Anemia Flashcards
Why is anemia a disease of perfusion?
> > there aren’t enough RBC’s to carry adequate oxygen to tissue
-manifestation of something else
Anemai for men vs women
- Hg < 12 g/dL in women
- Hg < 13.5 g/dL in men (or 14 g/dL, per Iggy)
anemia a manifestation of
something else
anemia is temporary or permanent
either
labs for anemia
- CBC
- RBC’s (4-6 M cells/mcL)
- Hemoglobin (14-18g/dL/ 12-16 g/dL)
- Hematocrit (42-52%/ 37-47%)
- *Reticulocytes (0.5 – 2%)
- MCV (Mean Corpuscular Volume) (80-95)
normal HGB ranges
14-18g/dL/ 12-16 g/dL
normal hematocrit
42-52%/ 37-47%
normal reticulocytes
0.5 – 2%
Normal RBC
4-6 M cells/mcL
what is a reticulocyte
immature RBC
Why do I care about reticulocytes in relation to anemia
-Insight into whether the problem is production (low reticulocytes) or destruction (high- don’t have enough time to mature)
What does MCV stand for and what is the normal range
Mean Corpuscular Volume 80-95
Microcytic anemia is problem with
not having enough iron, RBC are too small
Macrocytic anemia is problem with
DNA synthesis, doesn’t have enough Folic Acid
–>cell continues to grow b/c DNA synthesis is slow
3 types of hemolytic anemia
- Sickle Cell Disease
- Glucose 6-Phosphate Dehydrogenase Deficiency Anemia
- Immunohemolytic Anemia
hemolytic anemia is characterized by
increased destruction of RBC
3 types of anemia that are a decreased production of RBC
- Normocytic Anemia
- ->Anemia of Chronic Disease - Macrocytic Anemias (DNA issue)
- ->Vitamin B12 deficiency anemia
- -> Folic acid deficiency anemia
- ->Aplastic Anemia - Microcytic Anemias (Hemoglobin issue)
- ->Iron Deficiency anemia ***
anemia risk factors
Blood Loss (Acute or Chronic) GI bleeding Hemorrhage Trauma Operative Menorrhagia Increased destruction of RBC’s Defective RBC’s Immune issue G6PD deficient Age Nutritional Issues GI Bleeding
Dietary intake issue or Malabsorption Iron deficient B12 deficient Folic acid deficient Bone Marrow Suppression Radiation Chemicals
anemia assessment
Fatigue Pallor Jaundice Dysrhythmias Tachycardia Dyspnea Shortness of breath Syncope Dizziness Headache Chest Pain
Nursing Interventions for anemia
Largely depend on the cause
Situationally, think:
Dyspnea Low SpO2- Elevate HOB , put oxygen on
Increased fatigue- rest periods
Intolerance of cold temperature- warm blanket
Orthostatic Hypotension- education about getting up slowly
Chest Pain - 12 lead EKG
Indication for Blood Transfusion=
When Hg < 7 g/dL OR your patient is anemic and symptomatic
causes of iron deficiency anemia
Poor diet
Blood loss
Poor GI absorption- common in elderly due to poor GI absorption
most common type of anemia?
iron deficiency
what do RBCs look like with iron anemia
Small RBC’s (microcytic/ low MCV)
iron deficiency anemia labs
Serum ferritin <10-12 ng/mL
Serum Iron < 60-80 mcg/dL
mouth fissures with what kind of anemia?
iron deficiency
*will not heal until anemia is better!
diet changes for iron deficiency anemia
Red meat & Liver Legumes Leafy greens Shellfish -Oral Supplements-constipation/stool dark color May cause GI distress
IV iron infusions = Only for ? and why?
severe iron deficiency, anaphylaxis risk!
Anemia of chronic disease common
elderly
severity of anemia of chronic disease?
mild to moderate
RBC appearance w/ anemia of chronic disease?
normocyctic
another name of anemia of chronic disease
anemia of inflammation
common causes of anemia of chronic disease
Kidney Disease Infection Cancer Inflammatory Bowel Disease Diabetes
how do we treat anemia of chronic disease?
treat the underlying causes
Vit b12 deficiency anemia result in what with RBC
macrocytic RBC
–>cell continues to grow b/c DNA synthesis is slow
causes of b12 anemia
- Dietary
- Chronic diarrhea
- Pernicious anemia - not able to absorb b12
b12 anemia s/s
-Pallor
-Fatigue
-Jaundice
-Weight loss
-Glossitis
Parasthesias –> nerves involved!
folic acid anemia causes
- Diet
- Malabsorption
- Drugs
- Alcoholism
folic acid anemia s/s
- Pallor
- Fatigue
- Jaundice
- Weight loss
- Glossitis
*same as b12 but no nerve stuff
how we treat B12 anemia?
Dietary changes
Oral supplements
B12 injections
Folic acid anemia interventions
Screening for: Older adults Poor nutrition Alcoholics Dietary Changes Supplement
What is sickle cell disease (patho)
-Autosomal recessive genetic disorder
-Causes mutation that results in HbS (vs HbA which is what most people have)
-HbS is sensitive to low O2
-Low O2 = Sickling of RBC’s
> Sickled cells clump together
>Create vaso-occlusive event (VOE)
HbS vs HbA
HbA = 2 alpha and 2 beta chains in cell
HbS = 1 of beta chains has alternation in amino acid causing changes in certain environments
—> in low O2 environment that beta chain loses is structure and causes entire HgB to sickle
carriers of sickle cell diesease
inherited 1 normal and 1 HbS allele
-people who are carriers have mild sxs!
Life span of HbS vs HbA RBC
HbA = normal =120 HbS = sickle = 20 days (sickled or not) = anemia = increased reticulocytes
Concern w/ VOE from Sickle cell crisis
-long term damage to tissue/organs organ failure Spleen Liver Heart Kidney Brain Bones & Joints Retina Lungs - acute chest syndrome = #1 people with sickle cell disease die
1 cause of death in Sickle Cell patients?
acute chest syndrome
conditions that cause sickling
- Pregnancy
- Hypoxia
- Dehydration > decrease blood flow
- Infection
- Venous stasis > immobility
- Alcohol
- High Altitudes
- Extreme temperatures
- Acidosis > DKA, infection
- Exercise >lactic acid build up
- Stress
- Anesthesia
sickle cell assessment
Signs of poor perfusion!
**Pain** - acute and chronic --> long term opioids Fatigue Pallor Jaundice Cyanosis Lower Extremity ulcers Joint pain > deformed joints > limited range of motion > swelling SHOB Pallor Jugular vein distension Capillary Refill > 2 seconds Diminished pulses Cool Tachycardia Cognitive changes -memory/clarity issues Coping Understanding of SCD Support System
complications of sickle cell
- Crisis
- Organ Failure
- Priapism- erection that doesnt go away , medical emergency, cannot urinate!
- Pneumonia
- **Acute Chest Syndrome **
Assessing for acute chest syndrome
-caused by VOE in pulmonary bed
-looks like PNA :
Cough
SHOB
Infiltrate on chest x-ray
Diagnostics for sickle cell
- # 1 diagnosis: Family history + Hemoglobin electrophoresis
- Low Hematocrit (new normal = 20-30% for SCD)
- High Bilirubin (May be high >1.2 mg/dL)
- High Reticulocytes (> 2%)
- High WBC’s (> 10 9 cells/L)
hematocrit sickle cell vs regular
sickle = 20-30 %
normal =(42-52%/ 37-47%)
interventions for sickle cell crisis
- *Oxygen (if Hypoxic) - oxygen can slow prdxn of RBC > only give if hypoxic! give minimum amt
- *Pain management
- *Hydration
- D5 1/2NS
- Promote Circulation
- Prevention of infection
- Early detection of infection> report fever to provider!
- Temperature adjustments to environment
- Blood transfusions > rarely indicated, only if really need them
- Crisis prevention > recognize triggers
- Hydroxurea (medication)
consideration for giving O2 during sickle cell crisis
oxygen can slow prdxn of RBC > only give if hypoxic! give minimum am
when are we using packed red blood cells
Hg < 7g/dL OR low with symptoms of anemia
when use washed PRBC
history of allergies or allergic reaction to blood products
when transfuse platelets?
Platelets < 20,000 OR < 50,000 with active bleeding
-platelets <20,000 = risk of
spontaneous bleed especially in brain!
this type of transfusion does not require type/cross
platelets
when use fresh frozen plasma
- Elevated PT / INR (with or without bleeding) - trouble with clotting
- Reversal of coumadin (in emergency)
- For patients who have received multiple PRBC transfusions
universal donor =
universal recipients =
- O- = universal donor
* AB+ = universal recipient
1st thing to do when giving blood?
-Verify order* & consent* - if another nurse says they got consent YOU still need to verify consent
After consent for blood make sure you have a _______ from w/in 3 days
type and cross
iv access for blood?
large bore - 18/19/20
how soon to start blood once it comes from blood bank?
w/in 15 minutes
the unit of blood should be administered within ____ hours
4
tubing for blood?
filter!
stay w/ patient for the first _____ minutes
15
transfusion reaction types
- febrile
- hemolytic
- allergic
- bacterial
- TRALI
- circulatory overload
- Graft vs host
febrile transfusion reaction
(fever, chills, tachycardia, low BP, tachypnea- occurs within 4 hours)
hemolytic transfusion reaction
(fever, chills, low back pain, chest pain, anxiety, low BP, tachycardia, tachypnea)
allergic transfusion reaction
(itching, urticaria)
bacterial transfusion reaction
(tachycardia, low BP, fever, chills)
TRALI
(dyspnea, hypoxia)
circulatory overload transfusion reaction
(hypertension, bounding pulse, JVD, anxiety) - give diuretics
Transfusion associated graft versus host disease
(thrombocytopenia, nausea, vomiting, weight loss, infection)
which transfusion reactions are acute?
Mild allergic Anaphylactic Acute Hemolytic Febrile non-hemolytic Bacterial Circulatory overload
which transfusion reactions are delayed?
Delayed Hemolytic
Transfusion-associated graft-versus -host
transfusion reaction interventions
- !Stop transfusion
- Remove blood tubing
- Notify charge nurse or Rapid response
- Do not flush unless you have no other IV access
- Apply oxygen
- Administer Benadryl
- Proceed appropriately (monitor, administer other medications…)
