Hematology Flashcards
What Is anemia
Anemia is a condition in which the hemoglobin concentration is lower than normal; it reflects the presence of fewer than the normal number of erythrocytes within the circulation.
What is a hypoproliferative anemia?
In hypoproliferative anemias, the marrow cannot produce adequate numbers of erythrocytes. Decreased erythrocyte production is reflected by an inappropriately normal or low reticulocyte count. Inadequate production of erythrocytes may result from marrow damage due to medications (eg, chloramphenicol) or chemicals (eg, benzene) or from a lack of factors (eg, iron, vitamin B12, folic acid, erythropoietin) necessary for erythrocyte formation.
What is a Hemolytic Anemia
In hemolytic anemias, premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma; the released Hemoglobin is converted in large part to bilirubin and therefore, the bilirubin concentration rises.
What can Cause Hemolysis
Hemolysis can result from an abnormality within the erythrocyte itself (eg, sickle cell anemia, glucose-6-phosphate dehydrogenase [G-6-PD] deficiency) or within the plasma (eg, immune hemolytic anemias), or from direct injury to the erythrocyte within the circulation (eg, hemolysis caused by mechanical heart valve)
Normal Levels Hemoglobin Women (Hgb)
12-16 g/dl
Normal Levels Hemoglobin Males (Hgb)
13-18g/dl
Biggest cause of Hypoxemia related to Anemia
Decreased Hemoglobin, reduces O2 carrying capacity in blood resulting in Hypoxemia
Erythrocytes are
Red Blood Cells
Average life span of 120 days
Normal Levels of Erythrocytes in Males
4,600,000 (4.6x106)cu mm to 6,200,000 (6.2x106) cu mm
Normal Levels of Erythrocytes in Females
4,200,000 (4.2x106)cu mm to 5,400,000 (5.4x106) cu mm
What are the two types of Iron Obtained from Food
Heme is from animal sources
Non-Heme From plant sources
Transferin does what
Transport Iron in the blood
Name five sources of Non-Heme Iron
Fortified Cereals
Dried Beans(Kidney Beans, Chick peas)
Peas
Sweet Potates
Green leafy Veggies(Spinach, Kale)
Name Three Sources of Heme Iron
Muscle Meats (Beef, Pork, Dark meat chicken)
Tounge(Tripe)
Organ Meats (Liver, Kidneys)
Eating Both Heme and Non-Heme Sources of Iron have a Synergestic effect with absortion.
TRUE OR FALSE
True. If you eat at least 10% Non-Heme sources with Heme there is a synergistic effect increasing the absorption of the Iron.
Normal Values Of Hematocrit For Males
40-52 %
Normal Values Of Hematocrit for Females
36-48%
What are Reticulocytes
Imature RBC’s
What are Reticulocytes Used to monitor
Reticulocytes are utilized to montior for Bone marrow failure.
An Increase in Reticulocytes after Iron treatment for anemia shows treatment is working
No increase or lack of production indicates a bone marrow disorder
Hyprolifitive anemia
Defect in production of RBCs due to Iron, Vitamin B12, or Folate Deficiancy.
Also From Decreased Erythorpoietin production and cancers
Hemolytic Anemia
Results from Excessive Destruction of RBCs
SLE( Systemic Lupus Erythropoesis)
Hyperspleenism
Altered Erythropoisis(cell Shape)
May also be caused by blood loss
MCV (Mean Corpuscular Volume)
The measure of the average size of a single RBC
Macrocytic (large)
Microcytic (small)
MCHC (Mean corpuscular Hemoglobin Concentration)
Measure of the average percent of hemoglobin on a single RBC
RDW
Red cell distribution- essentially and indication of the degree of abnormal variation in sizes of RBCs
Assists in determining type of anemmia present or causes
Macro cytic disorders indicate
B-12 issues
Micro Cytic indicate
Iron disorders
Clinical Manifestations of Anemia
- Fatigue, weakness, mailase(most common)
- Palor and Jaundice(Hemolytic only due to increased BilliRubin)
- Cardiac and Respiratory (due to increase vascular Rates)
- Tounge changes (iron = Smooth Red, B12/Folate = Red Beefy)
- Nail Changes
- Angular Cheilosis (Mouth edges Split)
- PICA (ice chewers= anemia)
Erythropoetin is?
A hormone from the kidney that increases RBC production.
What is the relationship to of the kidneys with anemias?
95% of anemias can lead to Kidney disorders and concerns. With anemia be sure to monitor for kidney fucntion
Assessment is Key
What parts of assessment are VIP
- Health hx and Physical exam- ETOH Decreases Absorbtion of Folic acid, also heredity is a good indicator of anemia
- Lab Datas
- Nutrition and Meds- Strict Vegitarian diet can decrease B12
- Recent blood lossess( Menses or GI bleeds)
- Nero- B12 Defiicits can cause Delirium
Priority for managing fatigue R/T anemia
Assisting the patient to prioritize activities and establish a balance between activity and rest is very important because it has the largest effect on the quality of life of an anemic patient.
it is very important as a nurse not to cluster your care like you normally would to avoid overwhelming the patient.
provide breaks between tasks such as bathing, toileting, and ambulation programs
What Are some diagnoses for Patients with anemia
- Fatigue R/T Decrease Hgb and decreased O2 Carrying capacity of the blood
- Imbalanced nutrition less than body requiremets r/t B12,, Folic Acid, or Iron Deficiencey
- Ineffective tissue perfusion r/t decreased RBC’s
- Noncompliance with Prescribed medicine therapys
What is the best treatment for anemias
Proper nutrition
Problems with Compliance include
- Need to understand the purpose of the med
- Undesireable S/E
- GI constipation
- cost inhibitive
Potential Complications from Anemia
- Heart failure
- angina
- paresthesia
- confusion
- injury r/t falls
- Depressed mood
Hyporoliferative anemia
Iron Deficiency Anemia
Most Common of all ages and all the world
Hypochromic(poor color) Micro Cytic( Small Cells)
Low Reticulicytes, Iron, Ferritin, MCV and Increased TIBC(transferin)
Hyporoliferative anemia
Iron Deficiency Anemia
Most Common Cause
Dietary Concerns
Not enough Dietary Iron
Sometimes related to Increased blood loss from Menses or GI Bleed
TIBC
Total Iron Binding capacity
Iron Supplements
care and Concerns?
GIve 1hr before or two hours after meals
Avoid giving with H2 blockers, Antacids, calcium, coffee/tea, fiber and some phospate sodas(colas)
Best absorbed on an empty stomach with vit c, (orange Juices)
Iron dextrane only used if oral Ferrous Sulfate is not tolerated.
Given as liquid to children with straw to avoid teeth staining.
Pernicious Anemia- Missing Intrinsic Factor
Must be treated by injections of B12 Oral will not help. The body does not absorb B-12
Can be hereditary, but is primarily a disorder of the elderly
Dietary concerns for Pericious Anemia
Soft food because of Beefy Tounge.
B12 Deficiency causes
Vegitarians who consume no meat or dairy
poor absorbtion (chrones, bariatric surgery)
S/S of Both Hyproproliferative Anemia’s(B12-Pernicous)
Nero symptoms
Confusion
Numbness tingling in Hands/Feet
Poor Balance(rombergs sign)
Trouble walking
Burning tounge
What is rombergs Sign
When patient closes their eyes and waivers while standing with thier feet together
What is Schilings test and how is it done
Evaluates the bodies ability to absorb B-12
Large dose given to
Pt fasting given radioactive b-12 and then an 24 hour urine is collected.
If radioctive is in urine body absorbed. if not then no absorbtion through GI tract
Folate Deficency anemia
Normochromatic and macrocytic
Rapid Onset mimics B-12
Decerase in Folate levels
People who rarely eat raw or uncooked veggis
ETOH, Preggers, pts with chronic Heolytic anemia
Nutrition considerations- Foods high in Folic Acid
Green Leafy veggies, organ meats, whole grains, enriched cereals
Management of anemias
B-12 : Veggies can take oral supplements or fortified soy mild
Perncious anemia- Monthy IM injections of B-12
Folic- Increasing Folic acid Intake in diet or supplement 1mg folic acid daily
***Folic acid is not used to treat until others are ruled out****
Aplastic Anemia
Normochromatic, Normocytic
Idyooathic
Is a decrease in precursor cells of the bone marrow
believed associated supstances- cytotoxic agents, anti thyroids, antimicrobials, inorganic arsenic, Benzene, pesticides, plutonium and radon
Essentially STEM CELLS FROM THE BODY Attack T-CElls from Bone marrow
S/S of Aplastic Anemia
Gradual Onset, weakness, pallor, Dysnea on exertion
Abnormal Bleeding on 1/3 of patients
sepsis
Treatment
Hemapoietic stem cell transplant
Immunosupresives
Generally not treated for pts over 60 Due to poor tx response
How do Hypoproliferate anemias affect renal disorders
They decrease Erythropoetin levels and increase creatinine levels.
Treated with Epogen, or Procrit
Hemolytic Anemias
altered erthyposis of cell- resulted in fragmented RBCs increased reticulocyte levels and billirubin
body destroys RBC’s monitor labs,
Sickle Cell Anemia
Inherited, RBCs Scikle when body dehydrates and there is poor perfusion.
Low O2 causes sickles, Increases Pain and swelling from poor perfusion
Treated with Oxygen and fluids
Clinical Manifestations of SCA
Hgb Levels of 7-10 are normal
Jaundice
Bone marrow expands in children
Dysrythmias in adults
Children can have enlargement of flat bones of face
Adults can have and enlarged heart
Types of SCA Crisis
Acute Vaso-Occlusive- Entrapment of Cells due to clumping and lack of venous space
Sequestiration- Results when other organs such as spleen pool blood
thalassemia
is a group of hereditary disorders that are associated with defective hemoglobin chain synthesis. Comes in two groups Alpha and Beta
Alpha Thalassemia Occurs Mainly in?
People form Asia and the middle East
This is the milder form
Beta Thalassemia occurs mostly in
People from the mediterainian regions and may also occur in asian or middle easterns
Complications of thalassemia are
Iron overload
infection due to splenic removal
enlarged spleen from RBC over load
slower growth rates
Heart problems
