Exam 1 Flashcards
What is hematopoiesis?
Blood cell production, which occurs most commonly in the bone marrow. It starts with hematopoietic stem cells that differentiate into precursor cells or “blasts,” and also occurs in the liver and spleen. The blasts become erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets). This process is stimulated by hormones like EPO and G-CSF
What stimulates erythropoiesis?
Low oxygen levels stimulate the kidneys to secrete erythropoietin (EPO), which in turn stimulates the bone marrow to increase red blood cell (RBC) production. This process also requires B-vitamins and iron.
What are the normal ranges for the following red blood cell indices: MCV, MCH, MCHC?
MCV (Mean Corpuscular Volume): 80-100 fL (avg. size of red cell)
MCH (Mean Corpuscular Hemoglobin): 27-34 picograms (pg) (avg. content of Hgb per cell)
MCHC (Mean Corpuscular Hemoglobin Concentration): 32-36 g/dL (avg. amt. of Hgb/unit vol. blood)
How are MCV values used to classify anemia?
Microcytic: MCV < 80 fL, often associated with iron deficiency.
Macrocytic: MCV > 100 fL, often associated with B9 (folate) or B12 deficiency.
Normocytic: MCV 80-100 fL.
What is the difference between hypochromic and hyperchromic red blood cells?
Hypochromic: MCH < 27 pg, meaning cells have less hemoglobin.
Hyperchromic: MCH > 34 pg, meaning cells have more hemoglobin.
What is anemia, generally speaking?
A condition characterized by a decreased quantity or quality of hemoglobin and/or volume of red blood cells, which leads to a decreased capacity to deliver oxygen, resulting in tissue hypoxia.
What are the common symptoms of moderate to severe anemia?
Fatigue, weakness, pallor, dizziness, shortness of breath (SOB), chest pain (CP), and cold hands/feet.
What are some causes of Iron Deficiency Anemia (IDA)?
IDA is most commonly due to nutritional intake issues or malabsorption issues. It can also be associated with blood loss. Iron is absorbed in the duodenum, requiring an acidic environment.
What are some key symptoms of IDA?
Pallor, glossitis (inflammation of the tongue), cheilitis (cracking at the corners of the mouth), and headaches. Also includes orthostatic hypotension and chest pain.
What are some important considerations when administering iron supplements?
Iron supplements are best absorbed in an acidic environment.
Absorption can be enhanced with vitamin C or food sources.
Common side effects include N/V, constipation, abdominal discomfort, and stomach cramps.
Stools may turn dark green or black.
Take with food if needed to diminish GI upset, although bioavailability drops 33-50% when taken with food.
What are the roles of Vitamin B12 in the body?
Vitamin B12 is necessary for RBC formation, brain and nerve cell development, and DNA replication. A deficiency leads to megaloblastic anemia.
What is pernicious anemia?
Pernicious anemia results from a lack of intrinsic factor (IF) and hydrochloric acid (HCl) which are needed for B12 absorption, causing megaloblastic anemia. If left untreated can cause neurological symptoms. Lifelong treatment with B12 replacement is necessary.
What are some important things to know about B12 replacement therapy?
B12 replacement is available in IM, subcutaneous, SL, and nasal sprays. Neurological symptoms and a sore or red tongue may be present. If left untreated for 6-12 months, it can cause irreversible neurological damage.
What is the role of folic acid in the body?
Folic acid is essential for RBC formation, cell growth, and DNA synthesis. A deficiency leads to megaloblastic anemia.
What are some causes of folic acid deficiency and what are the associated symptoms?
Causes include insufficient dietary intake and chronic alcoholism. Symptoms are similar to B12 deficiency, but without the neurological problems.
What are some common chronic disease causes of anemia?
Alcoholism, inflammatory bowel disease, gastric resection, liver disease, and chronic kidney disease.
What is neutropenia and why is it dangerous?
Neutropenia is a reduction in neutrophils with an absolute neutrophil count (ANC) < 1000 cells/mcL, which results in a high risk of life-threatening infections with opportunistic pathogens.
What is Granulocyte Colony-Stimulating Factor (G-CSF) and what is its purpose?
G-CSF (filgrastim) binds to receptors of precursor cells and stimulates neutrophils to grow and mature, which are needed to fight infections. It is continued based on ANC and discontinued if ANC > 10,000 cells/mm3 during chemotherapy. A common side effect is bone pain.
What is Erythropoietic (EPO) Agent: epoetin alfa and what is its purpose?
EPO is used for erythropoiesis. It is given IV or subcutaneously. It is not for emergent anemia and requires functional bone marrow. Iron, B12, and folic acid are needed. It is used for anemia associated with CKD and chemotherapy. Side effects include hypertension, and there is a black box warning for an increased risk of cardiac events.
What are some important nursing implications when administering EPO?
Assess BP, Hgb, and Hct. Hold if Hgb ≥ 10 and consult with MD. Monitor for embolic events. Assess for hypertension and iron levels. It is a gradual treatment for chronic anemias. There is no risk of tachycardia but there is a risk for thrombotic events.
