronic weakness, fatigue.