Anemia Flashcards
Anemia
Condition in which red blood cells have a reduced capacity to deliver oxygen to tissues
Anemia consider a sign of an
underlying disorder
Goal: identify underlying cause and treat
Anemia causes
Blood loose due to hemorrhage
Increase erythrocyte destruction
Decreased erythrocyte production
Anemia S/S
pallor, decrease exercise tolerance, fatigue, lethargy; dizziness or fainting; severe – heart failure
Anemia Classified by
erythrocytes size and color
sizes example
normal (normocytic), small (microcytic), or large (macrocytic).
Color example
Color – normal red (normochromic) or light red (hypochromic).
Macrocytic–normochromic
Description and example
Large, abnormally shaped erythrocytes with normal hemoglobin concentration
Goal for anemia is
identify the underlying cause to treat
Microcytic–hypochromic
example and descrption
Small, abnormally shaped erythrocytes with decreased hemoglobin concentration
Iron-deficiency anemia, thalassemia
Normocytic–normochromic example and description
Destruction or depletion of normal erythroblasts or mature erythrocytes
Aplastic anemia, hemorrhagic anemia, sickle-cell anemia,
Iron Deficiency Anemia
Cells are microcytic and hypochromic.
Iron Deficiency Anemia caused
Inadequate iron absorption or consumption decreases erythropoiesis, which causes anemia.
Conditions associated with iron-deficiency anemia include
Gastrointestinal (GI) bleeding (found in more than 50% of clients with this anemia) Chronic peptic ulcer disease (PUD) GI malignancies Pregnancy Blood loss during menses
Test to determine time of anemia
peripheral smear
Treatmetn of anemia varies according to
severity
Mild anemia treatment
increased dietary intake of iron-rich foods such as fish, red meat, fortified cereal, and whole-grain bread
Moderat anemia treatment
oral iron supplementation
severe anemia treatment
iron supplementation; IV or IM iron therapy may be given if the client cannot tolerate oral supplements
Most common cause of iorn deficience anemia
GI bleeding
Iron preperations build
serum iron and iron storage in the body
Iron preparations pharmacokinetics
Enhanced absorption if iron stores low
Ferrous form absorbed more readily
Food affects absorption
Eliminated via shedding of gastrointestinal (GI) mucosal cells or via bleeding
Iron preperations precautions and contraindications
Hemochromatosis and hemolytic anemia
Iron preparations ADR
GI symptoms (constipation, GI upset) Acute toxicity possible, especially in children
Iron preparations drug interacions
Chelation
Decreased absorption
Iron prepartions clinical use and dosing
Iron-deficiency anemia
Treatment for 3 to 4 months after Hgb/Hct return to normal
Adults: 150 to 300 mg elemental iron daily
Premature infants: 2 to 4 mg/kg/day
Infants and young children: 4 to 6 mg/kg/day
Iron preparations monitoring
Monitoring
Reticulocyte count 5 to 10 days after starting therapy
Hgb, hct, ferritin at 4 weeks, then 3 months, then annual
If Hgb, Hct, and ferritin do not return to normal levels, the patient should be evaluated for a source of blood loss in other pathology.
Iron preparations take with what to enhance absorption
Take with vitamin c to enhance absorption
Pernicious Anemia
Vitamin B12 deficiency the result of Large, immature RBCs
Pernicious anemia S/S
pallor, fatigue, lethargy, dizziness & faintness
Vitamin B12 cannot
Cannot be synthesized from the body, only bacteria in the gut can
Must interact with the intrinsic factor
Deficiency in B12 can be
caused by inflammatory diseases of the small intestine, or by gastric resection
Vitamin B12 supplement route
Vitamin B12 supplement - parental, oral. Intranasal not generally used.
Vitamin B12 ADR
: uncommon but can include hypokalemia, rashes, itching & sodium retention
The most common cause of vitamin B12deficiency is absence of
intrinsic factor, a protein secreted by stomach cells. Intrinsic factor is required for vitamin B12to be absorbed from the intestine.The hematopoietic stem cells produce abnormally large erythrocytes that do not fully mature.
The symptoms of pernicious anemia are often
nonspecific and develop slowly, sometimes over decades. Nervous system symptoms may include memory loss, confusion, unsteadiness, tingling or numbness in the limbs, delusions, mood disturbances, and even hallucinations in severe deficiencies.
Vitamin B12 deficiency etiology
Poor intake (vegans, vegetarians) Impaired absorption caused by lack of intrinsic factor, diseases of the ilium, stasis (constipation) Gastrectomy, bariatric surgery
B12 pharmacokinetics
IM, SC, or intranasal well absorbed
Stored in liver and excreted in urine
B12 dose prevention
Pregnancy: 2.2 mcg/day, lactation 2.6 mcg/day
Infants: 0.3 to 0.5 mcg/day
Children age 1 to 10 years: 0.7 to 1.4 mcg/day
B12 dose deficiency
1,000 mcg oral cobalamin daily for 6 to 12 weeks
pernicious anemia B12 initial dose
Initial dose 1,000 mcg/day IM or SC for 7 days, then 100 to 1,000 mcg IM per week for a month
pernicious anemia B12 maintenance dose
1,000 mcg IM monthly
500 mcg intranasal cyanocobalamin weekly
1,000 mcg orally daily
pernicious anemia B12 monitoring
Reticulocyte counts, Hgb and Hct, iron, folic acid, and vitamin B12 serum levels prior to treatment, at 5 to 7 days of therapy, then frequently until Hgb and Hct are normal
Monitor potassium levels
Liver function tests every 2 to 4 weeks to monitor for hepatotoxicity
