Hematological Medicines: Classes, Uses, Safety and Nursing Care

Table of Contents

Hematological Medicines: Classes, Uses, Safety and Nursing Care

Hematological medicines act on blood cells, coagulation, haemostasis or blood formation. They include antianaemia medicines, anticoagulants, antiplatelet agents, thrombolytics, haemostatic medicines, growth factors and blood products. These medicines can save life but also cause catastrophic bleeding, thrombosis or transfusion reactions when assessment and monitoring are inadequate.

Safety principle: Before giving a medicine affecting coagulation, verify the indication, current bleeding, weight, renal and liver function, platelet count, relevant coagulation tests, interactions and the correct dose and route.

Learning Objectives

Classify medicines affecting blood and explain their major actions.
Describe indications, adverse effects, contraindications and monitoring.
Administer anticoagulants and iron preparations safely.
Recognise haemorrhage, thrombosis, haemolysis and transfusion reactions.
Apply patient education and Uganda-relevant nursing practice.

Major Classes

Class and examples	Main uses	Monitoring and major risks
Oral iron Ferrous sulfate, fumarate or gluconate	Prevention and treatment of iron deficiency	Confirm cause of anaemia. Nausea, abdominal pain, constipation and dark stool are common. Keep away from children: overdose is dangerous. Assess haemoglobin response and continue long enough to replenish stores as prescribed.
Parenteral iron Iron sucrose, ferric carboxymaltose or locally available formulation	Iron deficiency when oral treatment is ineffective, not tolerated or too slow	Calculate the iron deficit and follow product-specific dilution and rate. Monitor during and after administration for hypersensitivity, hypotension and infusion reactions; ensure resuscitation readiness.
Folic acid and vitamin B12 Folic acid; hydroxocobalamin or cyanocobalamin	Documented deficiency, pregnancy supplementation and selected megaloblastic anaemias	Do not treat unexplained megaloblastic anaemia with folate alone before excluding B12 deficiency, because neurological injury can progress despite correction of blood counts.
Erythropoiesis-stimulating agents Epoetin alfa	Selected chronic kidney disease or chemotherapy-associated anaemia	Correct iron deficiency, monitor haemoglobin and blood pressure, and avoid excessive haemoglobin rise. Risks include hypertension and thrombosis.
Unfractionated heparin	Rapid anticoagulation, acute thrombosis and selected procedures	Monitor aPTT or anti-Xa according to protocol, platelets and bleeding. Protamine reverses much of its effect. Consider heparin-induced thrombocytopenia when platelets fall or new thrombosis develops.
Low-molecular-weight heparin Enoxaparin	Prevention and treatment of venous thromboembolism; acute coronary syndromes	Dose by indication, weight and renal function. Do not expel the air bubble from a prefilled syringe unless instructed. Avoid rubbing injection site. Protamine reversal may be incomplete.
Vitamin K antagonist Warfarin	Long-term anticoagulation for selected indications	Monitor INR and interactions with medicines, alcohol and major dietary change. Many antibiotics and herbal products alter effect. Vitamin K and coagulation-factor replacement may be needed for major bleeding.
Direct oral anticoagulants Apixaban, rivaroxaban, dabigatran	Selected atrial fibrillation and venous thromboembolism	Routine INR is not used, but adherence, renal/liver function, haemoglobin and bleeding must be monitored. Dose depends on indication and patient factors. Reversal availability varies.
Antiplatelet medicines Aspirin, clopidogrel	Acute coronary syndrome and prevention of arterial thrombosis	Risks include gastrointestinal and intracranial bleeding. Verify indication and dose. Aspirin is not routinely given to children with viral illness because of Reye syndrome risk.
Thrombolytics Alteplase, tenecteplase, streptokinase where used	Selected acute ischaemic stroke, STEMI or massive pulmonary embolism	Time-critical specialist medicines. Screen strictly for bleeding, recent surgery, stroke history and uncontrolled hypertension. Stop infusion and escalate for sudden headache, neurological change or bleeding.
Haemostatic medicines Tranexamic acid, vitamin K, desmopressin	Selected traumatic, surgical, obstetric or mucosal bleeding; reversal or factor-related indications	Give tranexamic acid early only for appropriate indications and protocol. Adjust in renal impairment. Treat the cause of bleeding; do not use a haemostatic medicine as a substitute for resuscitation or surgery.
Blood components and factors Red cells, platelets, plasma, cryoprecipitate, factor concentrates, anti-D immunoglobulin	Replacement of a defined cellular or coagulation deficit	Use compatibility and cold-chain procedures. Check patient identity at bedside, monitor closely and stop transfusion immediately if a reaction is suspected.

Antianaemia Medicines

Anaemia is not a single disease. Causes include iron, folate or B12 deficiency; malaria and parasitic disease; chronic inflammation; kidney disease; bleeding; haemoglobin disorders and bone-marrow disease. Treat the cause as well as the low haemoglobin.

Oral Iron Nursing Care

Explain that stool may become dark and that gastrointestinal adverse effects are common.
Give according to the prescribed schedule; absorption is reduced by some antacids, calcium products and beverages, while food may improve tolerability but reduce absorption.
Liquid iron can stain teeth; use a straw where appropriate and rinse the mouth.
Reassess adherence, ongoing blood loss and diagnosis if haemoglobin does not respond.
Store securely because accidental ingestion can be fatal.

Safe Anticoagulant Administration

Confirm indication, dose, latest weight, renal function, platelet count, haemoglobin and relevant coagulation result.
Check for active bleeding, recent surgery, neuraxial procedure, pregnancy and interacting medicines.
Use an independent double-check for high-risk infusions and facility-defined high-alert medicines.
For subcutaneous LMWH, rotate abdominal sites, inject into a skin fold as trained and do not massage.
Minimise intramuscular injections and unnecessary invasive procedures.
Document the exact last dose and communicate it during transfer, surgery planning and discharge.

Recognition and Management of Bleeding

Look for haematemesis, melaena, haematuria, heavy vaginal bleeding, bruising, persistent wound bleeding, falling blood pressure or haemoglobin.
Headache, confusion, weakness or reduced consciousness may indicate intracranial bleeding.
Stop or withhold the suspected medicine only according to emergency protocol or prescriber direction, call for urgent help, support ABC, obtain IV access and send blood tests/cross-match.
Identify the last dose, medicine and indication. Prepare the specific reversal strategy and blood components ordered.

BLEED check: Blood pressure and ABC; Last anticoagulant dose; Examine all bleeding sites; Evaluate haemoglobin, platelets, renal function and coagulation; Discuss reversal and definitive control urgently.

Heparin-Induced Thrombocytopenia

HIT is an immune complication of heparin that causes a platelet fall and paradoxical thrombosis. Suspect it when platelets fall substantially several days after exposure, or sooner with recent heparin exposure, especially if new thrombosis, skin necrosis or a systemic reaction follows a bolus. Stop all heparin sources and obtain urgent specialist guidance for a non-heparin anticoagulant; platelet transfusion is not routine unless there is significant bleeding or a specialist indication.

Transfusion Nursing Responsibilities

Confirm prescription, indication, consent, compatibility testing and venous access.
At the bedside, positively identify the patient and match the component label with another trained professional according to policy.
Record baseline temperature, pulse, respiration and blood pressure; begin at the prescribed rate and observe closely.
If fever, chills, rash, dyspnoea, chest or back pain, anxiety, hypotension or dark urine occurs: stop transfusion, keep IV access with compatible fluid, assess ABC, call the clinician and blood bank, recheck identity and follow the reaction protocol.
Never restart a suspected reaction without authorised investigation and direction.

Patient Education

Carry an anticoagulant card or medicine list and tell every clinician, dentist and pharmacist.
Take doses consistently; never double a missed dose unless specifically instructed.
Avoid non-prescribed NSAIDs, aspirin or herbal remedies that increase bleeding.
Use a soft toothbrush and electric razor when appropriate; seek care after significant head injury even without visible bleeding.
Report black stool, vomiting blood, heavy bleeding, severe headache, breathlessness or sudden limb swelling immediately.

Uganda-Relevant Practice

Investigate malaria, hookworm, nutritional deficiency, obstetric blood loss, sickle cell disease and chronic infection when appropriate.
Follow Uganda Clinical Guidelines, transfusion policy and the current Essential Medicines and Health Supplies List.
Blood scarcity increases the importance of correct indication, patient blood management and early bleeding control.
Ensure referral when monitoring, reversal agents, blood components or specialist care are unavailable.

Revision Summary

Identify and treat the cause of anaemia; do not prescribe iron automatically.
Anticoagulants prevent and treat thrombosis but require bleeding assessment and renal-dose review.
Antiplatelets act differently from anticoagulants and are used mainly for arterial disease.
Thrombolytics are time-critical and have strict contraindications.
Correct identity checks and immediate action are essential in transfusion safety.

Authoritative References

This educational note does not replace patient-specific prescribing, local protocols or specialist advice.