Anemia part 1 Flashcards
What is the definition of Anemia?
It means a reduction of RBCs or hemoglobin.
What are the 3 main causes of anemia?
Not enough RBCs being made
Too many RBCs are being destroyed
A lot of RBC’s are being loses (from bleeding)
How are symptoms of anemia organized?
Certain groups of symptoms go with whichever reason is the main cause of anemia.
Not enough RBCs being made Symptoms
Pallor due to no coloring from rbc
Tachycardia for compensation
Fatigue bc of no 02
Muscle Weakness bc of no 02
Systolic murmur due to compensation
Too many RBCs being destroyed Symptoms
Jaundice/sclera from breakdown of rbc Tachycardia Dark urine from bilirubin excretion Splenomegaly Hepatomegaly Low blood pressure from shock Frontal bossing (large forehead) from more bone activity
Losing RBCs from bleeding Symptoms
Pallor
Tachycardia
Fatigue
Muscle Weakness
Cool skin due to no circulation
Decreased peripheral pulses bc of a lack of volume
(basically the same as not making enough rbcs)
What is iron deficiency anemia?
How prevalent is this?
When you don’t have enough iron to produce hemoglobin for oxygen transference to the parts of your body
Most prevalent nutritional disorder in the US
What age do iron stores from mom deplete in infants? What are the implications?
5-6 months
At this monthly age, we will start to supplement or this is around the time parents introduce solid foods to babies.
T/F
Term babies have less iron stores than preterm ones
What are the implications?
False!
The preterm infants are the ones who will have even less iron stores to last them.
They’ll need iron supplementation way before the term baby since they most likely can’t eat solid foods yet .
Good examples of food with iron to give infants?
Riced cereal
Vegetables with leafy greens
- Helps if they eat it with something acidic due to vit C
Symptoms of iron deficiency anemia
Similar to when not enough RBC’s are being made Symptoms
Pallor Underweight Overweight (if only feeding them milk is the reason they aren't getting iron) Edema Delayed growth
When diagnosing iron deficiency anemia, what will rbc count look like?
Either normal or just moderately reduced.
But the size, shape, and color of rbcs is what is important.
What tests can they do to check for iron deficiency anemia?
Increased TIBC or total blood iron capacity.
And decreased SIC or serum iron concentration (highest in morning)
Retc ct normal but Si is reduced
What age do infants get routinely diagnosed for iron deficiency anemia?
What time of day should they do the tests?
6 months - 1 years old
In the morning
How do they focus on managing the iron deficiency anemia?
Will focus on prevention and nutrition by giving infant food with iron fortification as early on as possible.
Can give iron supplement of ferrous sulfate too
How do you avoid an overweight iron deficient anemic, milk baby?
Educate mom to pull back on breast feeding around 5-6 months and give solid foods
How do you know an iron supplement is working when treating iron deficiency anemia?
The poop will darken & this is good!
How to give an infant an iron supplement?
Child?
What if the iron deficiency is severe?
Orally by using a syringe to place in buccal area for absorption
Child can drink liquid iron with orange juice
If severe, they can give IV
- check for infiltration and necrosis of the site
What do we need to educate parents about iron supplementation?
Retic ct increase?
Hemoglobin?
There could be iron staining, Gi irritation, constipation
Retic increase after 1 week
hgb/hct after 1 month needs to be increased
How much milk should an infant have after 1 yr to prevent iron deficiency?
Is an overweight baby healthy?
24 oz
Nope not always. Could just be a milk baby
What is sickle cell anemia?
Adult hemoglobin changing shape to abnormal hemoglobin and causing a clump effect since the cell can’t move around as efficiently.
Can you tell if an infant has sickle cell anemia?
No due to the infant hemoglobin having the same Beta chain
IDK IF THIS IS TRUE
What triggers the sickle cell anemia change?
Dehydration - mucous membranes, skin dryness & replace fluids
Acidosis - check blood gases
Hypoxia - perfusion & o2. Do they need an order for oxygen?
Temperature elevation - temp
Need to treat the cause first so you can reverse it.
Can the shape change of the cell in sickle cell anemia be reversed?
Yes - but remember you have to have the gene in the first place. We just have to change the precipitant factor.
Which ethnicities does sickle cell anemia occur in the most
African American African Hispanic Italian Greeks Iranians Turks
But the mixing of ethnicities is increasing and therefore we can’t be surprised if someone who doesn’t appear to look like any of these has it.
Since the sickle cell shape doesn’t flow very well in the vessels, what can happen to the tissues
Bc of the clogging, Target tissues can experience hypoxia, ischemia, infarction.
Can be painful even
What happens to the spleen in sickle cell anemia?
What can this cause?
What other organ can this happen to?
Spleen becomes enlarged due to the shape of hemoglobin. Almost like they sequester or get trapped in the spleen.
This can cause scarring of the spleen which effects how well it functioning such as immunity (even by the age of 5).
Same thing can happen to the liver and cause liver in sickle cell anemia.
Why would you give a 5 year old a vaccine early if they have sick cell anemia?
Due to shape of hemoglobin, the cells clump in the spleen. And this can effect the child’s immunity so we go ahead and give them vaccines
- pneumococcal vaccine
- meningococcal vaccine
&& do so every-time you see them
A 1 year old sickle cell patient has a stroke. How can you explain this?
The 1 year olds cells are sickle cell shaped. This leads to occlusion issues to organs including the brain. This causes the stroke.
How can sickle cell affect the kidneys?
A failure to concentrate the urine can occur due to them not getting enough o2
Enuresis or night peeing in kids
How can sickle cell affect the Bones?
Hyperplasia and congestion happen which means spinal deformities
How can sickle cell affect the cardiac system?
There can be cardiomegaly from chronic sickle cell anemia
How can sickle cell affect the gallbladder?
Hyper-pigmented stones
Also due to sickle cell
legs?
growth?
fertility?
maturaion?
leg ulcers
delayed growth
decreased fertility
slow maturation
Vasoocclusive Crisis from sickle cell
Symptoms and signs?
Ischemia due to abnormal hemoglobin shape that causes mild to severe pain.
Abdominal pain Priapism or prolonged erection Arthralgia or joint pain Low grade fever Dactylitis or inflammation of phalanges
Which organs does sequestration crisis occur in?
Is this chronic or acute?
What is the main concern here? What things should you be checking?
Can occur in spleen or liver.
Can be both acute or chronic in cases.
Shock! Due to blood flow not happening since the rbcs are trapped.
- check vitals, cap refill, i & o etc and do so early!!!! If you don’t catch it, then it can affect the child for life.
What treatment is given to kids who have had more than one stroke in sickle cell anemia?
Is it done on everyone? How long will they need this done?
How is this done?
What do we watch for?
Exchange transfusions which work by swapping out bad sickle cells with normal hemoglobin cells that can’t change shape
- not done on everyone bc it has risks
- will be a lifelong treatment
Central line portacalf has access to vena wall under skin which reduces infection
Watch for hemosiderosis or iron overload
- can do chelation product to bind with iron and excrete it
How does sickle cell anemia cause chest syndrome?
Symptoms?
How to manage this? Treatment?
Due to the sickled cells, the chest alveoli do not get perfused which causes hypoxia
Chest pain, wheezing, cough, tachypnea
It’s really just important to stay on top of the respiratory assessments and catch it early. If hypoxic, give O2.
Main infections that occur in sickle cell anemia in children?
Why?
Prevention & treatment?
Strep & H. Flu
Due to spleen issues and immunity
Prophylactic Antibiotics at 2 months of age
How is sickle cell diagnosed?
Screening at birth
Sickledex test done later
Electrophoresis to look at the actual cells (final diagnosis)
How to treat Priapism ? What causes it?
Sickle cell anemia shape occlusion
Priapism - neosynephrine, phenylephrine
If giving PCA narcotics for sickle cell anemia, what do we need to remember?
Starting bolus to get them to therapeutic levels
How can administration of Hydroxyurea help with sickle cell anemia?
Can stimulate body to make fetal hemoglobin which eventually matures into adult hemoglobin & developing correctly this time
Why is it so important to do regular assessments with those with sickle cell anemia?
BC their status can change at any given time really
Again, when do you use Oxygen for treating sickle cell anemia?
Only give them oxygen if there’s actually hypoxia going on!!
How can you minimize deoxygenation in those with sickle cell?
Let them rest
Avoid low o2 environments
Avoid infections as well bc that requires more o2
Why are IV calculations so important with sickle cell anemia?
Need to be paying attention to whether the fluids input and output indicate dehydration signs
Family teaching for sickle cell anemia?
Compliance with prophylaxis treatment
Help them know the s&s of spleen issues and infections
Vaccines!!!
What is Beta-Thalassemia?
Why is this a problem?
anemia due to Beta-Thalassemia - is when there is an alteration in the beta globin chains to where there’s a lot of immature beta cells (usually) compared to mature alpha cells which changes the oxygen carrying ability of cells due to instability
Our cells need the equal alpha and beta to function
Which leads to us losing rbcs quicker than we can produce them & therefore anemai
Populations who experience Beta-Thalassemia?
How does someone get Beta-Thalassemia?
India Asia Africa Mediterranean Middle east
It is autosomal recessive genetic
Beta-Thalassemia effects?
Enlarged spleen Growth retardation Hyperuricemia/gout Frontal Bossing of the forehead and eyes Hemosiderosis (iron) anorexia bone pain activity intolerance too
Beta-Thalassemia diagnosis
Treatment
If there’s hemosiderosis, how will you treat it? Why is there hemosiderosis?
Electrophoresis or look at rbc
Transfusions to keep hgb level greater than 9.5
Treat hemosiderosis w chelation. Hemosidereosis due to rbc destruction
Beta-Thalassemia
What if the spleen is damaged?
What else does an enlarged spleen affect?
Sleepnomegaly done
- be aware of infection possibility afterwards
They can have breathing problems too. So taking it out kills two birds w one stone
What exactly is hemosiderosis again?
What can cause it?
treatment?
Excess iron storage in tissues
- spleen
- liver
- lymph
- heart
- pancreas
Could be from frequent transfusions
Chelation
How is chelation done
How do you know it is working?
How is the nurse involved?
Given IV usually with Deferasirrox or Deferiprone
chronic is 5/7 days/weeks
will do it at night for 8-12 hours
The urine will be turned orange.
Nurse will probably come get it started , stay the night for first times
What is Aplastic Anemia?
Suppression of bone marrow production making cbc relatively low
- rbc, wbc, platelet low
What causes Aplastic Anemia?
Aplastic Anemia is caused by infection, drugs from chemo, or idiopathic onset
How is Aplastic Anemia diagnosed?
Aplastic Anemia is diagnosed with a bone marrow aspirate
How is Aplastic Anemia treated first?
What can be donated?
First thing is to treat by fixing the cause of the suppression (infection, drugs, idiopathic) if possible
Bone marrow can be donated
- want to do this before doing transfusions
- sibling donor is more successful
Immunosuppressive therapy
Blood transfusions for hemoglobin
Types of immunosuppressive therapy that can be done for Aplastic anemia?
ATG, ALG, CSA - all suppress t cells
- ATG/CSA combo is common due to it sparing bone marrow function
Is doing frequent transfusions for aplastic anemia risky?
What else can this affect?
Yes bc it exposed you to antibodies. A rejection of blood can happen too. We’d like to reduce transfusions if possible so we will keep someone at maintenance level of hemoglobin.
It can affect the bone marrow transplant too
