Anemia Flashcards
What is anemia?
It is a reduction in the:
- the number of RBCs
- the amount HgB
- the amount of Hct
It is a clinical condition not a disease
What are the causes of anemia?
Dietary conditions Genetic disorders Bone marrow disease Excessive bleeding GI bleed - most common cause Decreased RBC production Increased RBC destruction Chronic RBC loss
What will you find on assessment with anemia?
Clinical manifestations are associated with Impaired Tissue Perfusion and Impaired Gas Exchange
- Fatigue – most common symptom
- Skin – pallor, cyanosis, signs of bleeding.
- Head and Neck – pallor, ulceration, or fissure
- Respiratory – tachypnea, SOB at rest or with exertion
- Cardiovascular – weak pulses, hypotension, tachycardia, palpitations
- Renal/Urinary – hematuria, proteinuria
- CNS – lethargy, forgetfulness
What are some lab values that relate to anemia?
Hgb ↓, Hct ↓ , RBCs ↓
Hemoglobin S (HbS) 80-100% (Sickle Cell Disease)
Serum Ferritin <10 ng/mL (Iron deficiency anemia)
presence of microcytic RBC (Iron deficiency anemia)
presence of macrocytic RBC (Folic Acid and Vit. B12 deficiency anemia), presence of sickling cells (Sickle Cell Disease)
reticulocyte count ↑, Total-Iron Binding Capacity (TIBC) ↑
What are some other diagnostic tests for anemia?
Bone marrow aspiration - positive for anemia
Blood loss - chronic or acute
Medical history of chronic kidney, cardiac, respiratory disorders
Physical symptoms increase as a compensatory mechanism. Cardiac output increases when Hgb drops below 7g/dl.
Imaging: Radioisotopic imaging, Xrays, CT, MRI
What are some risk factors for anemia?
Diet high in fats and carbohydrates but lacking in iron, protein, or vitamins or vegan diet.
Poor nutrition or malabsorption
Family history of blood disorder or genetic disease such as sickle cell.
Medication history of anemia-producing drugs – refer to Table 39-3 on p. 801 (FYI only)
GI surgery or GI disorders
What are some nursing diagnoses related to anemia?
Ineffective tissue perfusion Impaired gas exchange Activity intolerance Anxiety Impaired Immunity
What are some types of anemias?
Sickle cell disease (formerly called Sickle cell anemia)
Iron deficiency anemia
Vitamin B 12 deficiency
Folic acid deficiency
There are others -don’t need to know for now: Aplastic anemia, Glucose-6-phosphate Dehydrogenase Deficiency anemia(G6PD), Immune hemolytic anemia
What is sickle cell disease?
A genetic disorder that results in abnormal formation of hemoglobin chains (HbS).
In decreased oxygen states, the RBCs with large amount of HbS become sickle shaped rigid and clump together causing blockage or stoppage of the blood flow (vaso-occlusive event).
Vaso-occlusive event (VOE) leads to cycle of more sickling cell due to hypoxia blood vessel obstruction, inadequate tissue perfusion, ischemia tissue/organ damage (mostly affects the spleen, liver, heart, kidney, brain, joints, bones, retina).
Sickle cells go back to normal once the precipitating factor has been removed but “revived” cells are more fragile and break easily anemia.
What is the prevalence and complications of SCD?
Prevalence
Approximately 90,000-100,000 people in the US have SCD.
Most common in African Americans (1 in 500 have SCD and 8% to 10% are carriers), but can include people from Middle east, the Mediterranean, and aboriginal tribes India.
Complication
Acute chest syndrome – VOE causes infiltration and damage to the pulmonary system – leading cause of death in SCD
What is a sickle cell crisis?
Periodic episodes of extensive cellular sickling.
Has a sudden onset and occurrence vary from weekly to once a year.
Crisis occur in response to conditions such as hypoxemia, strenuous exercise, dehydration, venous stasis, acidosis, anesthesia, low body temperature.
What are the clinical manifestations of SCD?
Pain – most common during a crisis Refer to Physical Assessment/Signs and Symptoms - Cardiovascular changes - Respiratory changes - Skin changes - Abdominal changes - Renal changes - Musculoskeletal changes - CNS changes
How is SCD diagnosed?
Lab results
Higher percentage of hemoglobin S (80%- 100%), percent of cells with permanent sickling (5% - 90%)
Hematocrit may be low (between 20% and 30%), reticulocyte count ↑, white blood cells ↑, Total bilirubin ↑
Other findings
Changes in bone tissues on x-ray ( such as joint necrosis or destruction ), ECG changes, CT or MRI changes in soft tissues from poor oxygenation and chronic inflammation.
How is SCD managed?
Collaboratively:
Pain management
- History – past pain history, previous drug use, disease complication
- Pain Assessment
- Drug therapy
- –> Opioid analgesia
- IV opioid for at least 48 hours – given on a routine schedule or PCA (patient controlled analgesia)
- Oral opioid – once relief obtained
- Avoid “as needed” schedule – not as effective
- –> Hydroxyurea – stimulates fetal HgB production to reduce sickling cells and pain – can increase risk for leukemia, bone marrow suppression – monitor CBC and drug toxicity
What are the complications of SCD and how are these complications prevented?
- Prevention and Early Detection Strategies
Thorough and frequent handwashing
Monitoring for infection
Strict aseptic techniques for invasive procedures
Appropriate precautions - Drug therapy
Prophylactic antibiotic
Immunization - Preventing vaso-occlusive event (VOE) and promoting perfusion
Hydration – oral or IV
Oxygenation – O2 therapy, monitor saturation
Transfusion – to dilute HbS levels
Assess for adequate perfusion to all body areas
