Anemia

Question 1

Anemia

Answer 1

• Reduction in either the # of RBCs, amnt of hgb or hematocrit
• It is a clinical indicator, not a specific disease bc it occurs w/ many hlth problems
• Can result from:
  > dietary problems
  > genetic disorders
  > bone marrow disease
  > excessive bleeding
• Most common reason for anemia in adults:
  > GI bleeding

Question 2

Types/Causes of Anemias

Answer 2

• Deficiency in one of the components needed to make a fully functional RBC
  > EX: iron deficiency, folic acid deficiency, vit b12 deficiency
• Dcrd in RBC production
  > EX: aplastic anemia
• Incrd in RBC destruction
  > EX: hemolytic anemia
• RBC loss
  > EX: GI bleed

Question 3

Anemia Key Features

integ
cardio
resp
neuro

Answer 3

• Integumentary
  > pallor
  > cool to touch
  > intolerance to cold temps
  > nails become brittle & concave over time
• Cardiovascular
  > tachycardia
  > murmurs & gallops when anemia is severe
  > orthostatic hypoten
• Respiratory
  > dyspnea on exertion
  > dcrd oxygen sat lvls
• Neurologic
  > fatigue & somnolence
  > headache

Question 4

Iron Deficiency Anemia

causes
CMs

Answer 4

• Causes:
  > blood loss
  > poor GI absorption of iron
  > inadequate iron in diet
• CMs:
  > weakness & pallor
  > fatigue
  > reduced exercise tolerance
  > fissures at the corner of mouth
• A microcyctic anemia (RBC will be small)
• W/ chronic anemia S/S may be more mild

Question 5

Iron Deificiency Anemia - Labs

Answer 5

• Hgb/Hct & RBC dcrd
• Ferritin dcrd less than 10mg/mL (12-300 normal)
• MVC (mean corpuscular vol), MCH (mean corpuscular hgb), & MCHC (mean corpuscular hgb concentration) dcrd

Question 6

Iron Deficiency Anemia - Interventions

Answer 6

• Incr oral intake of iron from food sources
  > 10-15g iron/day
  > red meat, organ meat, egg yolks, kidney beans, leafy greens, raisins
  > 5-10% of dietary iron is absorbed
• Oral iron supplements (Ferrous Sulfate)
  > take btwn meals for better absorp & reduce GI distress
  > take w/ vit C for better absorp
  > expect 2 gm/dL incr in 4wks
• With severe deficiency give IV or IM iron solutions
  > EX: iron dextran (Dexferrum) or Ferumoxytol (Feraheme)

Question 7

Vitamine B12 Deficiency

causes
CMs

Answer 7

• Causes:
  > vegan diet or diets lacking diary products
  > GI disorders: sm bowel resection, chronic diarrhea, diverticuli, tapeworm, overgrowth of intestinal bacteria
  > anemia resulting from failure to absorb vit B12 (pernicious anemia) secondary to gastritis
• CMs:
  > pallor
  > jaundice
  > glossitis (a smooth, beefy-red tongue)
  > fatigue
  > weight loss
  > paresthesias in feet & hands
  > poor balance
• Macrocytic anemia (large RBC)
  > dcrd hgb/hct & RBC
  > incrd MCV, MCH, & MCHC

Question 8

Vitamin B12 Deficiency Interventions

Answer 8

• Incr dietary intake of foods rich in vit B12
  > if it r/t an inadequate intake
  > EX: animal proteins, fish, eggs, nutes, dairy products, dried beans, citrus fruit, leafu greens
• Vitamin supplements if anemia is severe
• For pernicious anemia:
  > admin B12 injections weekly initially, & then mnthly for rest of lives
  > B12 nasal sprays or sublingual forms may be used to maintain vit lvls after pt’s deficiency has first been corrected

Question 9

Folic Acid Deficiency

causes
CMs
treatment

Answer 9

• Causes:
  > poor nutrition (chronic alcohol abuse)
  > malabsorption
  > drugs (anticonvulsants, oral contraceptives)
• CMs:
  > similar to vit B12
  > but nervous syst funcs remain normal
• Treatment:
  > diet rich in foods containing folic acid & vit B12: leafy greens, citrus fruits, beans, breads, cereal, rice, pasta
  > folic acid replacement

Question 10

Aplastic Anemia

Answer 10

• Deficiency of circulating RBCs bc of failure of bone marrow to produce these cells
• Causes:
  > long-term exposure to toxic agents
  > drugs
  > ionizing radiation
  > viral infection
  > unknown
• Pts will have manis of severe anemia

Question 11

Aplastic Anemia Interventions

Answer 11

• Treatment:
  > assess for bone marrow failure; weakness, pallor, petechiae, ecchymosis, poor oxygen
  > close monitoring of CBC
  > infection prevention
  > bleeding precautions
  > blood transfusions; due to low platelet count
• Hematopoietic stem cell transplantation w/ donor cells
  > best treatment
• Immunosuppressive therapy meds
• Splenectomy
  > if spleen is enlarged either destroyinf normal RBCs or suppressing their development

Question 12

Hemolytic Anemia

causes
interventions

Answer 12

• Results from an autoimmune process tht causes excessive destruction of RBCs
• Causes:
  > autoimmune
  > trauma
  > viral infection
  > exposure to a chemical or drug
• Interventions:
  > immunosuppressive therapy
  > plasma exchange
  > splenectomy