Care of Patients with Anemia Flashcards
Reduction in either the number of RBCs, the amount of hemoglobin, or hematocrit
Is a clinical indicator, not a specific disease process because it occurs with many health problems
Can result from
Most common reason for anemia in adults
Types or causes of anemias
Anemia
Dietary problems
Genetic disorders
Bone marrow disease/decreased func
Excessive bleeding
Can result from
GI bleeding
Most common reason for anemia in adults
Deficiency in one of the components needed to make a fully functional RBC
Decrease in RBC production
Increased in RBC destruction
RBC loss
Types or causes of anemias
Ex. Iron deficiency (most common); Folic acid deficiency; vitamin B12 deficiency
Deficiency in one of the components needed to make a fully functional RBC
Ex. aplastic anemia - exposed to toxin/med that affects func of bone marrow
Decrease in RBC production
Ex. hemolytic anemia - autoimmune process
Increased in RBC destruction
Ex. GI bleed; trauma; blood lost in trauma
RBC loss
Integumentary
Cardiovascular
Respiratory
Neurologic
Key features
Pallor
Cool to the touch
Intolerance of cold temperatures
Nails become brittle and become concave over time
Integumentary
Tachycardia - severe enough; heart trying to compensate
Murmurs and gallops when anemia is severe
Orthostatic hypotension - severe enough
Cardiovascular
Dyspnea on exertion - severe enough dyspnea
Decreased oxygen saturation levels
Respiratory
Sig Fatigue and somnolence
Headache
Neurologic
Most common anemia worldwide
Causes:
When iron deficient the stores will decrease first
A microcytic anemia (RBC will be small)
Labs:
Clinical Manifestations:
Iron deficiency anemia
More among women (menstruating), older adults, and people with poor diets
Most common anemia worldwide - Iron deficiency anemia
Blood loss
Poor GI absorption of iron
Inadequate iron in diet
Causes: - Iron deficiency anemia
Hbg/Hct & RBC decreased
Ferritin decreased < 10ng/mL (12-300 normal) (decreased iron stores)
MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin) and MCHC (mean corpuscular hemoglobin concentration) decreased
Labs: - Iron deficiency anemia
Weakness and pallor
Fatigue
Reduced exercise tolerance
Fissures at the corners of the mouth
*with chronic anemia signs and symptoms may be more mild than acute situation
Clinical Manifestations: - Iron deficiency anemia
Increase oral intake of iron from food sources
Oral iron supplements (Ferrous Sulfate)
With severe deficiency give IV infusion (lot monitoring with first dose) or IM iron solutions - very irritating and do Z track method
Iron deficiency anemia interventions
10-15 grams of iron a day
High in iron: red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, raisins, dark chocolate, soy beans
5-10% of dietary iron is absorbed - eat lot iron to supplement; may need supplements
Increase oral intake of iron from food sources - Iron deficiency anemia interventions
Take between meals for better absorption and reduce GI distress
Take with vitamin C for better absorption
Expect 2 gm/dL increase in 4 weeks - not immediate improvements
Oral iron supplements (Ferrous Sulfate) - Iron deficiency anemia interventions
Ex. Iron dextran (Dexferrum) or ferumoxytol (Feraheme)
With severe deficiency give IV infusion (lot monitoring with first dose) or IM iron solutions - very irritating and do Z track method - Iron deficiency anemia interventions
Vitamin B12 plays a key role in the formation of RBCs as well as normal functioning of the nervous system - helps move folic acid
Causes:
May be mild or severe, usually develops slowly
Macrocytic anemia (large RBC) - not proper process - see in CBC
Clinical manifestations - mild to severe
Vitamin B12 Deficiency anemia
Vegan diets or diets lacking dairy products
GI disorders: small bowel resection, chronic diarrhea, diverticuli, tapeworm, overgrowth of intestinal bacteria
Anemia resulting from failure to absorb vitamin B12 (pernicious anemia) secondary to chronic gastritis
Causes: - Vitamin B12 Deficiency anemia
Intrinsic factor is a substance normally secreted by the gastric mucosa and is not secreted, which is needed for intestinal absorption of vitamin B12
Anemia resulting from failure to absorb vitamin B12 (pernicious anemia) secondary to chronic gastritis
Decreased Hbg/Hct and RBC
Increased MCV, MCH and MCHC
Macrocytic anemia (large RBC) - not proper process - see in CBC - Vitamin B12 Deficiency anemia
Pallor
Jaundice
Glossitis (a smooth, beefy-red tongue)
Fatigue
Weight loss
Paresthesias in the feet and hands
Poor balance - NS impact
Clinical manifestations - mild to severe - Vitamin B12 Deficiency anemia
Increase dietary intake of foods rich in vitamin B12
Vitamin supplements if anemia is severe with B12 - common
For pernicious anemia
Vitamin B12 deficiency anemia interventions
If it is related to an inadequate intake
Ex. animal proteins, fish, eggs, nuts, dairy products, dried beans, citrus fruit, and leafy green vegetables
Increase dietary intake of foods rich in vitamin B12 - Vitamin B12 deficiency anemia interventions
administer B12 injections weekly initially, and then monthly for the rest of their lives
B12 nasal sprays or sublingual forms of may be used to maintain vitamin levels after the patient’s deficiency has first been corrected - after stablized via injections
For pernicious anemia - Vitamin B12 deficiency anemia interventions
Folic acid plays a key role in RBC development because importance in DNA synthesis
Common causes:
Clinical manifestations:
Develops slowly
Treatment:
Folic acid deficiency anemia
Poor nutrition: Chronic alcohol abuse
Malabsorption
Drugs (anticonvulsants, oral contraceptives)
Common causes: - Folic acid deficiency anemia
similar to those of Vitamin B12 deficiency, but nervous system functions remain normal because folic acid deficiency does not affect nerve function
Glossitis (a smooth, beefy-red tongue)
Clinical manifestations: - Folic acid deficiency anemia
Diet rich in foods containing folic acid and vitamin B12: leafy green vegetables, citrus fruits, beans, breads, cereal, rice, pasta
Folic acid replacement/supplements - esp for alcholic and malnourished pats
Treatment: - Folic acid deficiency anemia
Deficiency of circulating red blood cells because of failure of the bone marrow to produce these cells
Pancytopenia
Causes:
SERIOUS and hospitalized
Patient will have manifestations of severe anemia, leukopenia, and thrombocytopenia
Aplastic anemia
Injury to the stem cells in the bone marrow
Deficiency of circulating red blood cells because of failure of the bone marrow to produce these cells - Aplastic anemia
Deficiency of RBCs (anemia), WBCs (leukopenia) and platelets (thrombocytopenia)
Pancytopenia - Aplastic anemia
Long-term exposure to toxic agents
Drugs
Ionizing radiation
Viral infection
Unknown
Causes: - Aplastic anemia
Treatment
Hematopoietic stem cell transplantation with donor cells
Immunosuppressive therapy medications - if cannot do donor cells
Splenectomy
Aplastic anemia interventions
Assess for bone marrow failure
Close monitoring of CBC
Infection prevention
Bleeding precautions
Blood transfusions
Treatment - Aplastic anemia interventions
Weakness, pallor, petechiae, ecchymosis
Poor oxygenation
Assess for bone marrow failure
When the anemia causes disability or when bleeding is life threatening because of low platelet counts
Blood transfusions
Best treatment
Hematopoietic stem cell transplantation with donor cells - Aplastic anemia interventions
If spleen is enlarged either destroying normal RBCs or suppressing their development
Splenectomy - Aplastic anemia interventions
Results from an autoimmune process that causes excessive destruction of RBCs
Causes:
Interventions:
Hemolytic anemia
Autoimmune
Trauma
Viral infection
Exposure to a chemical agent or drug
Causes: - Hemolytic anemia
Immunosuppressive therapy - autoimmune
Plasma exchanges - clean plasma
Splenectomy - excessive destruction of RBC
Interventions: - Hemolytic anemia
