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