Anemia Handout Flashcards
What are the usual causes of low RBC or HBG
- Blood loss
- Inadequate production
- Increased RBC destruction
Depending on the severity, anemia can affect what
All major organ systems
What is the pathophysiology of anemia
Altered HBG synthesis such as iron deficiency
Altered DNA synthesis such as vitamin B12 or folic acid deficiency
Bone marrow failure such as aplastic anemia ( stem cell dysfunction)
Increased RBC loss or destruction: acute or chronic blood loss: increased hemolysis such as sickle cell anemia, infection.
What are manifestations of anemia
Pallor of skin, mucous membranes, conjunctiva, nail beds
Increased heart and respiratory rates as body compensates
Angina, fatigue, dyspnea on exertion, night cramps
Increased erythropoietin activity may cause bone pain
Cerebral hypoxia, headache, dizziness, dim vision
Heart failure with severe anemia
Signs of circulatory shock with rapid blood loss
Systolic heart murmur with chronic blood loss due to decreased viscosity of blood.
What is the most common type of anemia
Iron deficiency anemia
What is iron deficiency anemia
An inadequate iron supply which in turn, the body cannot synthesize hemoglobin which results in fewer RBCs which are microcytic, hypochromic and malformed ( poikilocytosis).
What is poikilocytosis
Malformed RBCs
What is the cause of iron deficiency anemia
Inadequate dietary intake
Malabsorption
Increased iron needs as with pregnancy and lactation
Chronic bleeding, menstrual blood loss,
Chronic occult blood loss in older adults
Slowly bleeding tumors, GI inflammation, hemmorhoids
Cancer
What are additions manifestations of iron deficiency anemia
Brittle, spoon shaped nails
Cheilosis ( cracks at corner of mouth)
Smooth sore tongue,
Pica
What is pica
Craving unusual substances such as clay, starch.
What is cheilosis
Cracks at corner of mouth
What is sickle cell anemia
A hereditary, chronic hemolytic anemia
Characterized by episodes of suckling in which RBC becomes abnormally cresent shaped.
It has a autosomal genetic defect causing abnormal form of hemoglobin within RBCs.
Sickle cell anemia is more common in which race?
African descent
What is the pathophysiology of sickle cell anemia
HGB becomes deoxygenated under hypoxemia and red blood cells deform into cresent or sickle shaped
The sickled cells clump together and obstruct capillary blood flow leading to ischemia and possible infarction of surrounding tissue. Under normal oxygen tension, sickled RBCs regain normal shape and u sickle. Repeated episodes weakens RBC and they are hemolyzed: RBC has a shortened life span.
What are general manifestations of sickle cell anemia
Pallor Fatigue Jaundice Irritability With vaso-occlusive crisis (4-6 days); painful swelling of hands, feet, large joints, priapism, abdominal pain, stroke.
What is priapism
Persistent, painful erection
What is aplastic anemia
Due to shortened life span of RBC and compromised erythropoesis
What is sequestration crisis
Pooling of large amounts of blood in liver and spleen occurring more in children
What is treatment of sickle cell anemia
Largely supportive: rest, oxygen, pain management, adequate hydration, Treat precipitating factors Folic acid supplementation Blood transfusions Genetic counseling
What is aplastic anemia
BONE MARROW FAILURE, resulting in pantocytopenia ( low levels of RBC, WBC, platelets)
Marrow is replaced by fat
What are causes of aplastic anemia
Causes as idiopathic,
Viral infection, stem cell damage from radiation, exposure to chemicals, certain antibiotics ( chloramphenicol), chemotherapeutic drugs
What are manifestations of aplastic anemia
Fatigue, pallor, headache, exertional dyspnea, tachycardia, heart failure
Bleeding due to low platelet levels
Fever, increased infection risk due to low WBC
What is treatment for aplastic anemia
Removal of causative agent
Blood transfusions
Bone marrow transplant
*Ensure adequate tissue oxygenation
Treatment determined by underlying cause
What are diagnostic tests for aplastic anemia
CBC, blood cell count, hemoglobin, hematocrit, RBC indices.
Iron levels and total iron-binding capacity ( TIBC): deficits occur with iron deficiency anemia
Serum ferritin
Sickle cell test
Hemoglobin electrophoresis
Shilling test
Bone marrow examination quantative assay of G6PD
What is serum ferritin
It is low with depletion of total iron stores
Ferritin is iron storage protein produced by the liver, spleen, and bone marrow.
What is hemoglobin electrophoresis
Separation of normal from abnormal forms of hemoglobin
What is the shilling test
- Measures vitamin B12absorption before and after intrinsic factor administration
- Includes 24 hour urine test
- Used to differentiate between pernicious anemia and intestinal malabsorption
What does a bone marrow examination do
Diagnosis aplastic anemia
What is a quantitative assay of G6PD
Diagnosis of aplastic anemia thru diagnosis of G6PD deficiency
What are meds for aplastic anemia
Iron supplements, oral or parenteral
Vitamin B12 parenterally
Folic acid for pregnant woman, clients with sickle cell disease, folic acid deficiency.
Hydroxyurea: promotes fetal hemoglobin production and reduces crisis for clients with sickle cell disease
Immunosuppressive therapy for clients with aplastic anemia
What are complimentary therapies of aplastic anemia
The use of specific plant enzymes
What is nursing mgmt of aplastic anemia
Prevention by teaching clients good dietary habits
Concurrent use of vitamin C with iron enhances iron absorption
What are nursing diagnosis for anemia
Activity intolerance
Impaired oral mucous membranes
Risk for decreased cardiac output
Self care deficit
What is the definition of anemia
Abnormally low number of circulating Red blood cells, hemoglobin concentration or both.
What are the types of polycythemia
Primary ( polycythemia-Vera-PV
Secondary
Who acquires polycythemia
It is uncommon affecting males of European Jewish ancestry aged 40-70
What is myeloproliferative disorder
It is a type of primary polycythemia
RBC are produced in absence of erythropoietin
What are manifestations of myeloproliferative disorder
Initially a symptomatic
Hypertension in common
Plethora, ruddy coloration of face, hands,feet, mucous membranes; painful pruritis of fingers and toes
Hyper metabolism: thrombosis, hemmorhage
What is secondary polycythemia
Response to elevated erythropoietin levels occurring as compensation to hypoxia ( living in high altitudes, smoking, chronic lung disease)
- RBC COUNT IS NORMAL BUT FLUID LOSS INCREASES THEIR CONCENTRATION
What is treatment for polycythemia
- Treat the underlying cause; smoking cessation
- Periodic phlebotomy, removing 300-500 ml of blood
- Primary polycythemia may be treated with medications hydroxyurea: to suppress bone marrow function
- Antihistsmines for pruritis
- Aspirin to decrease risk of thrombosis
What is thrombocytopenia
Platelet count less than 100,000 {abnormal bleeding}
Platelet count less than 20,000 { spontaneous bleeding and hemmorhage from minor trauma}
Platelet count less than 10,000 { serious or fatal bleeding can occur}
What type of bleeding occurs with thrombocytopenia
Usually bleeding occurs in small vessels resulting in
PETECHIAE- very small red or purple spots on skin
PURPURA- purple bruising
Areas prone to bleeding include mucous membranes of nose, mouth, GI tract, vagina.
What are mechanisms leading to thrombocytopenia
Decreased production
Increased sequestration in spleen
Accelerated destruction
What is primary thrombocytopenia
Immune thrombocytopenia purpura (ITP) or idiopathic thrombocytopenic purpura
It is a autoimmune disorder with accelerated platelet destruction
Who does immune thrombocytopenia purpura typically occur in
Chronic form affects adults aged 20-40 mostly females
Acute form lasts 1-2 months
What is the pathophysiology of immune thrombocytopenia purpura
Platelets stimulate antibody production igG
Functions normally but destroyed by spleen after 1-3 days of circulation
What are manifestations of immune thrombocytopenia
Petechaie and purpura on chest, arms, neck, oral mucous membranes, epistaxis,excessive menstrual bleeding, bleeding gums, hematuria
What is thrombotic thrombocytopenia purpura ( TTP)
- Rate disorder in which thrombi occlude arterioles and capillaries of microcirculation and the client develops hemolytic anemia.
What are manifestations of thrombic thrombocytopenia purpura (TTP)
Purpura
PETECHIAE
Neurological symptoms
- can be fatal without treatment
What are diagnostic tests for primary thrombocytopenias
CBC
PLATELET COUNT: decreased
Antinuclear antibodies (ANA): assess antibodies
Serologic studies for hepatitis viruses, cytomegalovirus, Epstein- Barr virus, toxoplasma, HIV
bone marrow examination
What are medications for thrombocytopenia
Immunosuppressive meds including glucocorticoids, azathioprine, cyclophosphamide, cyclosporine
What are treatments for thrombocytopenia
Platelet transfusions for acute bleeding { expected increase is 10,000 ml per unit transfused
Plasmapheresis for acute TTP
What surgery is may be needed for thrombocytopenia
Splenectomy is the treatment of choice for ITP, which relapsed after glucocorticoids were stopped
What is the function of erythrocytes
Transport oxygen and some carbon dioxide
What is the function of leukocytes
Part of the body’s defense against disease
What is the role of neutrophils
Phagocytosis
What is the role of eosinophils
Counteracts histamine in allergic reactions
Destroys parasitic worms
What is the role of basophils
Release histamine and the anticoagulant heparin; called mast cells in the tissues
What are lymphocytes
Produce antibodies: functions in immunity
What is the role of monocytes
Phagocytosis: engulf relatively large particles called macrophages in the tissues
What is the role of thrombocytes
Helps control blood loss by forming a platelet plug and releasing factors necessary for blood clotting.
Hydroxyurea
Prevents RBC from sickling
Sequestration crisis
Pooling of large amounts of blood in liver and spleen, most commonly seen in children
What is aplastic anemia
Bone marrow failure resulting in pantocytopenia
The marrow is replaced by fat
What is serum ferritin
Iron storage protein produced by the liver, spleen, bone marrow
What type of therapy is recommended for aplastic anemia
Immunosuppressive therapy
What is polycythemia
Excess of RBC with HCT above 55%
