How to care for the haematology patient

Do you get excited or nervous when that IMHA patient arrives at the door?

Before I began caring for these patients regularly, they used to make me a little nervous. We didn’t do blood transfusions often, and when we did, they were generally performed by the vets... now I know I was missing out back then!

The reality is our patients with anaemia, coagulation disorders and platelet disorders can be challenging but very rewarding to nurse. They are a fantastic way to use our veterinary nursing skills, from laboratory testing and diagnostics, assisting with procedures and administering blood transfusions, we can make an enormous difference to these patients.

In this post, we’re going to look at 5 key areas nurses can use their skills when caring for haematology patients.

PS. If you want to know more about how nurses can make a difference to medical patients, make sure you register for my free webinar here.

#1: Laboratory skills

Haematology patients have varying changes to their red blood cell levels, white blood cell levels, platelet levels and clotting factors, so it makes sense that many of our nursing skills will be put to use in the practice lab!

These patients need several different tests, including haematology and coagulation time testing, as well as several manual tests. These in-house tests can (and should!) be performed by veterinary nurses.

In addition to using in-house analysers, the veterinary nurse will often need to review blood smears, examine red blood cell morphology (looking for things like spherocytes which can indicate immune-mediated haemolytic anaemia), examine white blood cell morphology, perform manual platelet counts (to ensure the platelets are of a sufficient level and detect any platelet clumps missed by an analyser) and differential white blood cell counts. Other common tests include the in-saline agglutination test (performed where IMHA is suspected) and the buccal mucosal bleeding time test (which is used to evaluate platelet function).

#2: Diagnostic imaging

The nurse also plays a key role in supporting the haematology patient during diagnostics. These patients frequently need abdominal and thoracic imaging, to screen for concurrent diseases such as neoplasia which may be causing secondary haematological changes.

Supporting the patient throughout diagnostic imaging typically includes administering sedative or anaesthetic agents and monitoring the patient throughout the procedure, as well as positioning/restraining the patient and assisting with the collection of any samples (such as ultrasound-guided FNAs from organs like the spleen and liver).

When monitoring these patients under sedation or anaesthesia, the veterinary nurse should consider pre-oxygenating the patient (anaemic patients have a reduced oxygen-carrying capacity, but do transport some oxygen dissolved in plasma), and pay close attention to the patient’s cardiovascular parameters (heart rate, pulse quality and blood pressure). If an ECG is available, monitoring for any arrhythmias may also be advisable.

#3: Procedure support

Other diagnostic procedures may be performed in the haematology patient, especially if underlying bone marrow disease is suspected. The most common procedure (other than imaging) that we perform in these patients is a bone marrow aspirate and core biopsy - this is the collection of bone marrow, which is submitted for cytology and histology analysis.

The veterinary nurse is vital in ensuring the necessary equipment is prepared and ready ahead of sample collection, as bone marrow samples clot very rapidly. Other nursing considerations include anaesthetic monitoring, and providing appropriate analgesia (incorporating local anaesthetic techniques is beneficial in these patients, as they can react significantly when the bone marrow biopsy needle is advanced through the bone) in the perioperative and postoperative periods.

#4: Blood transfusions

Blood transfusions are great fun and a way for nurses to showcase their skills. Calculating blood product requirements, preparing the products and patient for transfusion and monitoring the patient are all skills which should be performed by veterinary nurses (under the direction of the veterinary surgeon).

Where banked blood products are not available, blood donors will need to be sourced and a fresh whole blood donation performed. The veterinary nurse is ideally positioned to support donor patients and clients, including explaining the donation process (and associated risks!) to clients, gaining informed consent, performing pre-donation assessments and testing, and performing the donation itself.

#5: Nursing care

Haematology patients require vast amounts of nursing care. Their monitoring requirements are often intensive, particularly during the administration of blood products, with regular assessment of vital parameters and repeat blood testing (such as PCV, total solids and manual platelet estimates).

These patients also have several specific care requirements, including minimising haemorrhage, keeping the patient calm and rested, barrier nursing (where immunosuppressive or cytotoxic agents are used in the patient’s treatment plan) and monitoring for complications of disease (such as thromboembolic disease).

Other considerations include nutrition, fluid therapy administration, care of intravenous catheters and, in some cases, recumbency care.

So there you have it! Our haematology patients have a lot of nursing considerations, but are a great opportunity for nurses to showcase their skills, particularly in the laboratory, when assisting with diagnostics and procedures, and when blood transfusions are required! They really are a fantastic example of just how much we can do with our medical patients in practice!