anemia Flashcards
Normocytic, normochromic RBC causes anemia by:
normal size and color
• Acute blood loss, hemolysis, chronic kidney disease, chronic disease, cancers, sideroblastic anemia, endocrine disorders, starvation, aplastic anemia, sickle cell anemia, pregnancy
Microcytic, hypochromic RBC causes anemia by:
small size, pale color)
• Iron-deficiency anemia, vitamin B6 deficiency, copper deficiency, thalassemia, lead poisoning
Macrocytic (megaloblastic), normochromic RBC causes anemia by:
large size, normal color
• Cobalamin (vitamin B12) deficiency, folic acid deficiency, liver disease (including effects of alcohol abuse), post splenectomy
causes of anemia
elated to an underlying cause such as iron deficiency, bleeding, chronic disease/inflammation, renal insufficiency, or a hematologic cancer.
three main causes of anemia are
1) decreased production of red blood cells
2) blood loss
3) increased destruction of red blood cells.
Expand on the causes of anemia
1) decreased production of red blood cells
2) blood loss
3) increased destruction of red blood cells.
1) decreased production of red blood cells
- Decreased hemoglobin synthesis
- Defective DNA synthesis
- Decreased number of RBC precursors
2) blood loss
- Acute (Trauma, Blood vessel rupture, Splenic sequestration crisis)
- Chronic (Gastritis, Menstrual flow, Hemorrhoids)
3) increased destruction of red blood cells.
- Hereditary (sickle cell disease)
- Acquired (Extrinsic) (trauma, immune, malaria)
What does Mean corpuscular volume measure? (MCV)
Average volume of red cells in a specimen
High MCV = large red bloodcells (macrocytic)
Low MCV = small bed blood cell (microcytic)
What does red cell distribution width measure (RDW)?
a measurement of the range in the volume and size of your red blood cells (erythrocytes).
What’s a normal hemoglobin range
12-17.5 g/dL
men, 13.5 to 17.5 grams per deciliter.
For women, 12.0 to 15.5
hemoglobin rante in mild, moderate and severe anemia
In mild anemia (Hgb 10 to 14 g/dL [100 to 140 g/L])
In moderate anemia (Hgb 6 to 10 g/dL [60 to 100 g/L])
In severe anemia (Hgb <6 g/dL [<60 g/L])
Assessment findings to suggest anemia
- Weight loss
- Anorexia
- Lethargy
- Sensitivity to cold
- Apathy
- Pallor
- Increased respirations and pulse
- Confusion, impaired cognition
Symptoms
Mild
Moderate
Severe
MILD
• May exist without symptoms
• with exercise Palpitations, dyspnea, diaphoresis
MODERATE
•Increased heart rate present while resting
• Increased heart rate present with activity
SEVERE • Pallor or jaundice • Pruritus • Icteric conjunctiva and sclera • Retinal hemorrhage vBlurred vision • Glossitis or a smooth tongue • Tachycardia • Increased pulse pressure • Systolic murmurs • Intermittent claudication • Angina • Heart failure or myocardial infarction (MI) • Tachypnea, orthopnea, dyspnea at rest • Headache or vertigo • Irritability, depression, impaired thought processes • Anorexia • Hepatomegaly, splenomegaly • Difficulty swallowing, sore mouth, bone pain, cold sensitivity
Anemia treatment
Dietary and lifestyle changes
Blood or blood product transfusions
Drug therapy
Oxygen therapy
Nursing interventions for anemia
Monitor VS
Monitor hematocrit, hemoglobin
Management of Oxygen therapy
Client teaching (relaxation, breathing)
Alternate rest with activity (1:3)
Limit visitors & interventions to promote rest (save energy for priority tasks)
Assist with ADL’s
Signs and symptoms of anemia in older adults may include
pallor, confusion, ataxia, fatigue, worsening cardiovascular and respiratory problems.
Explain Erythroctye Production
in red bone marrow.
• cells come from undifferentiated hemocutoblast.
• hemocytoblast stimulated by erythropoietin they evolve into RBC
erythropoietin comes from kidney
• RBC has 4 heme and 4 globin proteins
Iron-Deficiency AnemiaCollaborative Care
Treat the underlying disease
↑ Intake of iron
Nutritional therapy
Oral or occasionally parenteral iron supplements
Transfusion of packed RBCs
Oral Iron Replacement Therapy
- for iron deficiency anemia
- Inexpensive/Convenient
- Enteric-coated or sustained-release capsules are counterproductive and expensive
- Iron is best absorbed in an acidic environment.
- Undiluted liquid iron may stain the patient’s teeth.
- GI side effects may occur, including heartburn, constipation, and diarrhea
take before meals with vitamin C
Parenteral Iron Replacement
- IM or IV
- may stain the skin
- IV has risk of an allergic reaction
- use is indicated for malabsorption, intolerance of oral iron, a need for iron beyond oral limits, or poor patient adherence in taking the oral preparations
?mg per day is the recommended dose for folic acid replacement.
1
who is at increased risk for development of iron deficiency anemia:
premenopausal and pregnant women, people from low socioeconomic backgrounds, older adults, and individuals experiencing blood loss
Concerns with acute blood loss
1) Rapid blood loss leads to hypovolemic shock: tacaycardia and hypotension
2) Slower blood loss leads to↑ Plasma volume faster than ↑ in RBC therefore
↓ O2 due to ↓ RBCs available
3) Pain (Tissue distention, organ displacement, nerve compression )
What does reticulocyte count measure?
Immature cells.
Meausres how fast reticular cells are made by bone marrow and released into blood
High can mean bleeding, kidney disease or distruction of RBC
What does Erythrocyte Sedimentation rate measure (Westergren)?
- Test of immflamation (part of immune response system)
- Measures how fast eurythrocytes will settle at the bottom of a test tube that contains a sample.
- Faster rate = inflammation in the boidy
Three extrinsic categories in Aquired Hemolytic anemia
1) Physical factors Physical destruction of RBCs results from extreme force on the cells. 2) Immune reactions Antigen–antibody reactions destroy RBCs 3) Infectious agents and toxins
Sickling episodes
commonly triggered by a low oxygen tension in the blood.
Sickled RBCs become rigid and take on an elongated, crescent shape.
sickle cell symptoms
- PAIN: the pain is quite severe as a result of tissue ischemia
- fever, swelling, tenderness, tachypnea, hypertension, and nausea and vomiting.
Thalassemia symptoms
Thalassemia minor symptoms
Frequently asymptomatic
Mild to moderate anemia with microcytosis (small cells) and hypochromia (pale cells)
Thalassemia major symptoms
Delayed physical and mental development
Pallor
Splenomegaly, hepatomegaly, and jaundice from hemolysis of RBCs
Chronic bone marrow hyperplasia causing expansion of the marrow space
Thickening of the cranium and maxillary cavity
sickle cell treatment
- pain control
- anti sickling agent hydroxyurea
- Hydration Therapy
- Oxygen Therapy
- Blood Transfusions
Education
Teach the patient ways to avoid sickle cell crises. This may include taking steps to avoid dehydration and hypoxia, such as avoiding high altitudes and seeking medical attention quickly in an attempt to counteract potential causes of sickle cell crises, such as upper respiratory tract infections.
Thalassemia Major treatment
Managed with blood transfusions or exchange transfusions in conjunction with oral deferasirox or intravenous or subcutaneous deferoxamine (chelating agents that bind to iron) to reduce the iron overloading (hemochromatosis) that occurs with frequent transfusion therapy. Because RBCs are sequestered in the enlarged spleen, thalassemia may be treated by splenectomy.
Although hematopoietic stem cell transplantation remains the only cure for patients with thalassemia, the risk of this procedure may outweigh the benefits.
