Chapter 37: Concepts of Care for Patients With Hematologic Problems

Sickle cell disease exemplifies perfusion compromise, a genetic hemoglobinopathy where abnormal hemoglobin S polymerizes under low oxygen conditions, causing red blood cells to assume a rigid sickle shape that obstructs microvascular blood flow. This vaso-occlusion triggers acute pain crises requiring rapid intervention with high-flow oxygen, aggressive intravenous hydration using normal saline, and opioid analgesics. Chronic complications include hemolytic anemia, recurrent infections from splenic infarction and functional asplenia, and multiorgan damage. Patient education focuses on trigger avoidance including hypoxia, dehydration, infection, and emotional stress. The chapter addresses other anemic conditions including iron deficiency anemia, the most prevalent form globally, and vitamin B12 deficiency anemia, which causes glossitis and potentially irreversible neurologic damage if untreated. Hematologic malignancies represent the immunity concept exemplar through leukemia and lymphoid disorders. Polycythemia vera, a myeloproliferative disorder, demonstrates loss of normal cellular regulation resulting in excessive erythrocyte production and thrombotic complications. Leukemia management centers on managing severe bone marrow suppression following induction chemotherapy, which produces neutropenia and thrombocytopenia with life-threatening infection and hemorrhage risks. Multiple myeloma, a plasma cell malignancy, causes bone destruction, hypercalcemia, and severe skeletal pain. Critical nursing interventions include implementing bleeding precautions when platelet counts fall below 50,000 per cubic millimeter, recognizing fever as an immediate infection indicator in immunocompromised patients requiring urgent culture and antibiotic therapy, and ensuring transfusion safety through proper patient identification verification and administering blood products exclusively with normal saline to prevent hemolysis and clotting complications.