THERAPIES FOR HEMATOLOGIC DISORDERS
APHERESIS: "seperation"
THERAPEUTIC PHLEBOTOMY
FIBRINOLYTICS
SPLENECTOMY
COLONY GROWTH STIMULATING FACTORS
STEM CELL TRANSPLANTATION
surgical removal of the spleen
Removal 500 mL of whole blood
enlarged spleen may be the site of excessive destruction of blood cells causing severe thrombocytopenia
Treats: polycthemia vera
Splenectomy removes the “trap,” and platelet counts may normalize over time.
Laparoscopic splenectomy associated with decreased postoperative mobility compared to open splenectomy
Elevated Hematocrit
Treats: hemochromatosis
post-op complications: atelectasis, pneumonia, abdominal distention, and abscess formation.
Excess iron absorption
blood is taken from the patient and passed through a centrifuge, where a specific component is separated from the blood and removed. remaining blood is then returned to the pt
possibility of cure for some patients with hematologic disorders such as severe aplastic anemia, some forms of leukemia, and thalassemia.
If possible all age group patient should be vaccinated for pneumonia before splenectomy.
Can lead to iron deficiency
It's important to advise patient to seek medical attention for even minor symptoms of infection.
Monitor CBC
closed system so the risk of infection is low
different types of aphaeresis Table 32-2 page 913 plateletpheresis
leukapheresis
Erythrocytapheresis (RBC exchange)
Plasmapheresis (plasma exchange)
Stem cell harvest
Dissolve thrombus
"clot buster"
Give within 30 min of presentation to hospital
Nursing Considerations:
Minimize skin puntures
Check for S&S of bleeding
apheresis can be used to treat a wide variety of conditions. When it is used to treat a disease that causes an increase in a specific cell type with a short life in circulation (i.e., WBCs, platelets), the reduction in those cells is temporary.
Designate 1 IV line to use for blood draw
Major bleeding stop meds, notify provider
temporary reduction permits a margin of safety while waiting for a longer-lasting treatment modality to take effect. Apheresis can also be used to obtain stem cells for transplantation
Minor bleed apply direct pressure
Monitor for acute dysrhythmias
Monitor hypotension
group pf naturally occurring glycoprotein cytokines that regulate production, differentiation, survival, and activation of hematopoietic cells.
Erythropoietin stimulates RBC production.
Contraindication:
Thrombopoietin plays a key regulatory role in the growth and differentiation of bone marrow cells.
Interleukin 5 (IL-5) stimulates the growth and survival of eosinophils and basophils.
Stem cell factor and IL-3 serve as stimuli for multiple hematopoietic cell lines.
Granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, and macrophage colony-stimulating factor all serve as growth factors for specific cell lines.
Indication:
Chest pain more than 20 min unrelieved by Nitroglycerin
ST segments elevated at least 2 leads
Less than 6 hrs of onset pain
allogeneic or autologous donors.
Filgrastim (Neupogen)
Autologous- the patient’s own stem cells are harvested and then used in autologous transplant
allogeneic transplant is more effective. here, stem cells are obtained from a donor whose cells match those of the patient
Do not use if pt is bleeding/ bleeding disorder
Uncontrolled HTN
Recent major surgery/ trauma
Pregnancy
Hx of hemorrhagic stroke
Hx of intracranial vessel malformation