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MODULE 31
HEMATOLOGY AND NURSING IN HEMATOLOGY

Specialization in GENERAL NURSING ASSISTANT

Year II

1
 Blood disorders evolve with often impressive symptoms,
therapeutic means often cannot prolong life, obtaining only a remission of
symptoms.

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THE COMPONENTS AND FUNCTIONS OF BLOOD

Blood is a liquid tissue

represents 6-8% of body weight
- the circulating sector is made up of the formed elements (45%) and plasma
ohematii
. role of transporting oxygen to tissues
. CO2to the excretory organs
. Maintaining the acid-base balance
. No. 4500000 - 5000000/mm3
oLeucocyte
. They play a role in the body's defense against infections.
. Number 5000-8000/mm3
Thrombocyte
. Role in the process of hemostasis
. Number 150,000–300,000/mm3
the training sector represented by the hematopoietic organs
the red marrow that forms granulocytes, platelets, erythrocytes
lymph nodes
splinter
lymphoid formations of the tonsils
. these form lymphocytes and monocytes
functions of the blood
it transports oxygen and nutrients to tissues, while carbon dioxide
carbon the plaminate
orol in termoregulation
role in the defense of the organism
maintain the hydrostatic osmotic pressure
transport the catabolism products to the excretory organs
the role of the spleen
blood reservoir
role in iron metabolism – the cemetery of erythrocytes
role in the metabolism of carbohydrates, minerals
hematopoietic
oral in self-defense, by generating antibodies
hemostasis
a mechanism that allows for the stopping of bleeding in case of vessel injury
vascular, platelet and plasma factors intervene

MEASURES FOR PREVENTING HEMATOLOGICAL DISEASES

primary prevention
complete food
the administration of iron in the second half of pregnancy and in patients with
gastrectomy
the diagnosis and treatment of intestinal parasites

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 the prevention of accidents that can cause acute hemorrhages
genetic aspect in patients with hemophilia
secondary prevention
educating the hemophiliac child to avoid trauma, injections, extractions
to provide first aid in case of plagiarism, and if it is about to
a surgical intervention will be administered 8 hours before
plasma, cryoprecipitate or factor and after intervention
the discharge of the patient with severe anemia
tertiary prevention
professional orientation of patients with hematological diseases
orthopedic corrective treatment in cases of secondary vicious ankylosis
repetitive hemarthroses

Morpho-functional assessment of the blood and hematopoietic organs

Capillary blood collection for hematological tests

-hemoleucogram, hemoglobin, bleeding time, coagulation time, examination
parasitological
blood group
Preparation:
material
- protection
. rubber gloves
sterile
. ace, cotton swabs, test serums
nonsterile
. clean medical tray, humid room, dry, clean blades
degreased, polished, Potain pipettes
-disinfectant solutions -90° alcohol
patient
mental preparation
. it is announced not to eat
. it explains the necessity of performing the technique
physical preparation
. he/she sits down with his/her hand supported
Execution:
The skin of the ring or middle finger is sanitized with a 90° alcohol pad.
congestion is avoided through strong and prolonged friction
the evaporation of alcohol is expected
with a sudden movement, the skin on the side of the fingertip is pricked
extremities, perpendicular to the skin layers
the first drop is wiped off with a dry pad, and another drop is allowed to form
from which is harvested with a pipette or blade
it is cleaned with an alcohol pad
Preparation of the product for the laboratory:
At the tip of a blade, a drop of 3-4 mm in diameter is placed.

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 A sheet with edges polished at a 45° angle is placed with the blade (the drop is
extends by capillarity
-the blade is pulled towards the free side of the blade, maintaining the same inclination and
training the entire drop without fragmenting it
- the blade is shaken for drying
- it is labeled and sent to the laboratory
Sedimentation:
the progressive settling of the figurate elements towards the bottom of the blood test tube
coagulable left at rest (physical phenomenon).
Sedimentation rate of erythrocytes (ESR):
the speed at which their deposition occurs
Preparation for VSH:
material:
sterile
. dry 2 ml syringe
. sodium citrate solution 3.8%
. ace for venous puncture
-nesterile
. Westergreen stand and pipettes
. ["plug","oilcloth","test tube","renal tray","tourniquet","cotton"]
disinfectant solutions
. 70% alcohol
patient
mental preparation
. It is explained, 24 hours in advance, the necessity of undergoing the examination.
physical preparation
. it is announced not to eat
. to maintain physical rest
Execution:
The assistant washes their hands with water and soap.
put on sterile rubber gloves
-draw 0.4 ml of 3.8% sodium citrate into the syringe
puncture the vein without a tourniquet and aspirate blood up to 2ml (1.6 ml)
remove the needle and apply a pad with alcohol
mix the blood-citrate mixture in the test tube and homogenize slowly
place the test tube in the stand
-caring for the patient (see venipuncture)
Preparing the product for the laboratory:
the identity card is being filled out
-the product is labeled
- it is aspired with the Westergreen pipette up to the graduation 200 and is placed in the stand on
rubber rod, in a strictly vertical position (when the exam is conducted at the bed)
the patient)

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 Apart from current analyses for the diagnosis of system disorders
The following tests are also performed for hemopoietic:
The blood analysis from which conclusions are drawn about the etiology of anemias (when
Hb and Ht are low), as follows:
when the diameter of the red blood cell is less than 7 microns (normal) suspicion of
iron deficiency anemia
when the diameter is larger than 8 microns (megalocyte), suspicion of anemia
megaloblastic (Biermer's anemia).
Hematocrit:
Blood collection for the determination of hematocrit (HCT) is done through
venous puncture. 2ml of blood is collected on EDTA crystals (acid)
diaminotetraacetic 1%)– 0.5 ml solution, dried by evaporation.

Erythrocyte indices also guide the etiology of anemias, such as MCV.

(mean corpuscular volume):
normal 80–90 microns and present in hemolytic anemias;
smaller than 80 microns - microcytic - iron deficiency anemia;
over 90 microns macrocytic anemia;
V.E.M. - larger than 110 microns - Biermer anemia.

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 Leukocytes and the leukocyte formula
They are white blood cells
Blood is collected from the fingertip or venous blood.
The normal number is 3000–10000/mm3
Sideremia (iron serum)
Collection technique
It is harvested on an empty stomach (without fasting) 10-12 cm 3venous blood hemolyzed in
special material (silicone test tube and nickel needle released from the laboratory).
Normal values: 90–100 μg Fe / 100 ml serum for women and 130–140 μg Fe / 100 ml
to men.
Pathological variations:
decreased in: hypochromic anemias (iron deficiency);
raised in: Biermer anemia, hemolytic anemia, and hemochromatosis (diabetes
bronzed);
Globular resistance - specific test for diagnosing anemia
hemolytic.
Collection technique
It is harvested 5 – 6 cm3, which are immediately transferred into a round 100 ml balloon,
having 5-10 glass beads inserted into it for the defibrination of venous blood and prevention
coagulation.
Normal values - the onset of hemolysis usually occurs at 0.44% NaCl (0.46
–0.42%). Total hemolysis (the maximum resistance is at 0.32% NaCl).
Pathological variations:
the decrease of the osmotic resistance of erythrocytes to 0.50–0.70 % is equivalent
with the onset of hemolysis. It is present in: hemolytic anemias: hereditary (spherocytosis and
ovalocytosis) and in many cases of acquired hemolytic anemias;
the increase of osmotic resistance of erythrocytes (in which total hemolysis does not appear
than at 0.30–0.28% NaCl), is found in: acute anemias (due to hemorrhages or
hemolysis), thalassemias, iron deficiency anemias, and megaloblastic anemias.
The direct Coombs test – allows for the detection of incomplete antibodies
and circulating blockers.
Collection technique
1 – 2 cm is collected3venous blood on anticoagulant (trisodium citrate).
Interpret
When the test is positive, it indicates the presence of antibodies fixed on red blood cells.
His observation in a newborn is a pathognomonic sign for hemolytic anemia.
perinatal caused by the phenomenon of isoimmunization through anti-Rh antibodies, (produced by a
mother carrying an Rh positive fetus.
The adult can appear: either in the presence of cold antibodies (+4º), or in
autoantibodies in the heat (+37º) through the phenomenon of autoimmunization can be found in: anemias
hemolytic events that occur in the context of malignant hematopathies, L.E.D., viral conditions or
incompatible transfusions.
The indirect Coombs test - allows the detection of incomplete or blocking antibodies
circulating.
Collection technique
1-2 cm is collected3venous blood without anticoagulant.

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 Interpretare:
The positive result (+) indicates the presence of incomplete antibodies in the tested serum at:
pregnant woman (showing that the fetus is Rh negative);
and in patients it detects acquired hemolytic anemias.
Fibrinogen
The normal amount of circulating fibrinogen ranges from 200 to 400 mg per 100
ml plasma.
Coagulation is compromised if the fibrinogen concentration falls below 100 mg.
100 ml plasma.
Collection technique
It is harvested on an empty stomach 9 cm3venous blood per cm3anticoagulant in a test tube
sterile.
Pathological values:
decreased in: fibrinolysis (DIC), congenital fibrinogenemia, leukemias and insufficiency
severe hepatitis
grown in: A.R.A. (acute articular rheumatism) and various pneumonias.
Coagulation tests (were stated in acute abdomen)
Bleeding time (Ivy method) is 4 minutes (normal).
The coagulation time is 8 minutes (normal).
Clot retraction
Collection technique
Harvested 2-3 cm 3venous blood in tube 12 / 120 cm3and is put in the bath of
water, at 37ºC. The timer is started, the tube is tilted slightly and the timer starts.
when the blood no longer flows at the complete overturning of the tube signaling that it has occurred
the coagulation, after which the tube is placed back at 37ºC. After three hours the amount of serum
the liberated must represent 40 - 50 % of the total blood volume.
The liver lizard
The technique of execution
The clotting blood is kept at 37ºC which normally
it is not liquefied until the next day. In pathological conditions such as: acute hemorrhages or D.I.C.
Disseminated intravascular coagulation) the clot lysis occurs sometimes within minutes.
To be remembered
The coagulation time, retraction, and lysis of the clot are performed from the same sample of
blood (from the same tube).
Platelet count (determined in the counting chamber) - normal 150-300
me / my3from the blood collected for hemogram.
Pathological values:
low: below 50,000 per mm3appears in idiopathic thrombocytopenic purpura;
increased: appear after splenectomies.
Leukocyte alkaline phosphatase (L.A.P.)
The activity level of this enzyme is a useful hematologic test in
differentiation of types of leukemia and makes the differential diagnosis between a reaction
leukemoid and leukemia. Thus, in leukemoid reactions, the level of F.A.L. is very high.
when in CGL (chronic granulocytic leukemia) the level is very low reaching
down to zero in most cases.
Average physiological values - 35 (variations between 13 - 62).

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 Increased values can be found in: acute infections, carcinomatosis, myelosclerosis,
polycythemia vera. It is determined either from peripheral blood or from bone marrow aspiration.
Blood groups
The determination of blood groups OAB is based on the phenomenon of agglutination that
must appear between erythrocyte agglutinins A and B and anti-A and anti-B antibodies. They
it is determined on glass slides or in hemolysis tubes by two mandatory methods.
Collection technique
It collects 2 cm3venous blood without anticoagulant, which always requires
Simultaneous testing of anti-A and anti-B serum and red blood cells with anti-A and anti-B tests.
Rh factor (Rhesus)
Collection technique
It collects 2 cm3venous blood on sodium citrate 3.8%. It is placed in
contact the erythrocyte with anti-Rh serum and perform macroscopic and microscopic examination.
Normal values:
85% of the subjects are Rh positive.
15% of the subjects are Rh negative.
The interest of this method lies in the preventive detection of incompatibility.
factor Rh, fie: la o gravidă sau la un politansfuzat (pentru detalii vezi capitolul transfuzii).
Myelogram (spinal puncture)
Provide quantitative and qualitative indications on the evolution of the series: red, white and
platelet. It is performed by the hematologist.
bone marrow puncture
penetration with a sterile needle through the cortical layer down to the spongiosa, achieving a
communication between the medullary cavity and the external environment.
The purpose
Explorer – for hematogenous bone marrow in order to establish the structure
the composition of the marrow, as well as the study of the figurative elements of the blood in
different stages of their development, during the illness of the hematopoietic organs.

Therapeutic - is done for the administration of certain medications, blood transfusions

intraosseous (when other routes of administration are not possible due to burns,
obesity, plaster casts.

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 Bone puncture can also be performed on healthy individuals for marrow collection.
for the transfusion to patients with hematopoietic organ pathologies.

Necessary material:
2 puncture aces (Casirschi), which is made from a steel trochar
very durable, about 5 cm long, with a diameter of 1-2 mm and a short tip but
very sharp. The needle is equipped with a mandrel. The outer tip of the needle flares out in
disc shape, which adapts to the mandrel, on this end it will be supported
the doctor's palm, which performs the puncture. The needle is equipped with a protective, adjustable disc.
This disc serves to prevent the needle from penetrating beyond the medullary cavity into
posterior compact of the sternum.
10-20 ml syringe for aspirating bone marrow tissue, a watch glass.
2-5 ml syringe with needles for anesthesia, novocaine, blades or slides.
Material for disinfecting the punctured area.
Sterile typhoon for dressing, leucoplast
If the puncture is done for therapeutic purposes, instead of laboratory instruments (or alongside)
These) will prepare medicinal solutions that must be administered. The instruments will
I am preparing on a small table covered with a sterile field, under perfect aseptic conditions.
since the bone marrow is very susceptible to infection.
Preparing the patient and choosing the location for the puncture.
1. The preparation of the patient must begin by raising their morale, informing them
on the necessity and essence of the intervention.
For the sternal puncture, the patient is lying on their back with the torso slightly elevated.
The nurse ensures that the patient's bed is as firm as possible.
3. The sternum can be punctured in the handle or the body, or at the height of the rib.
IV or V, or in the second or third intercostal space, slightly outside the line
medial
The chosen site for the puncture will be washed, shaved if necessary, then disinfected with alcohol and
bandage with iodine tincture.
5. The nurse presents the doctor with the novocaine solutions aspirated into the syringe.
for the anesthesia of the soft tissues above the bone, including the periosteum.
The anesthetized area is again painted with iodine tincture, the region is isolated.
disinfected with sterile fields and after 15-20 minutes, necessary for installation
anesthesia, the puncture can be performed.
Technique:

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The puncture is performed in the treatment room.
The nurse presents the instruments to the doctor during the puncture.
First, the forceps are offered, with which the doctor selects the puncture needle.
The doctor fixes the protective disc at the supposed necessary distance (10-16 mm) and then
pierces vertically at the chosen location for the puncture, penetrating through the outer blade of
the bone with the help of the pressure exerted on the end of the mandrel with the bridge
palm tree.
5) After the needle enters the medullary cavity of the sternum, the doctor extracts
he takes the mandrel from the needle and gives it to the nurse, who keeps it sterile.
The nurse hands the doctor the 10 or 20 ml syringe prepared for aspiration.
and which the doctor adapts into a needle and aspirates the medullary content with it.
During aspiration, the patient feels a painful retrosternal sensation, very distressing.
After 1-2 seconds of aspiration, bone marrow appears in the syringe. The amount of marrow
The necessary bone for examinations is 0.5-1 ml.
The red hematogenous marrow has the appearance of blood, but when spread on a slide, it is viscous.
many face layers of fatty tissue.
9) If the sternal puncture was performed for therapeutic purposes or if an exploratory puncture is
continued with the administration of medications via intramedullary route, it will
Prepare the infusion or transfusion device in advance with the respective solution, which will be
harvest at the needle fixed in the bone. Only solutions can be administered through the intramedullary route.
isotonic drop by drop. The administration rate should not exceed 15-20
pic per minute. At this rate, up to 1500-2000 ml of solution can be administered in 24 hours.
in one place.
10) After the harvesting or administration operation is completed, the needle is removed from
puncture. The puncture site is cleaned and a plaster is applied.
Possible complications:
a) Nothing can be extracted from the medullary cavity due to a wrong position of
the needle - the clogging of the needle (which is unclogged with the sterile mandrel).
b) Perforation of the posterior blade of the sternum.
c) Introduction of infection into the medullary cavity.
Patients do not require special care after the puncture.
Preparation of the extracted marrow for sending to the laboratory:
The extracted marrow is mixed with blood from the marrow sinuses. From this
the syringe containing this mixture must be emptied quickly, for the blood can
to coagulate in it. The partial separation of the medullary tissue from the blood is done through
the evacuation of the syringe contents on an inclined plane (the clock glass with convexity
turned upwards), where the blood flows, leaving the fatty patches of myeloid tissue behind.
These are collected and spread on de-greased blades, just like the blood smears. During the
For a puncture, usually 3-4 blades are prepared with a bone marrow tissue smear and at the indication
The doctor will carry out other collections for counting the nucleated elements, for
the counting of reticulocyte elements, for histological examinations or notes will be made
through culture media. The harvested samples are sent promptly to the laboratory.
with the completed collection forms. The seeded culture media are placed as soon as possible
early in the thermostat.
ganglion puncture
bone puncture

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 splenic puncture
splenic scintigraphy
abdominal ultrasound
The Rumpel-Leede test – a positive test when approximately 15 spots appear below the level of
application of the pneumatic cuff

Manifestation of dependence
Signs and symptoms

intense asthenia
suggests a leukemia
excessive weight loss
in neoplastic processes
changes in coloration and integrity of the skin
opacities in anemias
hyperchromasia in polyglobules
dry teguments, reliable nails, presence of ulcers in chronic anemias
the presence of purplish elements in hemorrhagic diatheses
modifications of the ganglia
firm, generalized or unilateral lymphadenopathy
splenomegaly
joint pain in Hodgkin's disease
joint tenderness in chronic leukemia
petesii
subcutaneous or submucosal hematomas
it manifests in the form of reddish-purple spots
it shoots under pressure
ecchymosis
subcutaneous hemorrhages, round or lenticular, larger
I shoot under pressure

Particularities of care for patients with hematological conditions

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Hematological conditions often evolve with impressive symptoms.
it requires very careful attention from the nurse
the existing therapeutic means for the numerous blood and organ diseases
hematopoietic gives exceptional results
often I cannot significantly extend the patient's life and their effect is reduced only
the symptomatic remissions that suppress or temporarily reduce some
subjective manifestations
During numerous hematological conditions, periods of exacerbation occur,
what brings the patient in critical condition such as coagulopathies, severe anemias,
leukemias, agranulocytosis where medical assistance must show a lot of skill.
professional knowledge, observation skills, and efficiency
the attitude of the nurse towards these patients is dictated not only by their condition
record if you will of the prognosis of the disease, these patients should not feel their future
The perspective is that the nurse must do everything to prevent.
their psychological imbalance
Most of these patients have an optimistic mindset and a persistent character.
al bolii rar ajung la stari depresive
ensuring environmental conditions and the care provided
Patients hospitalized with hematological conditions are usually found in a state
often with vitamin and nutritional deficiencies
It pays special attention to oral cavity care which in many
hematological disorders are the gateway for the most diverse.
pathogenic germs
Acute leukemias as well as agranulocytosis stomatitis require a
special care

Mucozita

All hematological disorders will be dealt with after teeth cleaning.

gargle with weak antiseptic solutions
If ulcers exist, they will be treated with medicinal solutions.
methyl blue

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 Canker sores in the oral cavity

the diet must be substantial, rich in calories and vitamins

In anemia, the diet will be rich in meat.
The opposite of polycythemia will be a diet low in animal proteins and foods.
with iron content
The medical assistant must monitor and inform the doctor of any
changes that occurred in the patient’s evolution such as the following
to manifest
. hemorrhagic
nosebleed
purpura
menstruation
. acute anemia
. stomatitis
. oral ulcers
. gastrointestinal
. neurological
. cardiac
the application of the prescribed treatment
. among the treatment techniques, blood transfusion is applied more often and
erythrocyte mass
. the transfusion aims to improve the overall condition of the patient, of
to excite hematopoiesis and to lead in the recipient's organism
clotting factors
. blood transfusion often has an urgent character
. In hemolytic anemia of the newborn, it is performed
exsanguinotransfusion
. in the course of polyglobulinemias, blood transfusions are performed
. in the course of some genetic diseases, aplastic anemias, malignant diseases of
hematopoietic organs as well as some metabolic diseases are
medullary face transplant

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. bone marrow collected from the patient or compatible donor is
heparinizes and is filtered, then is administered intravenously
via central venous catheter
. patients who have undergone bone marrow transplants must be cared for in
sterile conditions for a longer period of time
. ferotherapy is practiced with ionizable iron
. iron preparations administered in the form of solutions color
dantura, for this reason it is good to be administered with a tube of
glass, by aspiration

. the iron solution ages over time, it oxidizes, the iron turns into
it becomes non-ionizable and loses effectiveness, acquiring an unpleasant taste
for this reason it must always be refreshed
. oral administration of iron is always done together with
vitamin C
. iron often causes gastrointestinal disorders that
constipation predominates and colors the stool black
. the presence of iron in the chair during ferotherapy should not
confused with upper gastrointestinal hemorrhage, especially with
Gregerson's reaction is positive
. in the case of administering iron in the form of intramuscular injections
care is going to be careful to apply technique 'Z' so that the substance
injected so that it does not reflux through the channel left by the needle in
subcutaneous layers, where it could leave undesirable pigmentation
. the latest medical discoveries have made it possible for iron to
administer intravenously such as the preparation VENOFER

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 . the treatment with cytostatic and antileukemic drugs receives a
increasingly greater weight in the hematology department
. the application of these medications is done according to protocols
International rules that must be strictly observed
. The preparation of cytostatic drugs is done under a fume hood and is
administers intravenously directly or in infusions
. care must be taken to ensure that the substance does not come into contact with the skin or mucous membrane
the patient or the nurse
. In the case of applying these medications, the assistant must notice.
any unwanted side effects such as
anorexia
the loser
nausea, vomiting
diarrhea
constipation
jaundice
itch
weakness
suspicion of venous thrombosis
. The medical assistant has the duty to inform the doctor of any of
take effects as soon as possible
. hormonal treatment, hemostatic, anticoagulant, deworming
Radiotherapy is a common treatment in the hematology department.

CARE OF PATIENTS WITH ANEMIA AND POLYCYTHEMIA

Anemia represents the decrease in the number of red blood cells and hemoglobin.
those produce p r i n
. loss of red blood cells
posthemorrhagic
hemolytic - hemolytic anemia of the newborn and through
blood incompatibility in the OAB system
. insufficient production of red blood cells and hemoglobin
iron deficiency anemia
pernicious anemia
polycythemia - disorders characterized by hyperplasia of the erythropoietic system
acute anemia
. it can occur as a result of trauma, anti-inflammatory medication
administration without gastric protection, previous hemorrhages
Sales to women

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 . manifests with
pebble
sudden onset of skin pallor
tachycardia
filiform pulse
hTA
dyspnea
lipotimia
digestive disorders
chronic anemia
. it can occur in individuals
work in a toxic environment
those who have a diet with iron deficiency
alcohol and tobacco consumer
with personal history such as: gastrectomy, giardiasis,
Adler's positive reaction in the chair
. manifests with
ameter
headache
asthenia
palpitations
precordial pain
dyspnea
the pallor of the lips, the palms, the plants
atrophied buccal mucosa
brittle nails and hair
fever
amenorrhea
poliglobulia
. it can occur in individuals

17
 with congenital heart conditions
heart and lung failure
aniline poisoning
. is manifested by
headache
ameteli
asthenia
tinnitus
greturi
vaginal bleeding
red, cyanotic, and itchy skin
HTA and dyspnea
Problems
Acute anemia
. Alteration of respiration and circulation
. Risk of loss of consciousness
. Risk of hemorrhagic shock
Chronic anemia
. Intolerance to physical activity
. Alteration of breathing and circulation
. Memory disorders
. Hyperthermia
. Menstrual cycle disorders
. Deficit of knowledge regarding self-care
. Risk of alteration of the integrity of the skin and mucous membranes
Poliglobulism
. Alteration of respiration and circulation
. Intolerant to physical activity
. Visual and hearing disorders
. Alteration of the integrity of the skin and mucous membranes
. Risk of hemorrhage - epistaxis, hemoptysis, HDS
- Objectives
The patient should
. Present appropriate respiration and circulation for the age.
. To affirm well-being
. To keep the skin intact and normally colored
. To be able to communicate effectively
. To eliminate the risks of complications

Care of patients with aplastic anemia

This rare disease occurs when the spinal cord does not produce enough blood cells.
In 50% of cases, aplastic anemia is caused by toxic agents.
certain medications or exposure to radiation. It can also be explained by diseases
serious pre-leukemia, especially in the early stages.

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 Patient with aplastic anemia

Special care
For patients with aplastic anemia, some precautions are required in daily life:
Protection against infections – by frequently washing hands with
antiseptic soap and by avoiding contact with other sick people.
Avoiding blades, knives, or other sharp instruments. Since anemia
Aplastic is associated with a low number of blood platelets, disorders
Clotting disorders are common. Therefore, they should be avoided as much as possible.
blood loss. For the same reasons, it is recommended to choose a toothbrush.
with soft bristles and avoiding contact sports.
Avoiding overly strenuous exercise. In the case of prolonged anemia,
due to the deficient transport of oxygen, the heart is overworked.
it is important for the heart to be cared for.

Treatment

Blood transfusions

Bone marrow graft

Immunosuppressive agents
If the anemia is caused by a self-destruction of the immune system cells,
the patient may be administered immunosuppressive drugs. These

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decreases or suppresses the activity of the immune system, allowing cells
attack to regenerate

Other therapies

The stimulation of blood cell production is a more recent treatment. Different substances
can stimulate the production of blood cells:
Erythropoietin (EPO) - This hormone, normally produced by the kidneys and liver,
stimulates the production of red blood cells in the bone marrow. Erythropoietin injections
synthetics are used to reduce fatigue.
Growth factors - Growth factors play an important role in the production process
blood cells. The different types (G-CSF, GM-CSF, etc.) can be combined with each other,
they can be associated with immunosuppressive agents to reduce the symptoms of anemia
to crush.
Androgens - Associated with cyclosporine, androgens can stimulate the production of cells.
sanguine

CARING FOR THE PATIENT WITH LEUKEMIA

malignant hemopathies characterized by hyperplasia of hematopoietic tissues and

metaplasia of them
abnormal proliferation of lymphocytes
metaplasia - the leukocytic tissue replaces the red series and no longer has the capability to form red blood cel

developing coagulation disorders

The prognosis of leukemias depends on the number of leukocytes, thus
oL=25000/mm3low risk
oL=25000–50000 mm 3medium risk
oL = over 50000 mm3 increased risk

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acute leukemia
what appears at
. children, young people under 25 years old
. insidious debut
manifests through
. anemic syndrome
paleness
asthenia
dyspnea
. infectious syndrome
fever
Frisian
curvature
. hemorrhagic syndrome
gingival hemorrhage
nosebleed
metrorrhagia
. pseudoneoplastic manifest
decreased appetite, weight loss
sweat
itch
. ulcerations of the oral cavity
chronic leukemia
what appears at
. men aged 35-45 years
. persons exposed to benzene poisoning, radiation
manifesto
. asthenia
. pain and a feeling of heaviness in the left hypochondrium
. weight loss
. skin itching
. generalized and symmetrical adenopathy
problem
acute leukemia
. hyperthermia
. intolerant to exertion
. liquid volume deficit
. alteration of the integrity of the oral mucosa
. food hydration incapacitated
. risk of tumor lysis syndrome - it is a metabolic complication
determined (spontaneous or therapeutic) by tumor necrosis or
fulminant apoptosis. The definitive metabolic triad is:
hyperuricemia, hyperkalemia, hyperphosphatemia. Acute lysis of
tumor cells lead to the rapid release into circulation of
potassium, phosphates, nucleic acids, thus imbalances occur
life-threatening electrolyte imbalances: hyperkalemia,

21
 hypocalcemia, acidosis, hyperuricemia, renal insufficiency (through
the precipitation of uric acid in the renal tubules
. risk of altering the general state - exitus
chronic leukemia
. intolerant to effort
. bone pain and in the left hypochondrium
. skin itching
. abdominal discomfort
. loss of self-image
objectives
the patient should have the longest possible remission periods
during the terminal periods the patient should be supported by family
to benefit from a dignified death
interventions
The basis of treatment consists of administering cytostatics, that is, medications that have
the ability to destroy tumor cells (lymphoblasts).
The cytostatic treatment depends on the specific type of acute lymphoblastic leukemia as well as
other factors such as the patient's age, the presence of other conditions (cardiac, pulmonary).
Furthermore, besides chemotherapy, there are also other important aspects such as
the necessity of red blood cell or platelet blood transfusions, antibiotic treatment
to control the side effects produced by chemotherapy.
In some countries, written consent from the patient is required for the procedure.
the treatment or some necessary procedures such as the placement of a central venous catheter
or for performing a bone biopsy.
In general, the treatment requires the insertion of a central venous catheter (a tube made of a)
flexible material inserted into a large vein, subclavian or jugular vein) through which will be
administer all medications and blood samples will be taken for tests,
thus avoiding multiple punctures of peripheral veins.
Generally speaking, in all types of LAL, the treatment consists of several phases. The first phase
this is the induction, the second is the consolidation and the third phase is the maintenance phase.
In some cases of LAL there is an increased risk of relapse even after performing
the treatment of consolidation requires performing a stem cell transplant
hematopoietic.
The overall duration of the treatment (including all these phases) is long and can last
up to 2 years.
Some stages are carried out in the hospital with discharge periods of 1-3 weeks in between.
cycles.
Between chemotherapy cycles, the patient can stay at home. It is very important that
the treatment program must be strictly followed without extending the duration of the break in between
treatment cycles.
Maintenance treatment is usually performed on an outpatient basis.
Induction of remission: several cytostatics are administered over a period of 4 - 5
weeks.
During the administration, bone marrow aplasia occurs, meaning a lack of production of leukocytes.
platelets and red blood cells due to chemotherapy that do not
it acts not only on lymphoblasts but also on normal cells in the bone marrow.

22
The objective of the induction treatment is to reduce the number of lymphoblasts in the bone marrow.
under 5%, obtaining what is called complete remission.
To highlight complete remission, once the induction treatment is completed,
when the tests show an increase in leukocytes, platelets and
hemoglobin, a new bone marrow aspiration will be performed to determine the number of
lymphoblasts from bone marrow.
If complete remission is not achieved, chemotherapy will be extended until
obtaining remission.
A bone puncture is also necessary in the middle of the induction stage to
evaluate the response to treatment and if deemed necessary, increase the chemotherapy dose
in the final part of the induction for obtaining a maximum response.
Intensification/Consolidation: consists of administering a few short cycles of
chemotherapy (approximately one week at intervals of about 2-3 weeks) including
chemotherapy drugs in large doses. In many cases, different chemotherapeutic agents from the induction phase are
administers in different combinations for the purpose of strengthening the response and elimination
residual cells.
Maintenance or upkeep therapy:
Aceasta se administreaza pentru o perioada lunga de timp (18 - 24 luni). Cuprinde
the combination of an oral chemotherapeutic agent (mercaptopurine) and one administered
parenteral (methotrexate).
In some cases of LAL, during the maintenance period there will be interspersed cycles of
reinforcer.
CNS prophylaxis: Given the possibility of CNS infiltration with lymphoblasts, it is necessary to
administer reduced doses of cytostatics directly at this level (intrathecal administrations).
Several lumbar punctures are performed during the course of treatment.
In administering chemotherapeutics, a few ml of cerebrospinal fluid are
extraction and analysis to check for the presence/absence of lymphoblasts.
In some units, simultaneous with intrathecal administrations, radiotherapy is also performed as
additional method of preventing brain disease assessments.
Hematopoietic stem cell transplant (bone marrow or peripheral): This procedure
It is indicated only in selected cases of LAL, those with a high risk of relapse, and it
takes place after the consolidation stage. It lasts on average 4 - 6 weeks and is done in
the context of a hospitalization. The highest success rate is achieved when chemotherapy has
eliminate most of the malignant cells (that is, when remission was achieved)
completed) before the transplant was performed.
The transplant consists of the administration of chemotherapy treatment, in
general associated with radiotherapy, followed by the administration of progenitors
hematopoietic. The purpose of chemotherapy and radiotherapy is to completely eliminate
lymphoblasts. However, this type of treatment not only eliminates malignant cells but also them
distruge si pe cele normale din maduva. Astfel, celulele progenitoare administrate in
the transplant framework counteracts the toxic effect of chemotherapy and radiotherapy and restores
hematopoiesis.
The transplant of peripheral stem cells or from the bone marrow can be autologous.
(if the stem cells are harvested from the patient himself) or allogeneic (if
stem cells are harvested from a compatible donor, related or unrelated
selected from the donor register.

23
Cells harvested from umbilical cord blood can also be transplanted.
Allogeneic transplantation is burdened by more severe complications than autologous transplantation.
the therapeutic benefits (curability) are greater after allogeneic transplantation.
The type of transplant is determined by the treating medical team, taking into account
the characteristics of the disease, the age of the patient, the general status of the patient and the existence of a
compatible donor. Thus, if the disease has a high risk of recurrence,
the patient's compatibility with his siblings (if any) will be tested early after the period of
induction by analysis of HLA molecules (in a sample collected from peripheral blood).
If there is no related donor, a potential unrelated donor will be searched for in the registry.
from donors (national or international) or in the umbilical cord blood bank.
For the harvesting of progenitor cells, there are currently three methods: progenitors from
peripheral blood, from hematopoietic marrow and from the umbilical cord. The choice of one or the
the other methods depend on the experience and preference of the transplant center and the
the donor.
Currently, the preferred method of collection is that from peripheral blood as it is the most
accessible as hospitalization is not necessary. To obtain stem cells from the blood
of the patient in the case of autologous transplant or of the donor in the case of allogeneic transplant,
the person is connected to a special device that separates stem cells from the rest
circulating cells, a procedure called apheresis.
The necessary cells are obtained in a few hours and are then frozen until the time of
the transplant and the patient or donor can go home.
Clinical trials: In certain situations, the medical team may suggest that you
participation in a clinical trial aimed at improving outcomes
of the treatment and consequently to sign an informed consent.
As already mentioned, in addition to chemotherapy, a series of are necessary.
supportive measures and treatments to prevent the side effects of chemotherapy.
These include:
Blood transfusions of red blood cell concentrates for correcting anemia
Platelet transfusions for controlling bleeding or preventing it
(if the platelet count is very low as a result of treatment)
Antibiotics, antivirals, and antifungals: these are used to fight
against infections caused by infectious agents (bacteria, viruses, fungi)
Granulocyte growth factors: these substances are injected subcutaneously
after the completion of chemotherapy to stimulate the production of leukocytes and
prevent the risk of infections.
Hydration: to protect the kidney from the toxic effects of chemotherapy and
to avoid affecting other organs by the release of toxic metabolites as a result of
Large amounts of fluids are administered to the patient during tumor cell destruction.
Oral hygiene: during chemotherapy administration and especially during the period of
Unfortunately, the use of a toothbrush is not recommended as it may encourage
gingival degeneration and facilitates the passage of microbes from the normal flora of the oral cavity into
circulation, increasing the risk of systemic infection. It is recommended to rinse the oral cavity with
different antiseptic solutions indicated by the medical team
The complications and side effects of the treatment
Most of the side effects are due to the chemotherapy treatment which on

24
the effect of destroying lymphoblasts also affects the production of cells from the cells
normal remaining of the marrow like other tissues and organs.
Most of these complications are reversible and can be successfully treated. In
continuation presents part of these complications:
great and the side effects: these are directly related to chemotherapy
but fortunately there are currently medications capable of controlling these
symptoms
anemia: caused by a deficiency of red blood cells leading to fatigue and
weakness. Each patient has their own threshold of tolerance for anemia but in certain
In situations of massive red blood cell transfusions, they are administered regardless of tolerance.
platelet production reduction increases the risk of
bleeding. Regular determinations of the platelet count will establish
the necessity of platelet mass transfusion if they decrease.
infections: the reduction in the number of leukocytes increases the risk of infections
any type and any location. Infections, among other manifestations, also cause fever.
Therefore, if the patient has a fever during treatment, samples will be collected.
cultures for the research of infections from urine, blood, and other sites, be for you
A chest X-ray will be performed and antibiotic treatment will be initiated urgently.
mucus: at the level of the mucosa of the oral cavity and the intestine, there can be
small ulcerations develop (what is called mucositis). These ulcerations cause pain
nutrition and respectively diarrhea. These ulcers occur due to a reduction in the number of
leukocytes as an effect of cytostatics
permanent sterility: chemotherapy does not usually cause
permanent sterility, but this is practically inevitable in the case of patients who will
perform stem cell transplantation. Therefore, in order to preserve reproductive function, there will be
sperm cryopreserved in men and respectively ovarian tissue or fertilized eggs in women.
alteration of other organs: in some cases chemotherapy can have an effect
toxic effects on some organs and systems that affect their function: heart, liver,
peripheral nerves. If these effects are severe, they can hinder the continuation.
chemotherapy or may impose changes in dosages or the elimination of certain cytostatics
from the treatment program.
- emotional problems: these arise from the impact caused by the diagnosis
communication about the patient and their surroundings. Many hospitals benefit from a
psychologist and psychiatrist specialist who can provide counseling to the patient and family.
Asthenia: after therapy, some patients may experience a sensation of physical asthenia.
extreme due to lack of "energy". These symptoms, termed "fatigability", can be
such chronic. The causes of this fatigue are not fully known, but they are
incriminated a series of chemical, physical, behavioral factors.
Regarding the ability to work, the patient will not work during the...
treatment but can resume activity after the completion of the program of
treatment based on physical status and the effort required by the activity
respective.

CARE OF PATIENTS WITH HEMORRHAGIC SYNDROMES OR CONDITIONS

PRODUCE THE DISTURBANCE OF HEMOSTASIS

25
 can be determined by vascular, platelet, coagulation disorders

Caring for the patient with immune thrombocytopenic purpura

Purpura is a condition characterized by the appearance of red spots on the skin.

Thrombocytopenia represents the abnormal decrease in the number of platelets (cell
sanguine plays an important role in blood coagulation from blood.

This is the most common thrombocytopenia diagnosed in childhood. The disease is often.
it can appear during the evolution or after an eruptive childhood illness: rubella, measles,
etc.
At the same time, however, 50-80% of cases are preceded by an apparently infectious episode.
viral, from 1 to 6 weeks before; it is generally about an infection of the pathways
upper respiratory.

The most frequently affected age is between 2-6 years. There is no predominance.
sexually transmitted in acute forms. The disease is more common in cold seasons, when also
viral infections are more numerous.

Signs and symptoms

The onset is sudden, like a petechial purpura (small red lesions on the skin or mucous membranes) and
in 20-30% of cases nasal bleeding (epistaxis) or oral bleeding, hematuria
(blood in urine), intestinal hemorrhages.

The general condition is good. The spleen is sometimes palpable, which is moderately enlarged.

26
Purpura trombocitara idiopatica este o urgenta in patologia hemoragica la copil.
The hospitalization is mandatory and will be carried out on an urgent basis. Injections are prohibited.
intramuscular, measurement of rectal temperature and administration of aspirin in case of fever.

Emergency treatment in the first 5-7 days will include:

administration of platelet concentrates, prepared by the centers of

hematology, when the platelet count is below 15,000/mmc
the use of corticosteroid preparations in acute phase, preferably using Solumedrol
in a dose of 5-10 mg/kg body/day

Intravenous immunoglobulin therapy administered at a dose of 400 mg/kg body weight/day for
5 days, or 800 mg/kg body/day for 3 days, accelerates healing both in forms of
favorable evolution, as well as in those with relapses.

Hemophilia

Although it is a rare disease, hemophilia is a complex condition in terms of diagnosis and

treatment. The treatment aims at preventing and treating bleeding, caring for
long-term term of joint and muscle lesions and prevention of sequelae,
the treatment of secondary complications of the actual treatment, namely the development
inhibitors of coagulation factors or viral infections. The current treatment of
Hemophilia requires a multidisciplinary approach.
The entire team is involved in the care of the hemophilic patient:

The hematologist
The orthopedic doctor
The dentist
The kinesitherapist
Family / the importance of family support should not be neglected

Patients and the family must be aware of the risks and difficulties caused by bleeding, to
to know the changes that occur throughout the growth and development of a child with
hemophilia, to inform themselves about the risk of having a child with hemophilia.

27
In general, the prevention of bleeding is desired and pursued. Some of the measures that are
The following can be done for this purpose:

Early and appropriate treatment of bleeding - ideally within the first 24 hours
Bleeding prevention is done by avoiding trauma as much as possible.
Avoiding known medications with antiplatelet effects, such as
Aspirin and other non-steroidal anti-inflammatory drugs (Indomethacin). Instead, for pain.
can paracetamol or cyclooxygenase 2 inhibitors be used
Avoiding intramuscular injections and arterial and venous punctures
Maintaining proper oral hygiene and avoiding any procedures
intervention as long as it is not imposed
Following a program dictated by a physiokinetotherapist for the purpose of maintenance
an adequate muscle tone
Avoiding contact sports, encouraging the practice of swimming

Substituting factors
The primary treatment for hemophilia is therapy with factor VIII or IX replacements.
concentrates of FVIII and FIX. These can be derived from plasma or produced based on
DNA recombination technology.
Initially, frozen plasma and cryoprecipitate were used as suppliers of coagulation factors,
The risk of transmitting viral infections, as well as the risk of volume overload, has limited.
their use. Cryoprecipitate is obtained by slowly thawing fresh plasma.
frozen at 4 degrees for 10–24 hours. In countries where concentrates are not available,
cryoprecipitate is used.
The derived factors from plasma are produced using plasma from blood donors, which
collect, treat, and process to separate the coagulation factors. Currently, it
a preliminary screening of donors is practiced and there are rigorous chemical processes through
which viruses become inactive, but the risk of transmission of viral pathogens remains
the blood is not completely eliminated.
Recombinant coagulation factors are effective in controlling bleeding in people with

28
Hemophilia theoretically reduces the risk of transmitting viral infections to a minimum.
These replacement factors are most frequently administered to hemophiliac patients with
severe illness, in very active hemophilic children and for preventive purposes before interventions
surgical
Substituting factors are extremely effective in stopping the hemorrhagic episode, but certain
people can develop a rejection reaction to these substitute factors. Their body
it reacts by creating inhibitors of coagulation factors, so that once
when concentrated FVIII or FIX is injected, the respective coagulation factor is inactivated, without
Factor IX inhibitors are much rarer than factor inhibitors.
VIII (1 case per 100 patients with hemophilia B compared to 1 case per 15 patients with hemophilia A).
The level of these inhibitors can vary in the same person. There are people for whom the level
the inhibition of these inhibitors is small, and the inactivation of factor VIII is very slow and there is
people for whom these inhibitors have a high level and are very active. It is not exactly known
how and why these factors appear. It is assumed that certain mutations that it can
The presence of hemophilia is associated with the development of inhibitors to coagulation factors.
Another theory is that these inhibitors appear as a reaction of the organism to certain stimuli.
from the surrounding environment. This is also the reason why doctors prefer to use later
the same concentrated product if it has initially proven its therapeutic efficacy in a patient.
These inhibitory factors of FVIII can also develop in individuals who do not have hemophilia (1 case)
the 1 million individuals annually). In this case, it is referred to as acquired hemophilia. These
antibodies developed by the body can appear at any time during life: after birth,
after a surgical intervention, following a trauma, after the administration of certain
antibiotics, either with the development of cancer or for no apparent reason.
To counteract factor VIII inhibitors, tolerance treatment is practiced.
immunity when large doses of factor VIII are administered for long periods of time (1
moon up to 1 year) or various medications that decrease the immune system's reaction. For
hemophilia type B the results of this treatment are not as good. Patients with hemophilia
tip B and inhibitors develop allergic reactions with prolonged administration of factor FIX, which
what makes immune tolerance treatment dangerous in their case. In this case, it
administers recombinant factor VII concentrates, and in the case of patients with hemophilia
Non-responsive inhibitors to immune tolerance treatment may be administered.
recombinant FVII concentrate, prothrombin complex concentrate, desmopressin.

Other treatments
Desmopressin
Desmopressin is a synthetic hormone that mimics the actions of vasopressin.
the antidiuretic hormone produced by the body (which retains water in the body). Desmopressin
It is the role of increasing the level of von Willebrand factor and thus factor VIII. It is
efficiency in patients with mild and moderate type A hemophilia, but not in patients
with severe hemophilia or hemophilia type B.

Different products are available - with intravenous, subcutaneous or

intranasal. The most common secondary reactions are facial erythema, headaches.
great and abdominal pain. After administering desmopressin, consumption is limited
How to avoid water retention in the body with hyponatremia.

29
Antifibrinolytic agents
There are medications that promote the maintenance of a blood clot once formed through
inhibition of an enzyme (plasmin) with a fibrin clot destruction effect
(fibrinolysis). Different products are available, the active substances being epsilon acid
Aminocaproic is tranexamic acid. These are especially effective in cases of bleeding.
that occur in the area of the oral cavity, nasal cavity, or genitourinary tract, areas where
The mucosa has intense fibrinolytic activity. Therefore, the indications for the use of these ...
agents are before urological, gynecological surgeries or interventions
dental.
The medications are available in tablet form. The side effects that may occur
I have: fatigue, dizziness, nausea, abdominal pain, diarrhea. These symptoms disappear at
reducing the dose or stopping the treatment.

Vaccination
Vaccinations for hepatitis A and B must not be overlooked.
In the case of patients with hemophilia and infectionpeople with HIV should avoid vaccinations with
live vaccines or attenuated strains (such as the poliomyelitis vaccine). They will be carried out
influenza and pneumococcal vaccinations.
The vaccines will be administered subcutaneously to avoid the formation of hematomas.
muscular.

hemorrhagic syndrome, hereditary, determined by the absence of factor VIII and

IX of coagulation
the disease occurs in the male sex

are characterized by bruises after minimal trauma

what appears at
. individuals with hereditary backgrounds of hemophilia
. the presence of hemorrhages in minor traumas
. newborns with delayed hemostasis after cutting the cord
umbilical
is manifested by
. abundant bleeding from minor trauma

30
 . ameteli
. asthenia
. the presence of hemarthrosis

problems
. intolerant to effort
. mobility disorders caused by hemarthrosis
. knowledge deficit for the prevention of complications
. risk of complications due to compressions produced by hematomas
objectives
. the patient should be protected from trauma, hemorrhages
. to prevent disabling complications
. to be aware of their lifestyle
interventions
. rest the foot
. ensures the hygiene of the skin and mucous membranes
. prevent the appearance of sores
. food is ensured according to needs
. vital functions are monitored
. if new hemorrhagic elements appear on the skin and
mucous and inform the doctor immediately
. cold compresses are applied to the joint in the case of hemarthrosis
. monitor bowel movements - stool, urine

31
 . The fluid balance is assessed in febrile patients.
. biological products are harvested
. patient and family education
Since it is an inherited disease, hemophilia cannot be
preventive.
If some of the close family members have hemophilia
or are healthy carriers, the genetic counsel of a
specialist in genetic diseases (medical geneticist)
in the case where a child is desired, before the appearance of
tasks.

A genetic counselor will tell you how likely it is.

This is to give birth to a child with hemophilia and how severe it will be.
this.
If this disease already exists, a state will be maintained as long as
better health, a constant weight, limitation
stress in the joints, which can causehemarthrosis.
Also, the specialist doctor will be consulted in the creation
a model of physical exercises for people with
hemophilia.
Daily physical exercise increases muscle strength and helps with
prevention of hemorrhage.
It is important to prevent joint bleeding because
it can lead to severe disabilities.

TRANSFUSION

OBJECTIVES OF THE PROCEDURE

Introduction of blood or blood derivatives safely into the venous circulation

32
Scope
Replacement of circulating blood volume

Increasing the capacity to transport oxygen by increasing the number of

red blood cells in case of hemorrhage, anemia or shock state

Improving coagulation in cases of hemophilia, repeated hemorrhages,

scurvy, thrombocytopenia

Nutritional contribution for proteins, vitamins, hormones, mineral salts

Maintaining and stimulating metabolic reactions in the body

Intensification of cellular exchanges

Stimulation of hematopoiesis through small and repeated transfusions

Cleansing the body of exogenous and endogenous toxic substances through

partial or total blood replacement (exsanguinotransfusion)

The absolute indication for transfusion therapy is the loss of a volume

blood over 25% in adults, and the critical limit/value of
the hematocrit is 30%

To be compatible (transfusible), between the donor's blood and that of the recipient
there must be an agglutinogenic identity. In practice, the most violent reactions produce
the ABO systems and the Rh system. Knowing them is mandatory for the establishment of a
transfusions.
The ABO system includes 4 blood groups classified according to the isoagglutinogens and
the isoagglutinins they contain. There are 2 main isoagglutinins marked with alpha and beta and
2 agglutinogens named A and B. Agglutinins are found in serum or plasma and
the agglutinogens are linked to the surface of red blood cells. From the combination of the 2

33
The A and B isoagglutinogens and the two isoagglutinins α and β result in the four blood groups.
main
Group 0 (I) contains isoagglutinins α and β and no agglutinogen, the subject.
this universal donor.
-group A (II) contains beta isoagglutinin in serum and agglutinogen A on the red blood cells
tomatoes.
Group B (III) contains agglutinin α in serum and agglutinogen B on the red blood cells.
tomatoes.
group AB (IV) contains both agglutinogens A and B on red blood cells and in plasma
no agglutinin, the subject is a universal recipient.
Observing the distribution of agglutinins and agglutinogens in the different blood groups,
we deduce their compatibility. Subjects in group 0(I) can only receive blood
belonging to the same group, their blood can be transfused to other groups.
Blood from group A (II) and B (III) can be transfused to the respective group or to those in the group.
AB (IV) can receive blood from group O (I).
Group AB (IV) cannot donate blood to other groups, but can receive blood without
the risk of hemolysis from any of the other groups.

The amount of blood that can be transfused to an infant and small child is 10-20 ml/kg.
corp. In the case of exsanguinotransfusion, the blood mass will be replaced 3 times.
The Rh system: the Rh agglutinogen is present in 85% of cases referred to as Rh+ (positive)
and is absent in 15% of cases, which are called Rh– (negative). The Rh agglutinogen is
independent of the AOB system and appears in the first months of intrauterine life, persisting
throughout life. The agglutinogen or Rh factor is found only on red blood cells. The determination
the Rh system is mandatory for all patients who are about to receive a transfusion, but
especially in patients with a history of repeated transfusions and in female children.
a. Determining blood groups
Before performing a transfusion, the blood type must be determined mandatorily.
For this purpose, venous blood will be collected with a sterile syringe. Determination of blood groups.

34
it is done using 2 methods: with hemotest serums and with washed red blood cells. In both cases,
the tests are known in advance. The test serum is prepared by a hematology center.
and transfusion. Serums 0 (I), A (II), and B (III) are wrapped and packaged in boxes. These
serums must be kept cold.
Direct test Beth – Vincent (the search for agglutinogen)
Testing technique: on a glass slide, 3 drops of test serum are placed. On the left side of the slide, it is placed
1 drop of test serum 0 (I), in the middle 1 drop of test serum A (II), and on the right serum B (III).
With the corner of a blade or a pipette, one drop of test serum is placed over the drops of serum, one drop at a time.
blood. For each test serum, the drop of blood will be placed with another corner of the slide, or with a
another pipette. It is recommended that the blood be previously citrated in order to remove fibrin,
whose presence can create a 'network' image that can be confused with
agglutination. After placing the drop of blood over the test serum, the circular blade is moved
mixing the serum with the blood. The result is read after 2-3 minutes. When reading
there may be 4 eventualities:
agglutination does not occur in any of the 3 drops, the blood is group O (I)
Agglutination occurs in test serums 0(I) and B(III), the blood belongs to group A(II);
-agglutination occurs in the sera 0 (I) and A (II), blood is part of group B(III);
- agglutination appears in all 3 drops, the blood is part of group AB (IV);

Washed Simonin cuhematii test

1-2 drops of 5% sodium citrate are placed in a test tube and 6-8 drops of blood are added, then
centrifuge and collect the plasma with a pipette. From the obtained plasma, put 2 each
drops on a blade. On the drop of plasma on the left side of the blade, the corner is placed.
some lame, the red blood cells known from group A (II), and over the drops on the right
red blood cells from group B(III). The result is read after 2-4 minutes, which can indicate 4
possibilities:
Agglutination occurs in both drops, the tested serum belongs to group 0(I)
-agglutination occurs only on B globules (III), the examined blood belongs to group A (II);
Agglutination occurs only on A (II) globules; the examined blood belongs to group B (III);
There is no agglutination, the examined blood belongs to group AB (IV).
It is advisable to perform both tests and to conduct the research at a temperature of
16-180C to prevent the occurrence of false reactions due to cold agglutinogens

35
The Jambreau test consists of placing a drop on a glass slide.
the patient's serum with 1 drop of transfused blood, monitoring for the absence or appearance
agglutination. One test is performed at room temperature ('cold') and another at thermostat
("the cold"). In case of agglutination, the transfusion cannot be performed due to the existence of some
antibodies "at low temperature" or "at high temperature".
The Oehlekercare probe consists of the initial administration of blood at a slow pace.
carefully observing the patient's reaction to blood administration.
b. Determining the Rh factor
Technique
On a glass slide, 3 drops of anti-Rh (-) negative serum from a donor are placed.
universal. The drop on the left side of the blade mixes with Rh(+) red blood cells (Rh positive),
the drop in the middle with the red blood cells we are examining and that on the right with red blood cells
Rh(-). After homogenizing the drops of anti-Rh serum with the red blood cells, the slide is introduced.
in a Petri dish on the bottom of which are placed 2 short glass rods so that the blade is
suspended. Under the blade, a round piece of filter paper soaked in saline is placed.
to maintain moisture in the Petri dish. The Petri dish is closed and placed in the thermostat at
370C. The reading of the reaction is done after 30 minutes. If agglutination occurs, the red blood cells are
Rh(+). The reading will be done compared to the control red blood cells.

36
After performing compatibility tests and Rh, the transfusion can be performed. I
mai indicat este a se transfuza sânge izogrup şi izo-Rh (donator cu primitor).
Whole blood can be transfused fresh or preserved (most commonly).

Derivatives of blood can still be transfused: whole plasma, defibrinated plasma, plasma
dry, anti-hemophilic plasma, human albumin solutions, red blood cell mass. In the absence of
of his blood or plasma, to replace lost plasma, substitutes can be transfused
artificial. Whether to use crystalline solutions (Ringer, Ringer-Looke) or colloidal solutions
(Dextran, Macrodex, Marisang etc).
PREPARATION AND CHECKING OF NECESSARY MATERIALS
Medical table or cart for treatments
Syringe/needle, appropriate sterile gloves
Take the bottle of blood iso-group, iso-Rh
Transfusion kit (infuser with filter)
Cannula/Flare
Disinfectant solution, pads
Garou, non-allergic plaster or adhesive tape
Label

37
-Tarpaulin, waste collection container
Flannel or blanket, stand
Check the infusion kit for packaging integrity and expiration date.
Check the integrity of the blood bag, the expiration date, the appearance
macroscopic of the blood
PATIENT PREPARATION
a) PSYCHIC:
Inform and explain the patient's procedure step by step (its purpose,
the sensations that may occur, the risks of transfusion
Obtain informed consent using a written consent form.
inform
Inform the patient about: the sensation of cold, itching, irritation, or symptoms
abnormal
b) PHYSICS:
Patient position - supine
Ensure patient privacy
Instruct the patient not to eat at least 2 hours before or after completion.
transfusion
Choose the site for the IV puncture - the quality and condition of the veins are examined.
The most accessible veins are those of the upper limbs, not those of the
lower limbs (possibility of thrombosis)
CARRYING OUT THE PROCEDURE:
Check the doctor's indication regarding the transfusion and the amount of blood or
the derivative of this
Verify the patient's identity
Wash hands/sterile gloves
- On the day of the transfusion, 2-4 ml of blood is collected for testing.
compatibilityJEANBREAU
Send a blood request to the transfusion point that includes:
the name of the hospital
the name of the clinic where the patient is hospitalized
the name and surname of the patient
age
patient's blood type
the amount of blood required
the name of the doctor who indicated the transfusion
the name of the nurse who administers the blood
day, month, year
Heat the blood to body temperature, maintain asepsis when opening the kit.
sterile perfusion
Place the bag or bottle of blood in the stand.
Open the transfusion kit
Fix the clamp/the stub at a distance of 2-5 cm below the perfusion chamber.
Close the clamp/perfusion set, remove the needle cover and insert it back into place.
entry of the bag or bottle

38
Press, squeeze the drainage chamber of the infusion and let it fill up to the
half with blood
Remove the protective cap from the other end of the tube, open it
clema/prestubul and let the blood flow through the tube until the air bubbles are removed
Keep the infusion drip at the height of the body to eliminate air bubbles, not downwards.
Close the clamp/pretension and put on the protective cover.
Select the right place (preferably the ones from the envelope)
Place the drape under the patient's arm
Apply the tourniquet 10-12 cm above the puncture site; the ends of the tourniquet must
directed away from the puncture area
Check the presence of the distal, radial pulse
Advise the patient to clench their fist.
Disinfect the skin (cotton pad with alcohol), 60 seconds
Position the non-dominant hand 4-5 cm below the puncture site and with the thumb.
stretch the skin over the vein
Remove the needle cap and the protective cap of the infusion device.
Attach the needle to the infusion set and puncture the vein.
Follow the course of the vein and when the blood returns through the lumen of the needle, advance the needle.
vein, 1-2 cm
Release the tourniquet and tell the patient to open their fist.
If the transfusion is installed with a catheter, hold it with your finger.
left index finger applying pressure 3cm above the puncture site
Remove the mandrel from the lumen of the cannula and attach the end of the cannula to the tube.
of the perfumer
Open the clamp/catheter and let the blood flow out
Fix the needle (cannula, flexural, butterfly) with adhesive tape or non-allergic tape
Start administering the blood
Perform the biological test Oelecker; let 20-30 ml of blood flow and
adjust the rate to 10-15 drops/minute for 5'; monitor the patient and
if no signs of incompatibility appear, repeat the operation
Apply the label to the bag or blood bottle indicating the time at which it was
start the transfusion
If the transfusion is finished, close the clamp/prestube.
Withdraw the needle and apply an alcohol swab or a sterile dressing.
Put the or bottle in which approximately 5-6 ml of blood must remain.
keep, in case of checks in the event of delayed post-transfusion accidents
PATIENT CARE
Place the patient in a comfortable position and cover them.
Check vital signs every 15 minutes in the first half hour after
the beginning of the transfusion, and every half hour or hour after the transfusion.
Inform the patient/family to notify the nurse in case of itching, shortness of breath,
dizziness, back or chest pain, as these may be reactions of
transfusion
Instruct the patient to inform the nurse if pain or redness occurs at the site.
venous punctures, as they are indicative of infiltration
The room temperature should be 1-2° higher.

39
Offer the patient warm liquids and cover them with a blanket.
REORGANIZATION OF THE WORKPLACE
Collect waste in special containers
Remove the gloves
Wash your hands
NOTES ON THE PROCEDURE
Note in the care plan:
Administration of the transfusion
The number written on the bag or bottle of blood, the time at which the transfusion started, the time at
where it ended and any potential reactions of the patient
EVALUATION OF THE EFFECTIVENESS OF THE PROCEDURE
Rezultate aşteptate/dorite:
Evaluate the patient's response to blood administration
vital signs are normal
the absence of chills, itching, hives or irritation
laboratory tests within normal limits
The mucous membranes and skin are pink, the patient understood the purpose and risks.
transfusion
Unwanted results/What do you do:
Pulmonary embolism - manifested by agitation, cyanosis, chest pain, choking cough,
hemoptysis
Intravascular hemolysis with renal blockage, post-transfusion shock, acidosis
metabolic, cardiac arrest due to hypothermia - can occur due to blood
unheated
Warm the blood before transfusing it.
Monitor the patient
Notify the doctor
Stop the infusion
-Hemolytic shock- group incompatibility - chills, tachycardia, dyspnea,
cyanosis, lumbar pain, retrosternal pain, altered general condition
Notify the doctor
The clogging of the infusion set and the needle with clots - the infusion set and the needle are changed.
Hypothermia
Warm the patient by increasing the number of blankets, applying compresses with water
warm
WARNING
Do not heat the blood in warm water or above heat sources, avoid
shaking the bag/bottle
If any post-transfusion reactions occur, return the bag/bottle of blood to the point of
transfusions
Respect asepsis
Do not fill the infusion chamber with blood - the flow rate can no longer be monitored.
If the needle is clogged, do not unblock it by applying pressure.

MONITORING OF THE PATIENT WITH TRANSFUSION REACTIONS

40
OBJECTIVES OF THE PROCEDURE
Preventing adverse reactions during and after transfusion.
Establishing measures to reduce transfusion reactions.
ADVERSE REACTIONS
Adverse reactions can occur within the first 15 minutes of the transfusion and after the transfusion.
There are systemic reactions to the administration of blood and blood derivatives,
incompatible with that of the beneficiary, which contain allergens, or are contaminated with
bacteria
- General adverse reactions can have symptoms ranging from: fever, chills,
hives, hypotension, and cardiac arrest. Other possible adverse reactions that may
Results from transfusion therapy include circulatory overload and transmission of diseases.
hepatitis, cytomegaloviruses or human immunodeficiency virus (HIV).
Acute hemolytic reaction - ABO, Rh incompatibility occurs in the first 5-15 minutes.
the establishment of the transfusion. This begins with an increase in temperature, heart rate,
a sensation of warmth and pain along the vein where the blood is transfused, chills,
headache, dizziness, chest and back pain, dyspnea, hypotension, hemoglobinemia
hemoglobinuria. The transfusion is stopped.
Delayed hemolytic reaction - the immune response developed by the recipient
against non-ABO donor antigens. Fever is unexplained, decreases
Inexplicable Hb, Ht, the Coombs test is positive. The transfusion is stopped.
Feverish non-hemolytic reaction - 1% of transfusions; a possible sensitivity of
the recipient's leukocytes and platelets from the donor's blood. This occurs at
30' after the initiation of the transfusion and at 6h after the completion of the transfusion. It manifests as fever.
temperature increased by 1°, facial redness, chills, headache.
Allergic reaction (mild or moderate) caused by the recipient's allergy to
the proteins in the donor's plasma. This occurs during the transfusion and 1 hour after
transfusion. Local erythema, skin rash, hives.
Severe allergic reaction caused by the recipient's allergy to an antigen.
the donor (usually IgA). Agglutination of red blood cells obstructs the capillaries and
blocks blood flow, causing major symptoms in all major systemic organs.
This occurs in the first 5-15 minutes after the initiation of the transfusion. Cough and nausea appear.
vomiting, respiratory distress, hypotension, loss
loss of consciousness and possible cardiac arrest. This is a life-threatening reaction.
The transfusion is stopped, the venous line is maintained, the doctor is informed,
administer the prescribed medications (antihistamines, corticosteroids,
epinephrine, antipyretics). Vital signs were measured every 5-15 minutes and were
initiate cardiopulmonary resuscitation if needed.
- Circulatory overload - can lead to pulmonary edema and occurs in
the cause of excessive volume or rapid transfusion rate. This can occur in any
moment, or 1-2 hours after the end of the transfusion. Symptoms include dyspnea, cough, tachypnea,
tachycardia, increased central venous pressure. The administration rhythm of 2- is respected.
4ml/kg/h. Special attention is given to the rhythm and volume of administration in patients.
age. The transfusion is slowed down or stopped, it is administered at the doctor's indication.
diuretics, oxygen, and morphine.
Bacterial sepsis - due to bacterial contamination of the transfused product.
This occurs during the transfusion and 2 hours after the completion of the transfusion.

41
manifests through fever, chills, abdominal cramps, vomiting, diarrhea, hypotension.
Appropriate care is applied. The transfusion is stopped and the line is maintained.
venous, the doctor informs, vital signs are monitored, samples are collected
blood culture. At the doctor's indication, intravenous fluids and broad-spectrum antibiotics are administered.
large antimicrobials, vasopressors, and steroids.
PATIENT EVALUATION
Observe the patient for fever with or without chills. Fever may indicate the onset of a
acute hemolytic reactions, non-hemolytic febrile reactions, or bacterial septicemia
Observe the patient for tachycardia and/or tachypnea and dyspnea. These may indicate
acute hemolytic reaction or circulatory overload. These symptoms may be accompanied by
from cough in case of circulatory overload.
Monitor the patient for hives or rash. These may be
early signs of an allergic, anaphylactic reaction, which occur after
transfusion.
Observe the patient for facial redness. Facial redness may be present.
in an acute hemolytic reaction, or a non-hemolytic reaction.
Observe the patient for gastrointestinal symptoms. Nausea and vomiting may be
present in acute hemolytic transfusion reactions, anaphylactic reactions, or sepsis.
Monitor the patient for a drop in blood pressure. Hypotension can be an acute reaction.
hemolytic, anaphylactic, or sepsis.
Monitor the patient for wheezing, chest pain, and cardiac arrest. These conditions are
anaphylactic reactions.
Be attentive to the patient's complaints of headaches or muscle pain in the presence of
February. Both can be indicators of a non-hemolytic reaction.
febrile.
Monitor the patient for disseminated intravascular coagulation.
renal insufficiency, hemoglobinemia/hemoglobinuria. All these are late signs of
acute hemolytic reaction.
Monitor the laboratory values for refractory anemia to therapy
transfusion. This could signify a delayed hemolytic reaction.
Observe patients receiving massive blood transfusions for mild hypothermia.
cardiac rhythm disturbances, hypotension and hypocalcemia, hyperkalemia.
Cold blood products can affect the cardiac conduction system resulting in
ventricular arrhythmias. Other cardiac arrhythmias, hypotension, and tingling may indicate
hypocalcemia occurs when citrate (used as a preservative for products of
Blood) combines with the patient's calcium. Hyperkalemia leads to intestinal colic, diarrhea,
oliguria, muscle spasms, changes in ECG, bradycardia preceding cardiac arrest
cardiac.
WHAT DO WE DO IN CASE OF TRANSFUSION REACTIONS?
Stopping the transfusion. The severity of reactions is related to the amount introduced.
Change the infusion set that contains blood clots and replace it with a new one, except
the case in which it is only a mild allergic reaction..
Inform the doctor. Transfusion reactions require immediate medical intervention. In the case of a
mild allergic reactions, the transfusion should be stopped and antihistamines administered.
the doctor's indication. The transfusion can be resumed.
Maintain the venous line for drug and solution administration as needed.

42
Note the blood and blood products, the time when the reactions occurred.
the transfusion, as well as the nurse's interventions.
Collect plain blood. A blood sample is taken before the transfusion for testing.
of compatibility. The second sample (if necessary) is collected from the opposite arm.
of the transfusion and free hemoglobin in serum will be checked, indicating hemolysis and also
the bilirubin level should be checked.
Return the bag of blood to the transfusion point, stopping a few ml of blood for a
possible verification in case severe post-transfusion reactions occur.
Monitor vital signs every 15 minutes or more frequently if necessary.
Maintain the continuous evaluation of the patient's cardiopulmonary status.
Administer the prescribed medication in accordance with the type and severity of the reaction to
transfusion
Antihistamines reduce some aspects of the allergic response by blocking
histamine receptors. In some cases, they can be administered pre-transfusion, at the indication of
the doctor
Antipyretics/analgesics - are administered to reduce fever and discomfort in:
acute hemolytic reactions, non-hemolytic febrile reactions, bacterial sepsis
Corticosteroids - stabilize cell membranes, reduce the release of histamine;
administer in severe allergic reactions
The rapid administration of intravenous fluids can help counteract certain symptoms.
but of anaphylactic shock
• diuretics/morphine - can be administered in circulatory overload to reduce
intravascular volume
Antibiotics are administered when bacterial contamination is suspected.
In the case of a cardiac arrest, cardiopulmonary resuscitation is initiated.
Collect the first urine sample - hemoglobinuria can occur due to
hemolytic reactions. The degree of kidney damage is influenced by the urinary pH and
of the urinary excretion rate. If kidney damage is severe, dialysis is recommended.
EXPECTED RESULTS
The patient will have pink mucous membranes. Tissue perfusion is improved.
Cardiac output will return to baseline values. Intravascular volume is
restabilize
- The TA will remain stable. The intravascular volume is restored. Absence
transfusion reactions.
The patient will be calm and expresses comfort. Nursing care is applied.
corresponding to maintain the safety and comfort of the patient.
The patient maintains their body temperature within normal limits.
The patient will excrete urine 0.5 - 1 ml/kg/h - reflects the optimal state of fluids.
The patient will maintain an oxygen saturation greater than 95%.

AUTOTRANSFUSION:

Autotransfusion is the reinfusion of one's own blood after it has been collected and filtered.
This is performed before, during, and after surgical interventions or trauma.
Autotransfusion has several advantages over blood transfusions from donors.
Thus, no post-transfusion reactions occur due to incompatibilities or mistakes in

43
establishing blood groups, diseases are not transmitted and blood loss is replaced.
immediate. Unlike the blood from blood donation centers collected from donors,
The autologous blood contains a normal level of 2,3 diphosphoglycerate which helps to
tissue oxygenation (this causes a decrease in the affinity of Hb for oxygen and, in
as a consequence, an increase in oxygen removal at the tissue level.
Blood collection for autotransfusion can be carried out preoperatively and is
recommended for patients with orthopedic surgical interventions, during which there is loss
blood donation. Blood collection can be done 4 to 6 weeks before
operation.
Most often, however, in bloody surgical interventions, it is used
cell-saver-ul, a device connected intraoperatively and postoperatively to the drainage tube of the wound,
takes the patient's blood, processes it, and autotransfuses it. It needs to be monitored.
if you notice the amount of blood that self-transfuses.
Patients who have donated blood preoperatively (donation can be done 4-6 weeks before)
before) they will be advised to remain in bed rest for another 10 minutes after donation, to drink as much
more fluids in the hours immediately following. If at home, on the day they donated blood,
They will feel dizziness and a state of near-fainting, they will be taught to position themselves.
Trendelenburg (with head lower than feet) until the complaints disappear
respective.
Complications:
The complications of autotransfusion can be: hemolysis, vasovagal reactions (hypotension,
bradycardia, thrombocytopenia, coagulopathy, hypovolemia (especially in patients
the elderly), sepsis (in case of not using sterile techniques).

Oral care

Scope: -prophylaxis of oral cavity infections

dental caries prophylaxis
achieving a state of well-being for the patient
Preparation of materials: -for the conscious patient: toothbrush, toothpaste, towel,
water pot, renal tray
for the unconscious patient: sterile tampons, compresses,
["mouth opener","lingual spatula","cotton pliers","20% borax glycerin","tray"]
renal sterile rubber gloves
The patient - conscious - sits in a seated position or in a left lateral decubitus.
with a towel around the neck
unconscious - the patient is placed in a supine position with the head in a
part, with the towel under the chin
Technique:
The conscious patient will be provided with the necessary materials and will be assisted if needed.
-the unconscious patient: - the mouth opener is introduced between the dental arches
tongue, palatine vault, inner and outer surface of the arches
teeth are wiped with pads soaked in glycerin borax.
with movements from the inside out
the teeth are wiped with another tampon
The dry lips are smeared with glycerin mixed with borax.

44
For unconscious patients who have dental prostheses, they will be removed, washed, and stored in a
mountain with water.
Oral cavity cleaning in an unconscious patient is performed with the index finger covered with a swab.
of the typhoon, the hand being dressed in a glove.
Hands should avoid contact with the patient's saliva secretions or with the used material.

Bone or marrow puncture

-penetration with a sterile needle through the cortical layer into the spongy one, achieving a
communication between the marrow cavity and the external environment.

The aim
Explorer - for hematopoietic bone marrow in order to establish the structure
the composition of the marrow, as well as the study of the figurative elements of the blood in
different stages of their development, during the disease of hematopoietic organs.

Therapeutic - is done for the administration of certain medications, blood transfusions

intraosseous (when other routes of administration are not possible due to burns,
obesity, plaster casts.
Bone puncture can also be performed on healthy people, for the collection of bone marrow.
for its transfusion to patients with hematopoietic organ pathologies.
Necessary materials:

45
 2 point aces (Casirschi), which is made up of a troacar made of steel
very durable, about 5 cm long, with a diameter of 1-2 mm and with a short tip but
very sharp. The needle is equipped with a mandrel. The external end of the needle widens into
disc shape, on which the mandrel will adapt, at this end it will rest
the doctor's palm, which performs the puncture. The needle is equipped with an adjustable protective disc.
This disc serves to prevent the needle from penetrating beyond the medullary cavity into
posterior compacta of the sternum.
10-20 ml syringe for aspirating bone marrow tissue, a watch glass.
2-5 ml syringe with needles for anesthesia, novocaine, blades or slides.
Material for disinfecting the punctured area.
Sterile typhon for dressing, leukoplast
If the puncture is done for therapeutic purposes, instead of laboratory instruments (or alongside
these) will prepare medicinal solutions that need to be administered. The instruments will
I am preparing on a table covered with a sterile field, under perfect aseptic conditions.
since the bone marrow is very susceptible to infection.
The preparation of the patient and the choice of the site for puncture.
1. The preparation of the patient should begin by boosting their morale, informing them
on the necessity and essence of the intervention.
For the sternal puncture, the patient is lying on their back with the torso slightly raised.
The nurse ensures that the patient's bed is as firm as possible.
3. The sternum can be punctured by the manubrium or the body, or at the height of the rib.
a-IV or V, or in the second or third intercostal space, slightly outside the line
medial

The chosen site for puncture will be washed, shaved if necessary, and then disinfected with alcohol.
badijon with iodine tincture.
The nurse presents the doctor with the novocaine solutions drawn into the syringe.
for the anesthesia of the soft tissues above the bone, including the periosteum.
6. The anesthetized area is brushed again with iodine tincture, the region is isolated.
disinfected with sterile fields and after 15-20 minutes, necessary for installation
anesthesia, puncture can be performed.
Technique of the puncture:
The puncture is performed in the treatment room.
The nurse presents the tools to the doctor during the puncture.
First, the forceps are offered, with which the doctor selects the puncture needle.

46
 The doctor fixes the protective disc at the presumed necessary distance (10-16 mm) and then
pierces vertically at the chosen puncture site, penetrating through the outer blade of the
of the bone with the help of the pressure exerted on the extremity of the mandible with the bridge
palm
5. After the needle penetrates the medullary cavity of the sternum, the doctor extracts
he hands the needle holder to the medical assistant, who keeps it sterile.
The nurse hands the doctor the syringe of 10 or 20 ml prepared for
aspiration and which the doctor adapts into a needle and uses to aspirate the medullary content.
7. During aspiration, the patient feels a painful retrosternal sensation, very
painful. After 1-2 seconds after aspiration, bone marrow appears in the syringe. The quantity
The bone marrow required for examinations is 0.5-1 ml.
8. Hematogenous red marrow has the appearance of blood, but when spread on a slide it is viscous,
with many fat tissue surfaces.
9. If the sternal puncture was performed for therapeutic purposes or if an exploratory puncture is
continued with the administration of medication substances intramedullary,
the infusion or transfusion device with the respective solution will be prepared in advance, which
it will be collected at the fixed needle in the bone. Only can be administered through the intramedullary route
isotonic solutions drop by drop. The administration rate should not be
exceed 15-20 drops per minute. At this rate, up to 1500-2000 can be administered.
ml of sun. in 24 hours, in one place.
10. After the completion of the harvesting or administration operation, the needle is removed from
puncture. The puncture site is cleaned and a plaster is applied.
Possible complications:
Immediate
Nothing can be extracted from the medullary cavity due to a position.
the needle hole - the clogging of the needle (which is unclogged with the sterile mandrel) -
white puncture
Perforation of the posterior blade of the sternum.
Fracture
Pneumothorax
The introduction of infection into the medullary cavity.
late
bruising
bone infections - osteomyelitis
growth disorders in children after tibial puncture
Subsequent care
ensure bed rest
The general condition and vital signs are being monitored.
the dressing is being monitored
Preparation of the extracted marrow for sending to the laboratory:
The extracted marrow is mixed with blood sourced from the marrow sinuses. From this
the syringe containing this mixture must be quickly evacuated, as the blood can
to coagulate in it. The partial separation of bone marrow tissue from blood is done by
the evacuation of the contents of a clock glass with convexity on an inclined plane
(turned upwards), where the blood flows, leaving behind the fatty fragments of myeloid tissue.
These are collected and spread on degreased slides, just like the blood smears.

47
Usually, 3-4 blades with a tissue smear of the medullary tissue are prepared at the indication.
the doctor will carry out additional collections for the counting of nucleated elements, for
the counting of reticulocyte elements, for histological examinations or notes will be made
by culture media. The products collected for samples are sent without delay to the laboratory
with the completed collection forms. The seeded culture media are placed as soon as possible
early in the thermostat.

Bibliography

1. Paraclinical explorations in medical practice – Mihai Cosma, 1982

2. Paraclinical explorations in medicine - Florea Marin, 1981
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4. Laboratory Diagnosis in Medical Practice - Gabriel Ivanovici
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[Link] explorations for middle management - Florin Marin and C.
Popescu, 1978
6. Semiotics - Prof. Marius Georgescu, 1998
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Dorina Boboin, 1981
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Bucharest 1999.
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12. HALL, J.B.; SCHMIDT, G.A.; WOOD, L.D.H.: Principles of critical
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13. LUCRETIA TITIRCA: EVALUATION TECHNIQUES AND CARE

REMEMBER THE MEDICAL ASSISTANTS – Viaţa Medicală Publishing

Romanian

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14. LUCRETIA TITIRCĂ: NURSING GUIDE - Life Publishing

Romanian Medical

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