Anemia Flashcards
Anemia is a deficiency in…
- Number of RBCs
- Quantity/quality of hemoglobin
- Volume of packed RBCs
What is hematocrit?
Volume of packed RBCs.
Causes of anemia…
- Decreased RBC production
- Blood loss
- Increased RBC destruction
Causes for decreased RBC production
- Deficient nutrients (iron, folic acid, cobalamin)
- Decreased erythropoietin
- Decreased iron availability
Causes for blood loss
-Chronic hemorrhage like bleeding duodenal ulcer, colorectal cancer, liver disease, acute trauma, ruptured aortic aneurysm, GI Bleeding
Increased RBC destruction
-Hemolysis like sickle cell disease, medication, incompatible blood, trauma
Clinical manifestations of anemia
-Caused by the body’s response to tissue hypoxia
Hemoglobin levels are used to determine
-The severity of anemia
-Mild: Hb: 10-12 g/dL
-Moderate: Hb: 6-10 g/dL
Severe: Hb: <6 g/dL
Mild Anemia
- Hb 10-12 g/dL
- May exist w/o causing symptoms
- If symptoms develop it is bc pt has underlying condition or experiencing compensation
- Symptoms include palpitations, dyspnea, mild fatigue
Moderate Anemia
- Hb 6-10 g/dL
- Cardiopulmonary symptoms increased
- Pt may experience them while resting as well as w/ activity
Severe Anemia
- Hb < 6 g/dL
- Pt has many clinical manifestations involving multiple body systems
Integumentary manifestations of anemia
- Pallor (Hbg & blood flow to skin decreased)
- Jaundice (increased concentration of bilirubin)
- Pruritus (increased serum & skin bile salt concentrations)
Cardiopulmonary manifestations of severe anemia
- Result from additional attempts by heart & lungs to provide adequate O2 to tissues
- Cardiac output maintained by increasing HR & stroke volume
Subjective data, nursing assessment anemia
- Past health history
- Medications
- Surgery or other treatments
- Dietary Health
- Functional health patterns (family, nutritional, elimination, activity, cognitive, sexuality)
Objective data, nursing assessment anemia
- General
- Integumentary
- Respiratory
- Cardiovascular
- Gastrointestinal
- Neurologic
- Diagnostic findings
Anemia nursing diagnoses
- Fatigue
- Imbalanced nutrition: less tahn body requirements
- Ineffective self-health management
Anemia gerontologic considerations
- Common in older adults (chronic disease, nutritional deficiencies)
- S/Sx may go unrecognized or may be mistaken for normal aging changes
Iron-deficiency anemia
- 1 of the most common chronic hematologic disorders
- Fe is present in all RBCs as heme in hemoglobin & in stored form
- Heme accounts for 2/3 of body’s iron
Etiology of iron-deficiency anemia
- Inadequate dietary intake (5-10% of ingested iron is absorbed)
- Malabsorption
- Blood loss
- Hemolysis
- Pregnancy
Iron absorption occurs where?
Duodenum (diseases or surgery that alter, destroy, or remove absorption surface area of intestine alter absorption)
Clinical manifestations of iron-deficiency anemia
- General manifestations of anemia
- Pallor (most common finding)
- Glossitis (second most common finding)
- Cheilitis
Cheilitis
Inflammation of the lips
Glossitis
Inflammation of the tongue
Iron-deficiency anemia diagnostic studies
- Lab findings
- Stool guaiac test
- Endoscopy
- Colonoscopy
- Bone marrow biopsy
Collaborative care iron-deficiency anemia
- Goal is to treat underlying disease
- Efforts aimed at replacing iron
Efforts aimed at replacing iron
- Nutritional therapy
- Oral or occasional parenteral iron supplements
- Transfusion of packed RBCs
Drug therapy for iron-deficiency anemia
- Oral iron (inexpensive, convenient)
- Parenteral iron
Oral iron
- Daily dose is 150-200mg
- Enteric-coated or sustained-released capsules are counterproductive
- Best absorbed as ferrous sulfate in acidic environment
- Liquid iron should be diluted & ingested via straw
- S/E: heartburn, constipation, diarrhea
Parenteral Iron
- Indicated for oral iron intolerance, malapsorption, need for iron beyond normal limits, poor patient compliance
- Can be given IM or IV (IM may stain skin)
At risk groups for iron-deficiency anemia
- Premenopausal women
- Pregnant women
- Persons from low socioeconomic backgrounds
- Older adults
- Individuals experiencing blood loss
Management of iron-deficiency anemia
- Diet teaching
- Supplemental iron
- Discuss diagnostic studies
- Emphasize compliance
- Continue therapy 2-3 months after hbg return to normal
Megaloblastic anemias
Group of disorders caused by impaired DNA synthesis & characterized by presence of large RBCs (megaloblasts)
Megaloblastic anemias result primarily from deficiencies in
- Cobalamin
- Folic Acid
Cobalamin deficiency
-Intrinsic factor is required for absorption in distal ileum (IF: protein secreted by parietal cells of gastric mucosa)
Pernicious anemia
- Caused by absence of IF
- Insidious onset
- Begins in middle age or later
- Predominant in Scandinavians & African Americans
Cobalamin deficiency etiology
- Caused most commonly by pernicious anemia
- GI surgery
- Chronic diseases of GI tract
- Chronic alcoholics
- Long-term uses of H2-Histamin receptor blockers & proton pump inhibitors
- Strict vegetarians
Clinical manifestations of cobalamin deficiency
- GI (sore tongue, anorexia, N/V, abdominal pain)
- Neuromuscular (weakness, paresthesia of feet & hands, decreased vibratory & position senses, ataxia, muscle weakness, impaired thought process)
Cobalamin deficiency diagnostic studies
- Macrocytic RBCs have abnormal shapes & fragile cell membranes
- serum level decreased
- Upper GI endoscopy w/ biopsy of gastric mucosa
- Normal serum folate levels & low cobalamin levels suggest megaloblastic anemia
Treatment for cobalamin deficiency
-Parenteral or intranasal administration of cobalamin is treatment of choice (pt will die in 1-3 years w/o treatment)
Folic Acid Deficiency
- Cause of megaloblastic anemia
- Folic acid is required for DNA synthesis
- Clinical manifestations similar to cobalamin deficiency but absence of neuro problems!
Common causes of folic acid deficiency
- Dietary
- Malabsorption syndromes
- Increased requirement
- Alcohol abuse & anorexia
- Loss during hemodialysis
Diagnosis and treatment of folic acid deficiency
- Serum folate level is low
- Serum cobalamin level is normal
- Treated by replacement therapy (1mg PO daily)
- Encourage pt to eat foods w/ large amounts of folic acid
Management of megaloblastic anemia
- Early detection & treatment
- Ensure safety
- Focus on compliance w/ treatment
- Regular screening for gastric cancer
