Hemo Flashcards
low levels of hgb
anemia
too much hgb
polycythemia
s/sx of anemia
- pallor
- weakness/fatigue
- malaise
normal value of MCV (size of RBC)
81-96
<81= too small >96= too big
normal value of MCHC (amount of hbg)
33-36
<33= hypochromic >36= hyperchromic
priority nursing diagnosis for anemia
ineffective tissue perfusion
iron deficiency anemia is most common among
- menstruating and pregnant women
- third world countries
s/sx of iron deficiency anemia
- pallor
- dizziness
- fatigue
- tachycardia
- elevated reticulocytes
when pt is taking iron what should you ask
what is the color of your stool?
-black stool is the side effect of iron
labs for iron deficiency anemia
-microcytic, hypochromic
clinical manifestations of iron deficiency anemia
- weakness/fatigue
- brittle, rigid nails
- smooth, red atrophic tongue
- angular cheilosis (cracking of the lips)
foods rich in iron
- animal meats, organ meats (beef, chicken, liver)
- black beans
- leafy green vegetables
- raisins
how is iron BEST absorbed?
acidic environments/ empty stomach
medication treatment for iron deficiency
-ferrous sulfate, ferrous gluconate, fumarate
what instructions/ pt teaching do you give to the pt for iron deficiency anemia
- eat foods high in fiber
- take medications together with meals
- vitamin c will enhance absorption
- stools will become dark in color
when should you do blood transfusion (in relation to hgb)?
when the hgb is 7 and below
chemicals causing anemia
-cytokines, and inadequate secretion of erythropoetin
pathophysiology of anemia
-if kidneys fail they can produce erythropoetin so you can not stimulate the bone marrow to make RBCs
labs for anemia of inflammation
- normocytic, normochromic
* low hemoglobin
which anemia is caused by disorders in the heme moeity (portion) of hemoglobin?
sideroblastic anemias (ringed siderblasts)
two types of sideroblastic anemias
-hereditary and acquired
common cause of acquired sideroblastic anemia
-more common than hereditary type
-common causes: Lead, alcohol, isoniazid
-
characterize hereditary sideroblastic anemia
X linked condition due to adbormality in pyridoxine metabolism
Congenital defect in the enzyme
(d-aminolevulinic acid (ALA) synthetase)
describe thalassemia
Diminished synthesis of globin chain of Hgb
RBCs are more rigid leading to early destruction
Characterized by severe microcytosis and hypochromia
describe a-thalassemia (Bart’s Hbg)
- Deficient a-chain synthesis, usually due to deletion of gene
- Most prevalent among Asians and middle Easterns
-Milder than beta forms and can occur without symptoms
→ may live normal life span
describe b-thalassemia (HbF)
- Due to malfunction of B-globin chain caused by B-gene abnormality
- Common among African descent
- Severe anemia, marked hemolysis, ineffective erythropoiesis
-Can be fatal within the few years of life
With early regular transfusion therapy growth and development through childhood are facilitated
megaloblastic anemia
Characterized by RBC that exceed 100 um in size
Defective DNA synthesis (main characteristic of megaloblastic anemia) RBC cannot produce nucleic acid → nuclear maturation arrested → cytoplasmic maturation arrest→ cytoplasmic maturation proceeds→ abnormally large cells
deficiencies for megaloblastic anemia
- folic acid deficiency
- vitamin b12 deficiency
clinical manifestations of megaloblastic anemia
- Weakness, fatigue, pallor, jaundice, smooth sore, red atrophic tongue
- Mild diarrhea, angular cheilosis
- Vitiligo, premature graying of hair often seen in pernicious anemia
- Paresthesias (numbing sensation) in the extremities, ataxia (B12)
- Schilling’s test (test for presence of intrinsic factor and intestinal function to determine cause of vit. B12
- High methylmalonic and homocysteine levels more sensitive vit B12 deficiency
describe aplastic anemia
-Damage to the marrow with replacement by fat (aplasia)
→ markedly reduced hematopoiesis
-Can be congenital or acquired
Infections, medications, chemical or radiation can cause the disease
Pancytopenia
clinical manifestations of aplastic anemia
fatigue , pallor, dyspnea
Bleeding tendencies: Purpura, bruising
Repeated infections such as sore throat, cervical lymphadenopathies
Retinal hemorrhage (bleeding behind eye)
Bone marrow biopsy: aplastic marrow replaced with fat
interventions for aplastic anemia
- Assess for signs of bleeding, anemic and infections
- Offending agent should be discontinued
- Prepare client for possible BMT or PBSCT
- Prepare client for immunosuppressive therapy (antithymocyte globulin and cyclosporine)
- Place client on isolation room
