Anemias Flashcards
1
Q
Anemia
A
- a condition in which blood has decreased RBCs or decreased Hgb
- Aplastic, pernicious, anemia of chronic disease, thalassemias
2
Q
Review Page 906 Blood Cells
Red Blood Cells
A
Red Blood Cells
- Iron Stores and Metabolism
- Vitamin B12 and Folate Metabolsim
Words to know
- Erythrocyte (RBC)
- Erythropoiesis (process which produces RBCs)
- Erythropoietin (produced in kidney; stimulate RBC production
- Hematocrit (% of RBC)
- Hematopoiesis (b
- Hemoglobin
- Red Blood Cell
- Reticulocytes (immature red blood cells)
3
Q
RED BLOOD CELLS BY THE NUMBERS
A
- One RBC contains 1 billion molecules of oxygen
- RBCs take 20 seconds to circulate the body one time
- RBC circulate for 120 days
- There are millions of RBC in one drop of blood
- 3 million RBC’s are made each second
4
Q
A
5
Q
Anemia- what is it
A
- reduction in either:
— The number of RBCs
— Amount of hemoglobin - Conditions in which blood has a lower than normal amount of RBCS or Hgb
- Hypoproliferative” defect/decrease in production of RBCs
— Caused by iron, vitamin B 12, or Folic acid deficiency, decreased erythropoietin production (kidneys), cancer - Hemolytic: excess destruction of RBCs
— Caused by altered erythropoiesis, or other causes such as hypersplenism, drug – induced or autoimmune processes, mechanical heart valves - Bleeding: may also be caused by blood loss
6
Q
Who is at risk:
A
- Mild anemia is common & treatable
- Higher risk:
— Women during menstrual periods & pregnancy
— People who donate blood frequently
— Those who do not get enough iron or certain vitamins
— Chronic inflammatory conditions Autoimmune disorders
—- Causes body to make fewer RBCs
— Taking certain medicines/treatments
—- chemotherapy
7
Q
Types of anemias
Hemolytic
A
- Anemias Resulting from Increased Destruction of RBCs
- Sickle cell disease
- Glucose-6-phosphate dehydrogenase deficiency (G6PD) anemia
- Immunohemolytic anemia
8
Q
Anemias Resulting from Decreased Production of RBCs (Hypoproliferative Anemias)
A
Hypoproliferative Anemias:
- Iron deficiency anemia
- Anemia in renal disease
- Anemia of inflammation
- Aplastic anemia
- Megaloblastic anemia
- Folic acid deficiency
- Vitamin B12 deficiency
9
Q
Anemia S/S:
A
- S/S depends on the rapidity of the development of the anemia, duration of the anemia, metabolic requirements of the patient, & concurrent problems
- Manifestations will depend on severity of anemia & how long they’ve had anemia
Central: - Fatigue
- dizziness
- fainting
Blood vessels: - Low blood pressure
Heart: - Palpations
- Rapid heart rate
- Chest pain/angina
- Heart attack
Spleen: Enlargement
Eyes: Yellowing
Skin: - Paleness
- coolness
- yellowing
- Sensitivity to cold
- Slowed capillary refill
- Tongue changes
- Nail changes
Respiratory: SOB
Muscular: weakness
G.I.: changed stool color
10
Q
Assessment
Mild anemia
A
- Hgb 10-14g
- Usually asymptomatic
- Symptoms usually follow strenuous exertion: palpitations, dyspnea, diaphoresis
11
Q
Assessment
Moderate anemia
A
- Dyspnea
- Palpitations
- Diaphoresis
- Chronic fatigue
12
Q
Assessment
Severe anemia
A
- Dizziness, syncope
- Pale, exhausted all of the time
- Profound weakness
- Severe palpitations
- Sensitivity to cold
- Loss of appetite
- HA
- Cardiac complications: HF, angina
13
Q
Care of the client with anemia
A
- Identify the cause of anemia
- Frequent rest periods
- High protein, high iron, high vitamin diet
- Monitor during blood transfusions
— What do you remember about blood transfusions? - Protect from infection
14
Q
Complications from anemia
A
- arrhythmias
- Enlarged heart
- Heart failure
- Infections
- Bleeding
- Neurologic
15
Q
Aplastic anemia - rare but serious disorder
A
- Disorder in which the body’s bone marrow doesn’t make enough new blood cells.
- Disorder in which all formed elements of the blood are depressed (bone marrow doesn’t make enough new blood cells)
- Usually occurs with leukopenia & thrombocytopenia (together this is called pancytopenia)
- Causes: often cause is unknown
— long-term exposure to toxic agents (pesticides, arsenic)
— radiation & chemo
— viral infections (hepatitis, Epstein-Barr, HIV) Autoimmune disorders (lupus & rheumatoid arthritis) - Manifestations of severe anemia: Cardiac
- Diagnostic Tests: CBC
- Severe macrocytic anemia, WBCs, PLTs
16
Q
Aplastic anemia- treatment
A
- Stem cell transplantation*
- Immunosuppressive therapy*
— could be caused by autoimmune things - Prednisone, cyclosporine A (Sandimmune), antithymocyte globulin (ATG), daclizumab (Zenapax)
- Blood transfusion – Supportive therapy
- Bone marrow biopsy
— shows replacement of cell-forming marrow with fat
17
Q
Megaloblastic Anemia
A
- Decrease in RBCs that cause hgb level to be lower than normal
- Noted by megaloblasts, which are large nucleated abnormally shaped RBCs
- Cause:
— Folic acid deficiency
— Vitamin B12 deficiency
— vegans
18
Q
Pernicious Anemia
A
- Decreased or lack of intrinsic factor causes decreased absorption of vitamin B12 in the gastric mucosa and therefore leads to vit B12 deficiency.
- Without enough vit B12, your RBCs don’t divide normally and are too large. They have trouble getting out of bone marrow
— Bone marrow produces fewer, larger (macrocytic) RBCs
— Body cant make enough healthy RBCs to keep its nervous system working properly. - Without enough RBCs to carry O2, pt may feel tired and weak. Severe or long lasting pernicious anemia can damage the heart, brain and other problems such as nerve damage.
19
Q
Pernicious Anemia 2
A
- Decreased or lack of intrinsic factor causes decreased absorption of vitamin B12 in the gastric mucosa leading to B12 deficiency
- Causes:
— Autoimmune destruction of gastric mucosa
— Chronic gastric inflammation
— Surgical removal of stomach or bowel - Inadequate dietary intake (vitamin B12 deficiency) is NOT the same as pernicious anemia)
20
Q
Pernicious anemia 3
A
- Gastric mucosa fails to secrete sufficient intrinsic factor required for absorption of vitamin B12
- Assessment:
— Fatigue, pallor, glossitis (inflamed tongue) , *sore red tongue, wt. loss, gait balance disturbances, paresthesias in hands and feet
— surgery? - Interventions: may need life long treatment
- Vitamin B12 IM injection
— Initial IM injection of 25-100 mcg vitamin B12, followed by 500-1000 mcg every 1-2 months - Cobalamin/ Cyanocobalamin
21
Q
Anemia of Chronic Disease “anemia of chronic inflammation”
A
- Anemia with presence of chronic inflammatory condition
— Microcytic or normocytic ◦
— Low reticulocyte count - Causes:
— autoimmune disorders (rheumatoid arthritis, lupus, crohn’s)
— Cancer
— Long term infections (HIV, AIDS, bacterial endocarditis
— Kidney disease
22
Q
Anemia of Chronic Disease “anemia of chronic inflammation”
S/S & Tx
A
- S/S: usually those of the underlying disorder (infection, inflammation, cancer)
- Tx: reverse underlying disorder, give erythropoietin
23
Q
Thalassemias
A
- Inherited blood disorders
- Causes body to make fewer healthy RBCs and less hemoglobin than nl
- Occurs because of a problem with chains of hemoglobin NOT because of a lack of iron
- Pts with thalassemias can have mild or severe anemia
- Most common among people of Italian, Greek, Middle Eastern, Southern Asian and African decent.
24
Q
Thalassemias s/s:
A
- may range from nothing to severe anemia
- Depending on the severity of lack of O2 in blood
- RBCs are smaller than normal
25
Q
Thalassemias Tx:
A
- blood transfusions, Iron chelation therapy, folic acid supplements
- (Regular blood transfusions can lead to buildup of iron in blood- iron overload)
- Iron chelation therapy: removes excess iron from blood using 2 meds:
— Deferoxamine- Liquid medicine given slowly under skin using a small portable pump overnight.
— Deferasirox – PO daily
26
Q
Iron Deficiency Anemia
A
- Most common type
- Causes:
— Poor nutrition/ inadequate diet
— blood loss
— Poor GI absorption of iron
— increased internal metabolism demands (ex. Pregnancy, infection)
27
Q
Iron Deficiency Anemia Interventions:
A
- Dietary increase of iron-rich foods (DAVIS): dried fruit, cereals,
- Iron supplements of IV (preferred) or IM iron dextran leafy green vegetables, red meats, dried bean & peas
— IM route causes pain, skin staining, higher incidence of anaphylaxis
— Oral supplements available
— Between meals (preferred) for maximum absorption
— Take with food if GI upset occurs
— Take with ascorbic acid (vitamin c; helps with constipation)
— Use a straw with liquid form
— Will change the color of stool
— Adverse effect is constipation
28
Q
Iron deficiency anemia Assessement:
A
- Fatigue
- *Inflammation of the tongue (Glossitis)
- koilonychia (spooning of nail bed)
- Impaired cognition
- Decreased serum albumin, gamma globulin and transferrin levels
- As iron stores are depleted, this is reflected in low serum ferritin levels.
- Decreased hemoglobin
- Hematocrit and RBC levels are low in
- relation to hemoglobin
- Bleeding in stools
29
Q
Thalassemia: genetic- microcytic
Iron deficiency tx: supplement/ diet
Pernicious: macrocytic tx: lack of intrinsic factor/ vitB12
Aplastic: bone marrow doesn’t make enough; treat symptoms; stem cell transplant
- support auto immune/ steroids
A
Know different types s/s / treatments
