Hematological Conditions Flashcards
Anemia
Deficiency in the…
of RBCs
Quantity or quality of hemoglobin
Volume of packed RBCs (hematocrit)
Anemia caused by…
Decreased RBC production (iron deficiency) Blood loss (acute and chronic) Increased RBC destruction - intrinsic (abnormal Hgb), extrinsic (physical trauma from dialysis)
RBC function
Transport oxygen from lungs to tissues
Carry CO2 form tissues to lungs
Anemia Classification
Morphological (cellular characteristics)
Etiological (underlying cause)
Anemia - Clinical Manifestations
Mild (Hb 100-120) - palpations, dyspnea and mild fatigue
Moderate Anemia (60-100) - cardiopulmonary symptoms
Severe Anemia (Hb<60) - symptoms involving multiple body systems
Anemia - Skin Manifestations
Pallor
Jaundice (increased concentration of serum bilirubin)
Pruritus (increased serum and skin bile salt)
Anemia- cardiopulmonary Manifestations
Increased HR and stroke volume
MI, HF
Anemia Management
Goals:
- assume normal ADLs
- Maintain adequate nutrition
- develop no complications related to anemia
Anemia Implementation
Blood transfusions Drug therapy Volume replacement Dietary and lifestyle changes Oxygen therapy Client teaching (nutrition intake)
Lifespan of RBC
120 days
Alteration in erythropoiesis may decrease RBC production
- decreased hemoglobin synthesis
- Defective DNA synthesis in RBCs
- Diminished availability of erythrocyte precursors
Most susceptible people for iron deficiency anemia
very young
poor diets
women in reproductive years
Iron-deficiency anemia etiology
inadequate dietary intake
Malabsorption
blood loss
hemolysis
Iron-deficiency anemia - Manifestations
Pallor
Glossitis (inflammation of the tongue)
Cheilitis (inflammation of the lips)
Iron-deficiency anemia - collaborative care
GOAL: treat underlying disease
increase intake of iron
nutritional therapy
oral/parenteral iron supplements
Transfusion of packed RBCs
How iron is best absorbed
duodenum and proximal jejunum
When Iron should be taken
an hour before meals (acidic environment)
Anemia of Chronic Disease (decreased # of RBC precursors)
underproduction of RBCs
mild shortening of RBC survival
Anemia of chronic disease - cause
renal disease
chronic liver disease
inflammatory, autoimmune, infectious or malignant disease
Anemia of chronic disease findings
increased serum ferritin
increased iron stores
normal folate and cobalamin levels
Causes of Anemia
Decreased Erythrocyte production
Acute Blood loss
increased RBC Destruction
Acute blood loss
result of sudden hemorrhage from:
trauma
complications of surgery
disrupted vascular integrity
Concerns of acute blood loss
hypovolemic shock
reduced plasma volume
Acute blood loss - manifestations
pain
- internal hemorrhage
- retroperitoneal bleeding (abd pain and distention)
- shock
Acute Blood loss - Collaborative Care
Replacing blood volume to prevent shock Identifying the source of hemorrhage Stopping blood loss Correcting RBC loss Providing supplemental Iron
Blood transfusions
The body needs 2-5 days to manufacture more RBCs in response to increased erythropoietin
IV fluids used in blood loss emergencies
dextran, hetastarch, albumin, crystalloid (lactated ringers)
Sources of Chronic Blood Loss
Bleeding ulcer
Hemorrhoids
Menstraul and postmenopausal blood loss
Chronic blood loss- management
Identify Source
Stop bleeding
Use supplemental iron
Hemolytic Anemia
Destruction or hemolysis of RBCs at a rate that exceeds production
Intrinsic hemolytic anemia
Abnormal hemoglobin
enzyme deficiencies
RBC membrane abnormalities
Hereditary
Extrinsic hemolytic anemia
More common than intrinsic
Acquired
Damage caused by external factors
Hemolytic Anemia - manifestations
Jaundice (increased bilirubin)
Enlarged spleen and liver (hyperactive w macrophage phagocytosis of defective RBCs)
Hemolytic Anemia can cause…
Accumulation of hemoglobin molecules that obstruct renal tubules = tubular necrosis
Example of Intrinsic hemolytic anemia
Sickle cell disease
Sickle Cell disease
Group of inherited, autosomal recessive disorders
Presence of an abnormal form of hemoglobin in the erythrocyte (Hemoglobin S)
Incurable and fatal
HbS in SCD
Causes RBC to stiffen and elongate (decreased O2 levels)
Causes vascular occlusion leading to acute or chronic tissue injury
Types of SCD
Sickle Cell Anemia (most severe)
Sickle cell-thalassemia
Sickle cell-HbC disease
Sickle cell trait
SCD - Manifestations
Sickling episodes - from low oxygen or infection, dehydration
Sickle cell crisis - severe pain from vaso-occlusive crisis
pain and swelling
pallor
jaundice
SCD complications
Pnuemonia
Other body systems (spleen, lungs, kidneys, brain)
Acute chest syndrome
SCD - Management
Alleviate symptoms of disease complications
minimize end target-organ damage
No specific treatment
client teaching (avoid high altitudes, maintain fluid intake, treat infections, pain control)\
O2 for hypoxia
Blood transfusions
Stem cell transplant
Antisickling agent
Hydroxyuria
Acute chest syndrome management
Antibiotics
O2 therapy
Fluid therapy
Transfusion
Acquired Hemolytic Anemia (extrinsic)
Physical factors
Immune reactions
Infectious agents and toxins
Iron storage
Bone marrow, liver, spleen, macrophages
