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THERAPIES FOR HEMATOLOGIC DISORDERS (SPLENECTOMY (surgical removal of the…
THERAPIES FOR HEMATOLOGIC DISORDERS
APHERESIS: "seperation"
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
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
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.
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
THERAPEUTIC PHLEBOTOMY
Removal 500 mL of whole blood
Treats: polycthemia vera
Elevated Hematocrit
Treats: hemochromatosis
Excess iron absorption
Can lead to iron deficiency
Monitor CBC
FIBRINOLYTICS
Dissolve thrombus
"clot buster"
Give within 30 min of presentation to hospital
Nursing Considerations:
Minimize skin puntures
Check for S&S of bleeding
Designate 1 IV line to use for blood draw
Major bleeding stop meds, notify provider
Minor bleed apply direct pressure
Monitor for acute dysrhythmias
Monitor hypotension
Contraindication:
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
Indication:
Chest pain more than 20 min unrelieved by Nitroglycerin
ST segments elevated at least 2 leads
Less than 6 hrs of onset pain
SPLENECTOMY
surgical removal of the spleen
enlarged spleen may be the site of excessive destruction of blood cells causing severe thrombocytopenia
Splenectomy removes the “trap,” and platelet counts may normalize over time.
Laparoscopic splenectomy associated with decreased postoperative mobility compared to open splenectomy
post-op complications: atelectasis, pneumonia, abdominal distention, and abscess formation.
If possible all age group patient should be vaccinated for pneumonia before splenectomy.
It's important to advise patient to seek medical attention for even minor symptoms of infection.
COLONY GROWTH STIMULATING FACTORS
group pf naturally occurring glycoprotein cytokines that regulate production, differentiation, survival, and activation of hematopoietic cells.
Erythropoietin stimulates RBC production.
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.
Filgrastim (Neupogen)
STEM CELL TRANSPLANTATION
possibility of cure for some patients with hematologic disorders such as severe aplastic anemia, some forms of leukemia, and thalassemia.
allogeneic or autologous donors.
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