Assessment of Hematologic System
Past Health History
o recent blood loss/trauma; clotting issues
o chronic liver, endocrine, spleen, and kidney diseases, dialysis
o GI disease (e.g. malabsorption, ulcers, gastritis, hemorrhoids, etc.)
o IV drug or alcohol use
o recent or recurrent infections
o previous radiation may have targeted bone marrow
Current Health
o bone marrow function and immune activity decrease with age
o women have lower blood cell counts than men due to menstruation and fluid retention from
female hormones (always assess RBCs in every woman no matter what)
o the liver makes clotting factors, plasma proteins, immunoglobulins, etc., and metabolizes
drugs, so any disorder affects hematology
o lymph node swelling?
o Excessive bruising/bleeding? Spontaneous or induced by trauma? amount and duration of
bleeding after dental work?
o Number of pads/tampons during a menstrual cycle? Amount of menstrual bleeding? Change
in menstrual flow? Menstrual clot size?
o SOB on exertion? Palpitations? Frequent infections? Fever? Recent weight loss? Headaches?
Paresthesias? All indicate hematologic disease
o Feelings of fatigue? Needing more rest? The most common manifestation of anemia is
fatigue as a result of decreased oxygen delivery to cells= less ATP for cells
o Other manifestations of anemia (e.g. vertigo, tinnitus, sore tongue)?
o Risk Factors:
alcohol
causes vitamin deficiencies; GI bleed, esophageal varices, and decreased
absorption of cobalamin and other nutrients)
damages platelet and liver function (which makes the platelets, stores blood
and iron, makes plasma proteins, etc.)-> increased risk for bleeding
cigarette/tobacco use
increases LDLs, and CO2-> hypoxia and changes in the anticoagulant
properties of the endothelium
increases platelet reactivity, plasma fibrinogen, hematocrit, and blood
viscosity
o Older Adults
Family History and Genetic Risk
o history of hemophilia, frequent epistaxis, postpartum hemorrhages, excessive bleeding after
tooth extractions, or heavy bruising after mild trauma
, o strong genetic link in sickle cell anemia, thalassemia, hemophilia, and hemochromatosis
o African Americans more prone to sickle cell anemia
o sickle cell disease develops if the trait comes from BOTH parents; if not, the patient only
carries the trait, but does not have the disease
o genetic predisposition to leukemia, pernicious anemia, and clotting disorders
Medications
o vitamins, herbal products, or dietary supplements
o long-term anticoagulant therapy (increased risk for bleeding); anticoagulants prevent
formation of new clot and extension of existing clots; they do not break down existing clots
o chemotherapy drugs and anti-retrovirals cause bone marrow depression
o chemo and alkylating agents increase risk for secondary leukemia/lymphoma
o Hematologic adverse effects of phenytoin include anemia, thrombocytopenia, leukopenia,
granulocytopenia, agranulocytosis, and pancytopenia.
o blood “thinners”: increase risk for blood loss
vitamin K antagonists: no vitamin K= no clotting factors (e.g. warfarin - Coumadin)
platelet inhibitors: prevent activation or aggregation (e.g. aspirin, naproxen,
ibuprofen, clopidogrel, dipyridamole, prasugrel, ticagrelor, ticlopidine…)
Thrombin Inhibitors:
Direct thrombin inhibitors: prevent conversion of prothrombin to thrombin= no
fibrin for clot (e.g. argatroban, rivaroxaban, bivalirudin, desirudin, lepirudin)
Indirect thrombin inhibitors: bind to and activate antithrombin III, which indirectly
inhibits thrombin (e.g. the herparins- enoxaparin (lovenox))
fibrinolytics: break down fibrin to dissolve clots (end in –plase: alteplase, reteplase,
tenecteplase, and urokinase- this one is only for massive pulmonary embolisms)
best clot breakdown with less disruption of blood clotting
first-line therapy for small, localized clots r/t MI, limited arterial thrombosis,
and thrombotic strokes
Surgery/Other Treatments
o past splenectomy, tumor removals, prosthetic heart valve placement, surgical excision of the
duodenum (where iron absorption occurs), partial/total gastrectomy (reducing IF needed to
absorb vitamin B12, gastric bypass, ileal resection (for vit. B12 absorption)
o Splenectomy can result in increased platelet levels and impaired immunologic function
because of the loss of storage and immunologic functions of the spleen.
o assess past wound healing and bleeding tendencies post-surgery or injury
o previous blood transfusions? any complications? the risk for transfusion reactions and iron
overload increases w/ the number of transfusions
Nutritional-Metabolic Pattern
o Nutritional Requirements for Blood: protein, iron, folic acid (folate), cobalamin (vitamin B12),
riboflavin (vitamin B2), pantothenic acid, pyridoxine (vitamin B6), niacin, ascorbic acid
(vitamin C), copper, and vitamin E
o diets high in fat and carbs and low in protein, iron, and vitamins increase the risk for anemia
Past Health History
o recent blood loss/trauma; clotting issues
o chronic liver, endocrine, spleen, and kidney diseases, dialysis
o GI disease (e.g. malabsorption, ulcers, gastritis, hemorrhoids, etc.)
o IV drug or alcohol use
o recent or recurrent infections
o previous radiation may have targeted bone marrow
Current Health
o bone marrow function and immune activity decrease with age
o women have lower blood cell counts than men due to menstruation and fluid retention from
female hormones (always assess RBCs in every woman no matter what)
o the liver makes clotting factors, plasma proteins, immunoglobulins, etc., and metabolizes
drugs, so any disorder affects hematology
o lymph node swelling?
o Excessive bruising/bleeding? Spontaneous or induced by trauma? amount and duration of
bleeding after dental work?
o Number of pads/tampons during a menstrual cycle? Amount of menstrual bleeding? Change
in menstrual flow? Menstrual clot size?
o SOB on exertion? Palpitations? Frequent infections? Fever? Recent weight loss? Headaches?
Paresthesias? All indicate hematologic disease
o Feelings of fatigue? Needing more rest? The most common manifestation of anemia is
fatigue as a result of decreased oxygen delivery to cells= less ATP for cells
o Other manifestations of anemia (e.g. vertigo, tinnitus, sore tongue)?
o Risk Factors:
alcohol
causes vitamin deficiencies; GI bleed, esophageal varices, and decreased
absorption of cobalamin and other nutrients)
damages platelet and liver function (which makes the platelets, stores blood
and iron, makes plasma proteins, etc.)-> increased risk for bleeding
cigarette/tobacco use
increases LDLs, and CO2-> hypoxia and changes in the anticoagulant
properties of the endothelium
increases platelet reactivity, plasma fibrinogen, hematocrit, and blood
viscosity
o Older Adults
Family History and Genetic Risk
o history of hemophilia, frequent epistaxis, postpartum hemorrhages, excessive bleeding after
tooth extractions, or heavy bruising after mild trauma
, o strong genetic link in sickle cell anemia, thalassemia, hemophilia, and hemochromatosis
o African Americans more prone to sickle cell anemia
o sickle cell disease develops if the trait comes from BOTH parents; if not, the patient only
carries the trait, but does not have the disease
o genetic predisposition to leukemia, pernicious anemia, and clotting disorders
Medications
o vitamins, herbal products, or dietary supplements
o long-term anticoagulant therapy (increased risk for bleeding); anticoagulants prevent
formation of new clot and extension of existing clots; they do not break down existing clots
o chemotherapy drugs and anti-retrovirals cause bone marrow depression
o chemo and alkylating agents increase risk for secondary leukemia/lymphoma
o Hematologic adverse effects of phenytoin include anemia, thrombocytopenia, leukopenia,
granulocytopenia, agranulocytosis, and pancytopenia.
o blood “thinners”: increase risk for blood loss
vitamin K antagonists: no vitamin K= no clotting factors (e.g. warfarin - Coumadin)
platelet inhibitors: prevent activation or aggregation (e.g. aspirin, naproxen,
ibuprofen, clopidogrel, dipyridamole, prasugrel, ticagrelor, ticlopidine…)
Thrombin Inhibitors:
Direct thrombin inhibitors: prevent conversion of prothrombin to thrombin= no
fibrin for clot (e.g. argatroban, rivaroxaban, bivalirudin, desirudin, lepirudin)
Indirect thrombin inhibitors: bind to and activate antithrombin III, which indirectly
inhibits thrombin (e.g. the herparins- enoxaparin (lovenox))
fibrinolytics: break down fibrin to dissolve clots (end in –plase: alteplase, reteplase,
tenecteplase, and urokinase- this one is only for massive pulmonary embolisms)
best clot breakdown with less disruption of blood clotting
first-line therapy for small, localized clots r/t MI, limited arterial thrombosis,
and thrombotic strokes
Surgery/Other Treatments
o past splenectomy, tumor removals, prosthetic heart valve placement, surgical excision of the
duodenum (where iron absorption occurs), partial/total gastrectomy (reducing IF needed to
absorb vitamin B12, gastric bypass, ileal resection (for vit. B12 absorption)
o Splenectomy can result in increased platelet levels and impaired immunologic function
because of the loss of storage and immunologic functions of the spleen.
o assess past wound healing and bleeding tendencies post-surgery or injury
o previous blood transfusions? any complications? the risk for transfusion reactions and iron
overload increases w/ the number of transfusions
Nutritional-Metabolic Pattern
o Nutritional Requirements for Blood: protein, iron, folic acid (folate), cobalamin (vitamin B12),
riboflavin (vitamin B2), pantothenic acid, pyridoxine (vitamin B6), niacin, ascorbic acid
(vitamin C), copper, and vitamin E
o diets high in fat and carbs and low in protein, iron, and vitamins increase the risk for anemia
