The blood and the organs that produce it (bone marrow, spleen, lymph nodes) are vital for oxygen transport, clotting, and immunity. Medications targeting the hematological system treat conditions like anemia, bleeding disorders, clotting problems, and blood cancers. These drugs often have significant effects and require careful monitoring.

This lesson outlines key medication groups used for blood conditions, focusing on their purpose and essential nursing considerations.

1. Medications for Anemia

Anemia means low red blood cells or hemoglobin, affecting oxygen transport. Treatment replaces deficient components or stimulates production.

• Replacing Deficient Nutrients:

  • Medications: Iron supplements (oral/IV), Vitamin B12 (injectable/oral), Folic Acid (oral/injectable).

  • Uses: Treat iron-deficiency anemia, B12 deficiency (pernicious anemia), folic acid deficiency.

  • Nursing Focus:

    • Administration: Iron: Oral best absorbed on empty stomach (unless GI upset occurs, then take with food). Avoid taking with milk, calcium, or antacids as they reduce absorption. Vitamin C enhances absorption. IV Iron: Monitor for infusion reactions. B12: Often IM injections initially.

    • Monitoring: Monitor Hemoglobin/Hematocrit, iron studies, B12/folate levels. Watch for GI side effects (oral iron – constipation, black stools).

    • Education: Oral Iron: Expected black stools, manage constipation, timing with food/other meds. B12: Lifelong treatment for pernicious anemia.

• Stimulating Red Blood Cell Production:

  • Medications: Erythropoiesis-Stimulating Agents (ESAs, e.g., Epoetin alfa).

  • Uses: Treat anemia from chronic kidney disease, chemotherapy.

  • Nursing Focus:

    • Administration: Subcutaneous or IV.

    • Monitoring: Monitor Hemoglobin (don’t let it rise too fast or too high – risk of blood clots). Monitor blood pressure (can cause hypertension).

    • Education: Purpose of medication. Importance of monitoring. Report signs of blood clots.

2. Medications for Bleeding Disorders

These conditions involve problems with blood clotting, leading to excessive bleeding.

• Promoting Clotting:

  • Medications: Vitamin K, Clotting Factor Concentrates (e.g., Factor VIII), Desmopressin (DDAVP).

  • Uses: Reverse warfarin effects (Vit K), replace missing factors (Hemophilia), increase factor levels (mild Hemophilia A, von Willebrand).

  • Nursing Focus:

    • Administration: Vitamin K (oral/injectable), Factors (IV), Desmopressin (injectable/nasal). Follow specific protocols for factor concentrates.

    • Monitoring: Monitor for effectiveness (reduced bleeding). Monitor coagulation tests (INR with Vit K). Monitor for allergic reactions (Factors, IV Vit K). Desmopressin: Monitor fluid balance, sodium levels (risk of hyponatremia).

    • Education: Recognize bleeding signs. Proper administration (home therapy). Importance of monitoring.

3. Medications for Clotting Disorders (Thrombosis)

These involve excessive clotting. Medications prevent or dissolve clots.

• Preventing Clots:

  • Medications: Antiplatelets (e.g., Aspirin, Clopidogrel), Anticoagulants (e.g., Warfarin, Heparin, DOACs like Rivaroxaban).

  • Uses: Prevent arterial clots (antiplatelets), prevent/treat venous clots (anticoagulants).

  • Nursing Focus:

    • Monitoring: Major focus: Monitor for bleeding! Assess for bruising, petechiae, purpura, blood in stool/urine, nosebleeds, gum bleeding, changes in neurological status (intracranial bleed). Implement bleeding precautions if platelet count is low or on anticoagulants/thrombolytics.

    • Administration: Oral (Aspirin, Clopidogrel, Warfarin, DOACs), SC/IV (Heparin, LMWH). Follow protocols.

    • Education: High risk of bleeding – report any unusual bleeding. Avoid activities causing injury. Warfarin: Interactions with Vitamin K foods, many drugs, requires regular INR tests. DOACs: Less monitoring, but still bleeding risk, do not miss doses.

• Dissolving Existing Clots:

  • Medications: Thrombolytics (e.g., Alteplase).

  • Uses: Emergency treatment for acute ischemic stroke, pulmonary embolism, myocardial infarction (in certain situations). Used in emergency situations.

  • Side Effects: Major risk of bleeding, allergic reactions.

  • Nursing Implications: Administer according to strict protocols in a monitored setting (ICU). Monitor for signs of bleeding (anywhere in the body). Monitor neurological status (for stroke treatment). Contraindicated in patients with high bleeding risk.

4. Medications for Blood Cancers

Treat leukemias, lymphomas, multiple myeloma.

• Chemotherapy: (e.g., Cytarabine, Doxorubicin)

  • Mechanism: Kill rapidly dividing cells.

  • Uses: Induce remission.

  • Nursing Focus:

    • Monitoring: Major focus: Bone marrow suppression! Monitor CBC closely (Neutropenia – increased infection risk, Thrombocytopenia – increased bleeding risk, Anemia). Monitor for nausea/vomiting, mucositis, hair loss.

    • Administration: Often IV, requires specialized training.

    • Education: Infection prevention (neutropenic precautions). Bleeding precautions. Managing side effects.

• Targeted Therapies: (e.g., Imatinib)

  • Mechanism: Block specific cancer cell pathways.

  • Uses: Specific blood cancers (e.g., CML).

  • Nursing Focus:

    • Monitoring: Monitor for specific side effects (fluid retention, rash, GI). Less severe than chemo but still present.

    • Education: Purpose, side effects.

• Immunotherapy: (e.g., Rituximab, CAR T-cell)

  • Mechanism: Use immune system to fight cancer.

  • Uses: Certain lymphomas/leukemias.

  • Nursing Focus:

    • Monitoring: Infusion reactions, increased infection risk. Requires specialized knowledge.

    • Education: Infection prevention.

Key Nursing Responsibilities

• Assessment: Assess for signs of anemia, bleeding, clotting, or infection. Monitor vital signs. Review lab results (CBC with differential, coagulation studies, specific factor levels).

• Administration: Correct route, dose, timing. Follow specific protocols (IV iron, factors, chemotherapy, thrombolytics). Monitor for infusion reactions.

• Vigilant Monitoring: Crucially monitor for bleeding and clotting. Monitor for signs of infection (neutropenia). Monitor CBC and coagulation labs. Watch for drug-specific side effects.

• Patient Education: Clear instructions on meds, purpose, dose, timing, side effects (when to report), importance of lab tests. Educate on bleeding/infection precautions. Drug/food interactions (Warfarin).

• Safety: Implement bleeding precautions, neutropenic precautions, fall precautions as needed.

• Emotional Support: Support patients/families with serious blood disorders or cancers.