GOAL: to rid the client of all leukemic or

other malignant cells

PROCEDURE:
4. Harvest
5. Conditioning
6. Transplantation
7. Engraftment
 multiple aspirations from the iliac crest
are done to retrieve sufficient bone
marrow for transplant
 VOLUME: 500 – 1000 mL of marrow

 marrow is FILTERED

 done before CONDITIONING is initiated

 Immunosuppression

 Used to eradicate ALL malignant cells

 Creates a space in the bone marrow for

engraftment of the new marrow
 Bone marrow is administered through a
CENTRAL LINE

 Infused over a period of 30 minutes or

administered by IV push directly into the
central line
 Transfused bone marrow cells move to the
marrow-forming sites of the recipient’s
bones

 Occurs when the WBC, RBC, & platelet

counts begin to rise

 When successful, process takes 2-5 wks

AKA: thrombocytes
Normal Values: 150,000-400,000 cells/mm³
↓ = thrombocytopenia
↑ = thrombocytosis

FUNCTIONS:
8. Nurture the endothelium of the blood vessels (inactive
state)
9. Form platelet plug that temporarily stops bleeding
(active state)

LIFESPAN: 7 – 10 days
The balance of coagulation (formation of
blot clot or thrombin) and fibrinolysis
(breakdown of fibrin clots) which occur
simultaneously a s a result of tissue injury.
It is a process that terminates bleeding
through a complex mechanism that
involves vasoconstriction and coagulation.
SEQUENCE OF EVENTS IN HEMOSTASIS

1. Vasoconstriction:after injury
platelets come in contact with a
damaged BV, their surface becomes
sticky and adhere to the damaged wall.

Release of serotonin which

constricts/narrows the vessel ---
reducing blood flow through it
2. Platelet Plug formation: adherent
platelets clump to each other and
release adenosine diphosphate which
attract more platelet to the site to
form a temporary seal to stop the
bleeding.

3. Coagulation (blood clotting): this

involve the use of clotting factors
resulting to formation of an insoluble
thread like mesh of fibrin which traps
blood cells and much stronger than the
rapidly formed platelet
I– Fibrinogen
II – Prothrombin
III – Tissue Factor (Thromboplastin)
IV – Calcium
V– Labile Factor: Proaccelerin
VII – Stable Factor: Proconvertin
VIII – Antihemophilic factor A, Antihemophilic globulin A
IX - Christmas factor, plasma thromboplastin component,
antihemophilic factor B
X– Stuart Prower factor
XI - Plasma thromboplastin antecedent (PTA),
antihemophilic factor C
XII – Hageman factor
XIII – Fibrin stabilizing factor

(there is no Factor VI)

Vitamin k is essential for synthesis of Factors II, VII, IX and X

 STAGES of COAGULATION
Thromboplastin (initiates
Platelets adhere to damage
coagulation) released by
BV lining
damaged tissue cells enters
the blood

Extrinsic pathway Intrinsic pathway

Prothrombin activator

Final Prothrombin(F II) Thrombin

Common
Pathway
Loose Fibrin
Fibrinogen threads
(FI)

Stabilized
fibrin clot
4. Fibrinolysis : after clot was formed
the process of removing it and healing
the damaged BV begins
 capillary fragility test
(Rumpel-Leede Test)
 performed to evaluate the fragility of the
capillary walls, or the deficiency of blood
platelets (hemorrhagic tendencies)
 assessed by inflating a blood pressure cuff on
an arm to above venous pressure (70 mm Hg)
for 5 minutes and then relieve the pressure.
 the ruptured capillaries will appear as
petechiae
 the amount of petechiae present after the
test are counted and are classified by a
scoring system
 decrease platelet level.
Etiology:
Decreased production – due to bone marrow
deficiencies. Ex in leukemia where Platelets are
being crowded out from bone marrow because
of increase WBC; radiation, chemo damaging
precursor cells in bone marrow
Increased destruction – imbalanced between
production and destruction of platelets.
> Greater than 50,000 cells/mm³:
 Excessive bleeding following surgery or
other trauma

> Below 20,000 cells/mm³:

 Appearance of petechiae
 Nose & gingival bleeding
 Excessive menstrual bleeding
> Less than 5,000 cells/mm³:
 Spontaneous bleeding

 CNS & GI bleeding

1. Treat underlying cause
2. Bleeding precautions
3. Platelet transfusion
4. Medications:
- corticosteroids
- avoid the use of aspirin
 increased destruction of platelets as an
autoimmune response induced by antiplatelet
antibodies

 characterized by petechiae & ecchymosis of

the skin

 exact cause: UNKNOWN

 SPLEEN: site of destruction for platelets

 petechiae: spider web appearance

 ecchymosis

 blood in any body secretions

 bleeding from mucous membranes

1. Control bleeding
2. Prevent bruising
3. Protect from infection
4. Bleeding precautions
5. Medications:
- steroids – platelet production
- analgesics
8. Platelet transfusion
9. Splenectomy
 Pad crib & playpen
 Provide soft toys
 Pads in clothing
 Headgear
 Use of soft toothettes instead of bristle
toothbrushes
 AVOID contact sports
 A group of bleeding disorders where there
is a deficit of one of several factors in
the clotting mechanism

 Sex-linked inherited disorder

 Hemophilia A: factor VIII deficiency
(75% of all hemophilia)

 Hemophilia B (Christmas Disease):

factor IX deficiency (10%-12% of all
hemophilia)

 Hemophilia C: factor XI deficiency

(autosomal recessive, affects both
sexes)
 Platelet plug may form at the
bleeding sites

Deficiency in clotting factors

Impairment of formation of stable

fibrin clots

BLEEDING
2. Prolonged bleeding after minor injury
3. Bruising & hematomas
4. Peripheral neuropathies: pain,
paresthesias, muscle atrophy
5. Hemarthrosis (bleeding in the joints like
knees, ankles, elbows, wrists)
Early signs & symptoms:

3. At birth after cutting of cord

4. Following circumcision
5. Following IM immunizations
6. Following loss of baby teeth
7. Increased bruising as child learns to
crawl & walk
Control acute bleeding episode:
Ice compress
Immobilize area
Elevate affected extremity above heart
level
Manual pressure or pressure dressing
Maintain calm environment
AVOID: sutures, cauterization, aspirin
Administer HEMOSTATIC agents:
- fibrin foam
- topical adrenalin/epinephrine
Provide care for hemarthrosis:
 Immobilize joint
 Elevate joint in a slightly flexed
position
 Administer ANALGESICS
 AVOID use of Aspirin
 Instruct pt to AVOID WEIGHT
BEARING for 48 hrs after bleeding
episode
 Provide active or passive ROM
exercises
 Administer CRYOPRECIPITATE (frozen
factor VIII)
- thaw slowly
- gently rotate bag
- infuse immediately when thawed
 Genetic counseling
 Discharge plan: prevention of trauma
 condition that results in exaggerated
clotting process

 increases the formation of clots in the

microcirculation
 Uncontrolled bleeding
 Bruising, purpura, petechiae, & ecchymosis

 Presence of occult blood

 Hematuria, hematemesis, or vaginal

bleeding
 Signs of shock
 Normal hemostatic mechanism are altered

Massive amt of tiny clots form in microcirculation due to

the release of thromboplastic substances into blood..

RBC are trapped in Microinfarct and

fibrin strands and tissue necrosis
hemolyzed

Platelet & clotting factors will be consumed

When consumed --- coagulation fails

Paradoxical result of excessive clotting ---- BLEEDING

1. Treat underlying cause
2. Oxygen supplement
3. Volume replacement
4. Blood transfusion
5. Monitor:
- urine output
- vital signs
- complications