anemia Flashcards
4 parts of anemia etiology
- problems with RBC production
- increased RBC destruction
- RBC malfunction
- blood loss
how long is the normal life span of an RBC
120 days
diet requirements for a pt with anemia
iron, vit b12, vit b6, folic acid, copper, protein
explain the roles of the following dietary requirements:
- protein (amino acids)
- vit b12 (cobalamin)
- copper
- folic acid
- iron
- niacin
- vit c
- vit e
protein (amino acids): heme/plasma membrane synthesis + structure
vit b12 (cobalamin): DNA synthesis, RBC maturation
copper: moves iron from tissues –> plasma
folic acid: DNA and RBC synthesis
iron: Hgb synthesis
niacin: RBC maturation
vit c: iron abs, keeps it in ferrous form
vit e: protects RBCs from oxidative damage
2 ways to classify anemia
quantity and quality
3 words to describe RBC size (quality)
microcytic, macrocytic, normocytic
3 words to describe Hgb concentration (quality)
hypochromic, hyperchromic, normochromic
tissue perfusion in a pt with anemia
sluggish cap refill, weak pulse, pale/cool skin
cardiac assessment in a pt with anemia
inc HR (tachycardia), heart murmur
respiratory assessment in a pt with anemia
increased RR
neurological assessment in a pt with anemia
- vit b12 deficiency?
vit b12 deficiency = paresthesia, tingling, glossy tongue (glossitis)
integumentary assessment in a pt with anemia
spooning of nails (iron deficiency), jaundice, petechiae, ecchymosis
GI assessment in a pt with anemia
heme postive stools (bloody)
musculoskeletal assessment in a pt with anemia
joint pain = sickle cell or hemolytic anemia
explain Hgb levels for each level and symptoms a pt could exhibit:
- mild anemia
- moderate anemia
- severe anemia
mild anemia
- Hgb 10-12; asymptomatic OR palpitations with dyspnea with activity
moderate anemia
- Hgb 6-10; roaring in the ear, fatigue, SOB, palpitations at rest or during activity
severe anemia
- Hgb <6; multiple body systems affected: vertigo, dyspnea at rest, tachypnea, jaundice, pruritus, glossitis, smooth tongue
what are foods that can encourage RBC maturation (from adaptive quizzing)
niacin high foods: avocados and red meat
why can a pt with anemia have yellowing of the eyes
if anemia is RBC destruction (lysing)
what do pale stools symbolize
RBC destruction and lack of bilirubin destruction
medications that can increase the risk of anemia
glyburide, methyldopa, ASA, NSAIDs
antibx, sulfanomides, anticoags, immunosuppressants
herbals
explain the normal range levels for these labs:
- RBCs
- Hgb
- HCT
- PLT
- folic acid
RBCs: 35-45
Hgb: 12-17
HCT: 35%-45%
PLT: 150,000 to 450,000
folic acid: 5-25
what is peripheral blood smear morphology and what can it dx?
test looks at the shape of the cell
- can dx sickle cell anemia
what is total iron binding capacity (TIBC) and what can it dx?
test the measures ability of iron to bind with hemoglobin
- can dx iron deficiency anemia
what is ferritin vs serum iron
the iron found in liver vs iron in circulation
what is the shilling’s test and what can it dx?
- explain the procedure
test that measures B12 deficiency
- can dx pernicious anemia
pt ingests radioactive b12 –> looking for non abs b12
intrinsic factors are supposed to bind to b12 for abs
no intrinsic factor –> no abs –> b12 deficiency
24 hr urine collection = measure b12 in urine not being absorbed
iron deficiency anemia
- physiology
- etiology
- risk factors
- dx
- tx
PHYS: iron is needed to form heme (found in hgb and RBCs)
E: dietary/chronic blood loss
RF: dec iron intake, slow/chronic blood los
Dx: microcytic, hypochromic, inc TIBC, dec ferritin
Tx: ferrous sulfate 325 mg PO TID, ferrous gluconate 300 mg PO BID, iron dextran IM, IV iron
s/s of iron deficiency anemia (book)
pallor, glossitis, burning sensation on tongue, chelitis
ferrous sulfate 325 mg PO TID
ferrous gluconate 300 mg PO BID
- take with ____
- avoid ____
- when to take
- SE of iron supplements
take with citrus fruits to inc absorption
avoid milk/dairy
take 1hr before meals
SE: black stools, constipation, heartburn
pernicious anemia
- physiology
- etiology
- dx
-tx
PHYS: need intrinsic factor to abs vit b12
E: lack intrinsic factor = b12 deficiency
Dx: macrocytic, normochromic, postive shillings
Tx: B12 injections, IM or PO if there’s little IF
s/s of pernicious anemia
red, beefy tongue, anorexia, weak, paresthesia, ataxia
folic acid deficiency
- etiology
- dx
- tx
E: dietary deficiency, dec intake/abs, medications (Bactrim, Dilantin, BC)
Dx: macrocytic, normochromic, low folic acid levels
Tx: folic acid 1mg PO/day, green leafy veggies, fruits
chronic disease anemia
- etiology
- dx
- tx
E: underlying disease, chronic inflammation/infection, cancer, CKD
Dx: normocytic, normochromic, dec Hgb, HCT, FE, ferritin
polycythemia vera
- physiology
- dx
- tx
PHYS: erythrocyte excess bc excess bone marrow prod of RBCs, leukocytes, PLTs
–> inc blood viscosity and blood vol
Dx: increased HCT, HTN – dx with bone marrow biopsy
Tx: phlebotomy, myelosuppressive drug, radiation therapy
s/s of polycythemia vera
ruddy complexion, hypervolemia, dizzy, HA, heart failure, peripheral gangrene, stroke from clot
ID the blood disorder: microcytic, hypochromic, inc TIBC, dec ferritin
iron deficiency anemia
ID the blood disorder: macrocytic, normochromic, positive shillings
pernicious anemia
ID the blood disorder: macrocytic, normochromic, low folic acid levels
folic acid deficiency anemia
ID the blood disorder: normocytic, normochromic, dec Hgb, HCT, FE, ferritin
chronic disease anemia
what is Epogen
erythrocyte growth fact; used to stimulate production of RBCs with erythropoietin
whole blood product
- what does it have?
plasma, proteins, clotting factors, everything basically
packed RBCs
blood replacement used during blood transfusions
PLT solutions
yellow solution; for low PLT or for pts needing help with clotting
what blood products to use for pts with severe blood loss?
packed RBCs and PLT solutions
fresh frozen plasma
used to reverse warfarin and help clotting factors
cryoprecipitate
rich in clotting factors
granulocytes
for infections unresponsive to antibx
albumin
protein, for 3rd spacing or burn patients
factor VIII, IX blood products
for hemophiliacs and pts who need these factors specifically
autologous
client donates + banks OWN blood for later
- typically for procedures where lots of blood can be lost
blood salvage
blood drained during surgical procedure thru closed vacuum system is re-infused back into the patient during the procedure
donor
must match ABO/Rh compatibility
at what Hgb level do we usually start doing a blood transfusion
is this different with a pt with CAD and anemia?
is this different with a pt who has sickle cell?
Hgb at 7 = start transfusion
CAD + anemia = start transfusion at hgb 8
sickle cell = start transfusion at hgb <7
explain the steps of doing a blood transfusion
- type and screen
- vitals from pt
- call blood bank
- double verification with nurse: patient matches blood
–> 30min to begin transfusing - have special tubing, prime ONLY SALINE first, then blood
- start rate (no more than 1-2mL/min)
- wait 15min (where most rxns can occur), get another set of vitals
- if not rxn after 15min, raise rate
- at 30min another set of vitals
- 4 hrs to infuse
explain the steps if the pt gets a rxn from a blood transfusion
- stop infusion
- get different tubing and different saline
- flush saline
- call Dr and blood bank
- IDs, monitor, benadryl, Tylenol
- send info to blood bank
- blood gets retesting for correct labeling
acute hemolytic reaction
- what is it
- s/s
immediate transfusion rxn within first 15-30min
s/s: chills, fever, flank/back/abd/chest pain, hypotension, tachycardia, SOB, circulatory collapse
anaphylactic/severe allergic reaction
- what is it
- s/s
sensitivity to donor proteins
s/s: urticaria, dyspnea, wheezing, b.spasms, shock, cardiac arrest
mild allergic reaction
- what is it
- s/s
sensitivity to donor proteins
s/s: flushing, pruritus, itching, hives
transfusion-associated circulatory overload (TACO)
reaction in which pulmonary edema and respiratory distress occur due to volume excess
febrile, non hemolytic reaction
- what is it
- s/s
sensitization to donor’s WBCs, PLTs, plasma proteins
s/s: chills, rigors, fever, HA, vomiting
transfusion related lung injury
- what is it
- s/s
rxn with donor’s anti leukocyte antibodies vs recipient leukocytes
s/s: pulmonary inflammation, capillary leak
massive blood transfusion reaction
happens when 10+ RBC units are given within 24 hrs
