Polycythemia

MSN- blood disorders

1. 11/24/2020 Melvin Jacob 1 POLYCYTHEMIA Mr. Melvin Jacob MSc Nursing

2. It is an abnormally increased concentration of haemoglobin in the blood, either through reduction of plasma volume or increase in red cell numbers. DEFINITION 2 11/24/2020 Melvin Jacob

3. NORMAL RANGE Haemoglobin :- 14 to 17 gm/ dL (M) 12 to 15 gm/ dL . (F) Hematocrit:- 41.5% to 50.4% (M) 36.9% to 44.6% (F) Red blood cell:- 4.5 million to 5.9 million cells/ mcL (M) 4.1 million to 5.1 million cells/ mcL . (F) 3 11/24/2020 Melvin Jacob

4. Haemoglobin:- > 15 g/ dL (F) > 17 g/ dL (M) Hematocrit:- > 48% (F) > 52% (M) 4 11/24/2020 Melvin Jacob

5. RISK FACTORS C hronic hypoxia long-term cigarette smoking familial and genetic predisposition living in high altitudes long-term exposure to carbon monoxide (tunnel workers, car garage attendants, residents of highly polluted cities) 5 11/24/2020 Melvin Jacob

6. T YPES PRIMARY POLYCYTHEMIA SECONDARY POLYCYTHEMIA RELATIVE POLYCYTHEMIA STRESS POLYCYTHEMIA 6 11/24/2020 Melvin Jacob

7. PRIMARY POLYCYTHEMIA Primary Polycythemia occurs when excess red blood cells are produced as a result of an abnormality of the bone marrow. Often , excess white blood cells and platelets are also produced 7 11/24/2020 Melvin Jacob

8. SECONDARY POLYCYTHEMIA Secondary polycythemia is usually due to increased erythropoietin (EPO) production either in response to chronic hypoxia (low blood oxygen level) or from an erythropoietin secreting tumor. 8 11/24/2020 Melvin Jacob

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10. RELATIVE POLYCYTHEMIA It is an increase in RBC numbers without an increase in total RBC mass. Usually, this is caused by loss of plasma v o l u m e with resultant hemo -concentration, as seen in severe dehydration related to vomiting and diarrhoea. 10 11/24/2020 Melvin Jacob

11. STRESS POLYCYTHEMIA Stress Polycythemia is a term applied to a chronic (long standing) state of low plasma volume which is seen commonly in active, hard working, anxious, middle-aged men. In these people, the red blood cell volume is normal, but the plasma volume is low. 11 11/24/2020 Melvin Jacob

12. CLINICAL MANIFESTATIONS Symptoms results from increased blood volume: Cyanosis Reddened face with engorged retinal veins Itching after bath Feeling of fullness in head with headache Weakness, fatigue and dizziness 12 11/24/2020 Melvin Jacob

13. Tinnitus (ringing or buzzing in the ears.) Parasthesia, numbness, burning or weakness in hands and legs. Visual disturbances Nose bleeding Abdominal bloating 13 11/24/2020 Melvin Jacob

14. Symptoms from increased viscosity : Angina Dyspnea Hypoxia Bone and joint pain T hrombophlebitis 14 11/24/2020 Melvin Jacob

15. Other symptoms are Weight loss Breathing difficulty when lying down Chronic cough Night sweats and sleep disturbances Burning sensation over fingers or toes Splenomegaly and hepatomegaly Formation of blood clots in the blood vessels 15 11/24/2020 Melvin Jacob

16. DI A GNOSIS History collection and physical examination: S moking Living at high altitudes Breathing difficulty Sleep disturbances and chronic cough. 16 11/24/2020 Melvin Jacob

17. Blood tests The blood studies will show An increase in the number of red blood cells Elevated hematocrit measurement Elevated levels of hemoglobin Very low levels of erythropoietin 17 11/24/2020 Melvin Jacob

18. Bone marrow aspiration or biopsy If an examination of the bone marrow shows that it's producing higher than normal numbers of blood cells, it may be a sign of polycythemia. 18 11/24/2020 Melvin Jacob

19. Other diagnosting m e a s s u r e s are, Chest X-Ray Electrocardiogram Echocardiogram SpO2 measurement 19 11/24/2020 Melvin Jacob

20. M A N A GE M ENT 20 PHLEBOTOMY : Drawing a certain amount of blood out of the veins in a procedure called phlebotomy is usually the first treatment option for people with polycythemia. Reduces the number of blood cells Decreases blood volume Blood to function properly. 11/24/2020 Melvin Jacob

21. Low-dose aspirin low dose of aspirin to reduce risk of blood clots. M ay also help reduce burning pain in feet or hands. 21 11/24/2020 Melvin Jacob

22.  Medication to decrease blood cells H ydroxyurea (Droxia, Hydrea ) :- to suppress the bone marrow's ability to produce blood cells Interferon alpha :- stimulate the immune system to fight the overproduction of red blood cells. 22 11/24/2020 Melvin Jacob

23. Therapy to reduce itching I tching - antihistamines , or ultraviolet light treatment to relieve discomfort . 23 11/24/2020 Melvin Jacob

24. Lifestyle and home remedies 24  Exercise . Moderate exercise can improve the blood flow, which decreases risk of blood clots. Leg and ankle stretches and exercises also can improve the blood circulation. 11/24/2020 Melvin Jacob

25.  Avoid tobacco. B lood vessels to narrow , increasing the risk of heart attack or stroke due to blood clots.  Watch for sores. Poor circulation can make it difficult for sores to heal, particularly on the hands and feet. Inspect the feet regularly and tell the doctor about any sores. 25 11/24/2020 Melvin Jacob

26. Avoid extreme temperatures Poor blood flow increases the risk of injury from hot and cold temperatures. A lways wear warm clothing ( hands and feet ) . In hot weather - drink plenty of liquids. 26 11/24/2020 Melvin Jacob

27. NURSING MANAGEMENT 27  Monitor for peripheral and cerebral thrombosis.  Assist the patient for ambulation  Perform phlebotomy as per doctors order  Administer iv fluids and encourage to take oral fluids  Administer pain management measures  Advice to do regular exercise 11/24/2020 Melvin Jacob

28.  Instruct to avoid tobacco  Advise to maintain skin hygiene  Avoid extreme temperatures  Provide psychological support to the patient. 28 11/24/2020 Melvin Jacob

29. NURSING DIAGNOSIS Impaired tissue perfusion related to phlebotomy as evidenced by cyanosis. Acute pain related to surgical intervention as evidenced by verbalization Impaired breath pattern related to decreased level of RBC in blood as evidenced by dyspnea . Imbalanced nutrition less than body requirement related to less oral intake of food as evidenced by weight loss. 29 11/24/2020 Melvin Jacob

30. CONCLUSION Polycythemia is an increase in the number of red blood cells in the body. Doctors may discover it as part of a routine blood check, or they might diagnose it once the person starts experiencing symptoms. 11/24/2020 30 Melvin Jacob

31. REFERENCE Smeltzer – Brunner & Suddharth Textbook of Medical Surgical Nursing, Wolters kluwer publishers, 12 th edition 2009. Black – Medical Surgical Nursing, Elsevier publishers, 8 th edition 2009. Nettina – Lippincott manual of Nursing Practice, Wolters kluwer publishers, 7 th edition 2014. 11/24/2020 Melvin Jacob 31

32. 11/24/2020 Melvin Jacob 32 Thank you