Hematology / Blood System
Hematology / Blood System
Blood and coagulation conditions, evidence, coding, and nursing diagnoses.
Major hematology conditions
Anemia
Anemia: Hgb <13.5 g/dL (men) or <12 g/dL (women). Classified by MCV: microcytic (iron deficiency), normocytic (chronic disease, AKI, blood loss), macrocytic (B12/folate). Identify and treat cause.
SCD
SCD: hemoglobin S polymerization causing RBC sickling, hemolytic anemia, vaso-occlusion, and organ damage. Hydroxyurea reduces crises. Voxelotor and crizanlizumab are newer agents.
VOC
Vaso-occlusive crisis (VOC): severe pain from ischemia in bones, chest, abdomen. Acute chest syndrome (ACS) — infiltrate + chest pain/fever — is life-threatening. Analgesia within 30 minutes.
Low Platelets
Thrombocytopenia: platelet count <150,000. Causes: ITP (immune), HIT, TTP, DIC, drug-induced, liver disease, bone marrow failure. Spontaneous bleeding risk when platelets <20,000.
HIT
HIT is antibody-mediated platelet activation by heparin-PF4 complexes causing paradoxical thrombosis. Platelet drop ≥50% 5-14 days after heparin. Stop ALL heparin immediately — use alternative anticoagulant.
DIC
DIC is pathologic systemic activation of coagulation causing simultaneous clotting and bleeding. Triggers: sepsis, trauma, obstetric emergencies, malignancy. Treat underlying cause + supportive.
Anticoagulation
Anticoagulation therapy for VTE prevention, AF stroke prophylaxis, and mechanical valves. DOACs (direct oral anticoagulants) have largely replaced warfarin. Reversal agents are available for all major DOACs.
Febrile Neutropenia
Neutropenia: ANC <1500. Febrile neutropenia: ANC <500 + temperature ≥38.3°C — oncologic emergency requiring broad-spectrum antibiotics within 1 hour. MASCC score guides inpatient vs outpatient.
Related nursing diagnoses
Nursing Diagnoses & Care Plans
Open the NANDA tool to review nursing diagnoses and care-plan concepts related to hematology conditions.