The document discusses hematology and provides information on blood components, blood disorders, and their management in the prehospital setting. It covers red blood cell disorders like anemia and sickle cell disease. White blood cell and platelet disorders are also reviewed. Physical exam findings and treatment focus on maintaining ABCs, oxygenation, volume replacement, and transporting appropriately.

1. Hematology
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2. Sections



Anatomy, Physiology, and Pathophysiology
General Assessment and Management
Managing Specific Patient Problems
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3. Hematology

The Study of Blood and Blood-Forming Organs

Includes study of blood disorders.
Red blood cell disorders
 White blood cell disorders
 Platelet disorders
 Coagulation problems

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4. Anatomy, Physiology,
and Pathophysiology
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5. Blood



Viscosity greater than that of water
Temperature, 380C (100.4'F)
pH of 7.35 to 7.45.
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6. Blood

Components
Red Blood Cells
 White Blood Cells
 Platelets


Hematopoiesis
Pluripotent stem cell
 Erythropoietin

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7. Components of Blood

Plasma

Water


Proteins


90–92% by volume
6–7% by volume
Other
2–3% by volume
 Fats, carbohydrates, electrolytes, gases, and chemical
messengers

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8. Components of Blood

Red Blood Cells
Hemoglobin
 Oxygen transport
 Bohr effect
 2,3 DPG
 Oxygen–hemoglobin
dissociation curve

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9. Red Blood Cells

Average life-span of Red Blood Cells ~120 days



Due to wear and tear on plasma membranes as they squeeze
through capillaries.
A healthy male has about 5.4 million RBC’s/mm3
A healthy female has about 4.8 million/mm3.
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10. Red Blood Cells

Red blood cell production
Erythropoiesis
 Hemolysis
 Sequestration

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11. inhibition
stimulation
Kidney and Liver
form:
More
Less
Erythropoietin
increases
Blood Oxygen
levels up
decreases
RBC production (Hemopoiesis)
in Bone Marrow
MORE RBC
FEWER RBC
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Blood Oxygen
levels down

12. Components of Blood

Laboratory analysis of red
blood cells
Red blood cell count
 Hematocrit
 Hemoglobin

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13. Components of Blood

White Blood Cells
Margination
 Phagocytosis
 White blood cell count

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14. Phagocytosis
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15. White Blood Cells

Leukopoiesis

Granulocytes
Neutrophil
 Basophil
 Eosinophil

Lymphocytes
 Monocytes

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16. White Blood Cells

Immunity

Subpopulation of lymphocytes known as T cells and
B cells
T cells develop cellular immunity.
 B cells produce humoral immunity.




Autoimmune disease
Alterations in the immune process
Inflammatory process
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17. Components of Blood

Platelets
Megakaryocytes
 Thrombocytopenia
 Thrombocytosis

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18. Blood Forming Organs



Bone marrow
Liver
Spleen
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19. Hemostasis

Controlling Blood Loss
Vascular spasms
 Platelet plugs
 Stable fibrin blood clots

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20. Dutchess Community College EMS

21. Hemostasis


Fibrinolysis
Thrombosis
Thrombolytics
 Medications affecting clot formation

Alter the enzyme
on the platelet.
 Affect the coagulation cascade.
 Enhance clotting.

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22. Dutchess Community College EMS

23. Blood Products and
Blood Typing

Blood Types

Antigens

A, B, AB, O
Universal donors
 Rh factor

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24. Transfusion Reactions
Donor’s RBC and Recipient’s Plasma
Recipient
Type A
Donor - RBC A antigens
B antibodies
Type B
B antigens
A antibodies
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
No reaction
Major
reaction
Major
reaction
No reaction
Minor
reaction
Major
reaction
Major
reaction
Major
reaction
No reaction
Major
reaction
Minor
reaction
Minor
reaction
Minor
reaction
No reaction
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Type AB
Type O
A+B antigens O antigens
O antibodies A+B
antibodies
Minor
Major
reaction
reaction

25. Blood Products
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26. Transfusion Reactions

Hemolytic Reactions

Signs & Symptoms


Facial flushing, hyperventilation, tachycardia, hives,
chest pain, wheezing, fever, chills, and cyanosis
Treatment
Stop transfusion, change all IV tubing, and initiate IV
therapy with normal saline or lactated Ringer’s.
 Consider furosemide, dopamine, and diphenhydramine.

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27. Transfusion Reactions

Febrile Nonhemolytic Reactions

Signs & Symptoms


Headache, fever, and chills
Treatment
Stop transfusion, change all IV tubing, and initiate IV
therapy with normal saline or lactated Ringer’s.
 Consider diphenhydramine and an antipyretic.
 Observe closely to ensure reaction is nonhemolytic.

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28. General Assessment
and Management



Scene Size-up
Initial Assessment
Focused History and Physical Exam

SAMPLE history


Hematological disorders are rarely the chief
complaint.
Physical exam

Evaluate nervous system function.
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29. Detailed Physical Examination

Levels of consciousness




Vertigo
Fatigue
Syncopal episode(s)
Skin





Prolonged bleeding
Bruising
Itching
Pallor
Jaundice
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30. Detailed Physical Examination


Visual disturbances
Gastrointestinal







Epistaxis
Bleeding gums / Infections of the gums
Ulcerations
Melena
Liver disease
Pain
Skeletal


Arthralgia
Nuchal rigidity
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31. Detailed Physical Examination

Cardiorespiratory
Dyspnea
 Chest pain
 Hemoptysis
 Tachycardia


Genitourinary
Hematuria
 Menorrhagia
 Infections

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32. General Management

General Treatment Guidelines

Maintain ABCs.
High-flow oxygen
 Assist ventilations as indicated
 Consider volume replacement.
 Monitor cardiac rhythm and vital signs.
 Treat rhythm disturbances.

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33. General Management

Pharmacological






Non-pharmacological


Oxygen
Platelet aggregate inhibitor
Alkalinizing agents
Narcotic/ analgesic
Diuretic
Provide reassurance, comfort care, and transport.
Transport considerations

Appropriate mode / facility
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34. Managing Specific
Patient Problems




Diseases of the Red Blood Cells
Diseases of the White Blood Cells
Diseases of the Platelets/Blood Clotting
Abnormalities
Other Hematopoietic Disorders
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35. Anemias

Epidemiology

Reduction below normal levels of hemoglobin or
erythrocytes, and is a symptom of an underlying
disease process
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36. Anemias

Pathophysiology

Morbidity/ mortality
Can be self-limiting disease
 Must be confirmed by laboratory diagnosis


Precipitating causes
Blood loss (acute or chronic)
 Decreased production of erythrocytes
 Increased destruction of erythrocytes

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37. Anemias

Pathophysiology cont.
 Hemolytic
 Hereditary
Sickle cell
 Thalassemia
 Glucose-6-phosphate dehydrogenase deficiency

 Acquired
Immune
 Drug

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38. Anemias


Signs and symptoms may not be present until
the body is stressed.
Treat signs and symptoms.
Maximize oxygenation and limit blood loss.
 Establish IV therapy if indicated.

Dutchess Community College EMS

39. Anemias

Initial assessment findings

Airway/ breathing


Labored breathing may or may not be present
Circulation

Peripheral pulses



Quality
Rhythm
Changes in skin



Color
Temperature
Moisture
Dutchess Community College EMS

40. Anemias

Focused History Complaints
 Complaints secondary to anemia
Fatigue
 Lethargy
 Hypoxia
 Dyspnea

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41. Anemias

Focused History Complaints
 Complaints secondary to leukopenia
 Infections
 Fevers
 Complaints secondary to thrombocytopenia
 Cutaneous bleeding
 Bleeding from mucous membranes
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42. Anemias

Management
Airway and ventilation
 Circulatory support
 Pharmacological

Analgesics
 Fluid volume replacement
 Control of bleeding


Non-pharmacological

Position of comfort
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43. Anemias

Transport considerations

Appropriate mode



Indications for rapid transport
 Significant changes in LOC
 Hypotension/ hypoperfusion
Appropriate facility
Support and communication strategies
Explanation for patient, family, significant others
 Communications and transfer of data to the physician

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44. Types of Anemia
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45. Sickle Cell Disease
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46. Sickle Cell Disease

Epidemiology


Highest incidence in blacks, Puerto Ricans and
persons of Spanish, French, Italian, Greek and
Turkish origin
Pathophysiology
A congenital hemolytic anemia
 A chemical defect within the hemoglobin of red
blood cells
 Morbidity/ mortality

Sepsis
 Shock
 Death

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47. Sickle Cell Disease

Initial assessment findings
 Levels of consciousness
 Airway/ breathing
 Circulation
 Peripheral pulses
 Changes in skin

Pallor, Cool, Clammy
 Hypotension/ hypoperfusion
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48. Sickle Cell Disease

Focused history
 Chief complaint
 Sudden onset develops into a condition called
“crisis”
Thrombotic crisis (painful)
 Aplastic
 Hemolytic

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49. Sickle Cell Disease

Detailed physical exam
 Airway / Breath sounds
 Circulation
 Skin
As above
 Temperature may vary

 ECG findings
Tachycardia
 Ectopy

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50. Sickle Cell Disease

Detailed physical exam continued
Increased weakness
 Aching
 Chest pain
 Sudden, severe abdominal pain
 Bony deformities
 Icteric sclera
 Abdominal pain
 Fever
 Arthralgia

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51. Sickle Cell Disease

Management
Position of comfort
 Pharmacological

Analgesia
 Fluid volume replacement


Transport for reperfusion
Indications for no transport
 Refusal


Support and communication strategies
Explanation for patient, family, significant others
 Communications and transfer of data to the physician

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52. Polycythemia

Epidemiology
Overabundant production of red blood cells, white
blood cells and platelets
 Rare disorder seen in persons over 50 years of age


Pathophysiology
Thrombosis
 Death from thrombosis

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53. Polycythemia

Initial assessment findings
Levels of consciousness
 Airway/ breathing



Labored breathing is common
Circulation

Peripheral pulses



Quality
Tachycardia
Changes in skin



Color - red-purple complexion
Red hands and feet
Pruritic
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54. Polycythemia

Focused history
Dyspnea
 Generalized pruritus


Detailed physical exam
Airway / Breath sounds
 Circulation


Skin



As above
Temperature may vary
ECG findings

Tachycardia
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55. Polycythemia

Management
Position of comfort
 Pharmacological

Analgesia
 Increase or decrease heart rate


Non-pharmacological

Phlebotomy
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56. Polycythemia

Transport

Indications for no transport
Refusal
 Referral


Support and communication strategies
Explanation for patient, family, significant others
 Communications and transfer of data to the
physician

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57. Diseases of the White
Blood Cells

Leukopenia/Neutropenia
Too few white blood cells or neutrophils.
 Follow general treatment guidelines and provide
supportive care.


Leukocytosis

An increase in the number of circulating white
blood cells, often due to infection.

Leukemoid reaction
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58. Leukemia

Pathophysiology

Morbidity/ mortality



Neoplastic disease


Blood loss
Death
Acute versus chronic
Precipitating causes





Radiation exposure
Viral infections
Chemicals
Immune defects
Chromosomal changes
Dutchess Community College EMS

59. Leukemia

Initial assessment findings
Levels of consciousness
 Airway/ breathing



Labored breathing may or may not be present
Circulation

Peripheral pulses



Quality
Tachycardia
Changes in skin



Color
Temperature
Moisture
Dutchess Community College EMS

60. Leukemia

Focused history

Complaints
Fatigue, bone pain, diaphoresis
 Elevated body temperature
 Sternal tenderness
 Heat intolerance
 Abdominal fullness
 Bleeding


Contributing history
Recurrent bleeding
 Increasing frequency and/ or duration

Dutchess Community College EMS

61. Leukemia

Detailed physical exam
Airway
 Breath sounds
 Circulation

Skin
 Blood pressure may low
 ECG findings
 Tachycardia
 Ectopic

Dutchess Community College EMS

62. Leukemia

Management
 Position of comfort
 Pharmacological
 Analgesia
 Increase or decrease heart rate
 Fluid volume replacement
 Electrical
 Constant ECG monitoring
Dutchess Community College EMS

63. Leukemia

Transport
 Criteria for rapid transport
 No relief with medications
Hypotension/ hypoperfusion
 Significant changes in ECG

 Indications for no transport
 Refusal
 Referral
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64. Lymphomas

Epidemiology
 Hyperplasia of the lymphoreticular system

Pathophysiology
 Morbidity/ mortality
 Blood loss
 Pain
 Death
Dutchess Community College EMS

65. Lymphomas

Initial assessment findings
Levels of consciousness
 Airway/ Breathing
 Circulation


Focused history

Complaints
Fever
 Night sweats
 Generalized pruritus
 Anorexia
 Weight loss
 Fatigue, bone pain, diaphoresis

Dutchess Community College EMS

66. Lymphomas

Detailed physical exam

Airway / Breath sounds
May be clear to auscultation
 Congestion in bases may be present


Circulation

Skin



Pallor during the episode
Temperature may vary
Diaphoresis is usually present
Blood pressure may low
 ECG findings



Tachycardia
Ectopy
Dutchess Community College EMS

67. Lymphomas

Management
Position of comfort
 Pharmacological

Analgesia
 Increase or decrease heart rate
 Fluid volume replacement


Electrical

Constant ECG monitoring
Dutchess Community College EMS

68. Lymphomas

Transport
 Criteria for rapid transport
 No relief with medications
Hypotension/ hypoperfusion
 Significant changes in ECG

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69. Diseases of the Platelets

Thrombocytosis and Thrombocytopenia

Thrombocytosis


Thrombocytopenia


An abnormal increase in the number of platelets
An abnormal decrease in the number of platelets
Management

Provide supportive care and follow general treatment
guidelines.
Dutchess Community College EMS

70. Hemophilia

Epidemiology
A hereditary disorder transmitted by the female to
the male
 In true hemophilia A factor VIII is nearly absent
 In hemophilia B there is a deficiency in factor IX
 The ability to produce thrombin is severely impaired
by deficiency or absence of these factors

Dutchess Community College EMS

71. Hemophilia

Pathophysiology
 Morbidity/ mortality
 Uncontrolled bleeding
 Shock
 Death
Dutchess Community College EMS

72. Hemophilia

Initial assessment findings
 Levels of consciousness
 Airway/ breathing
 Labored breathing is common
 Circulation
 Peripheral pulses

Weak and thready
 Tachycardia
Dutchess Community College EMS

73. Hemophilia

Changes in skin
Pallor, Cool, clammy
 Bleeding

From body orifices
 Knees, Wrists, Elbows
 Hematuria
 Epistaxis
 Hemoptysis
 Hematemesis
 Melena


Hypotension/ hypoperfusion
Dutchess Community College EMS

74. Hemophilia

Focused history
Dyspnea
 Bleeding


Detailed physical exam

Airway / Breath sounds
May be clear to auscultation
 Congestion in bases may be present


Circulation
ECG findings
 Tachycardia
 Ectopy
Dutchess Community College EMS


75. Hemophilia

Management
 Position of comfort
 Pharmacological
 Analgesia
 Fluid volume replacement
 Transport for reperfusion
 Indications for no transport

Refusal
Dutchess Community College EMS

76. Blood Clotting Abnormalities

Von Willebrand’s Disease

Deficient component of factor VIII
Generally results in excessive bleeding.
 Generally is not serious; provide supportive care.

Dutchess Community College EMS

77. Other Hematopoietic Disorders

Multiple Myeloma
Cancerous disorder of plasma cells.
 Pathologic fractures are common.

Dutchess Community College EMS

78. Disseminated Intravascular
Coagulopathy

Epidemiology
A complication of severe injury, trauma or disease;
acute bleeding disorder resulting from defibrination
 First phase characterized by free thrombin in the
blood, fibrin deposits and aggregation of platelets
 Phase two is hemorrhage caused by depletion of
clotting factors

Dutchess Community College EMS

79. Disseminated Intravascular
Coagulopathy

Pathophysiology
 Morbidity/ mortality
 Uncontrolled bleeding
 Shock
 Death
Dutchess Community College EMS

80. Disseminated Intravascular
Coagulopathy

Initial assessment findings

Airway/ breathing


Circulation



Labored breathing is common
Peripheral pulses are weak and thready
Tachycardia
Changes in skin





Pallor
Purpura over chest and abdomen
Cool, clammy
Bleeding
Hypotension/ hypoperfusion
Dutchess Community College EMS

81. Disseminated Intravascular
Coagulopathy

Focused history
 Complaints
 Dyspnea
 Bleeding
Dutchess Community College EMS

82. Disseminated Intravascular
Coagulopathy

Detailed physical exam

Airway / Breath sounds
May be clear to auscultation
 Congestion in bases may be present


Circulation

Skin



As above
Temperature may vary
ECG findings


Tachycardia
Ectopy
Dutchess Community College EMS

83. Disseminated Intravascular
Coagulopathy

Management
Position of comfort
 Pharmacological

Analgesia
 Increase or decrease heart rate
 Fluid volume replacement


Support and communication strategies
Explanation for patient, family, significant others
 Communications and transfer of data to the physician

Dutchess Community College EMS

84. Multiple Myeloma

Epidemiology
A plasma cell dyscrasia characterized by neoplastic
cells that infiltrate bone marrow
 Eventually plasma cells become malignant leading to
tumor formation within the bone


Pathophysiology

Morbidity/ mortality
Fractures
 Bleeding
 Shock
 Death

Dutchess Community College EMS

85. Multiple Myeloma

Initial assessment findings
Levels of consciousness
 Airway/ breathing



Labored breathing is common
Circulation

Peripheral pulses



Weak and thready
Tachycardia
Changes in skin

Pallor, Cool, clammy
Bleeding
 Hypotension/ hypoperfusion

Dutchess Community College EMS

86. Multiple Myeloma

Focused history

Complaints
Weakness
 Skeletal pain
 Hemorrhage
 Hematuria
 Lethargy
 Weight loss
 Frequent fractures

Dutchess Community College EMS

87. Multiple Myeloma

Detailed physical exam


Airway / Breath sounds
Circulation

ECG findings








Tachycardia
Ectopy
Increased weakness
Aching
Chest pain
Sudden severe abdominal pain
Bony deformities
Arthralgia
Dutchess Community College EMS

88. Multiple Myeloma

Management
Position of comfort
 Pharmacological

Analgesia
 Fluid volume replacement


Transport for reperfusion
Indications for no transport
 Refusal
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Support and communication strategies
Explanation for patient, family, significant others
 Communications and transfer of data to the physician
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Dutchess Community College EMS

89. Hematology
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Anatomy, Physiology, and Pathophysiology
General Assessment and Management
Managing Specific Patient Problems
Dutchess Community College EMS