Module 6: Hematologic Problems-Blood Component Therapy Flashcards
Anemia
A deficiency in
Number of erythrocytes (RBCs)
Quantity or quality of hemoglobin (Hgb)
Volume of packed RBCs (hematocrit)
Diagnosed based on
Complete blood count (CBC)
Reticulocyte count
Peripheral blood smear
Classified according to
Morphology
* Cellular characteristic
* RBC size and color
Etiology
* Cause
* Clinical condition causing anemia
RBC Function
Transport oxygen (O2) from lungs to systemic tissues
Carry carbon dioxide from tissues to lungs
Anemia Skin Manifestations
Pallor
Decreased Hgb
Decreased blood flow to the skin
Jaundice
Increased concentration of serum bilirubin
Itching
Increased serum and skin bile salt concentrations
Anemia
Cardiopulmonary Manifestations
Result from heart and lungs trying to provide
adequate O2 to tissues
Cardiac output maintained by increasing heart
rate and stroke volume
Low blood viscosity contributes to systolic
murmurs and bruits
Angina, MI, and heart failure may occur
Anemia
Clinical Problems
Fatigue
Nutritionally compromised
Inadequate tissue perfusion
Anemia Interventions
Acute interventions may include blood transfusions,
drug therapy (e.g., iron supplements), and O2 therapy
Patients with fatigue
Alternate rest and activity
Prioritize activities
* Accommodate energy levels
* Maximize O2 supply for vital functions
Aid to minimize risk of injury from falls
Monitor cardiorespiratory response
Evaluate nutrition needs
Anemia
Gerontologic Considerations
Anemia is not normal
Healthy older adults have a modest decline in Hgb of
about 1 g/dL after age 70
Often related to an underlying cause
* Iron deficiency, bleeding, chronic disease, renal problems
Signs and symptoms may be overlooked
Other health issues
May be mistaken for normal aging
Anemia
Decreased RBC Production
RBC production (erythropoiesis) is in equilibrium
with RBC destruction/ loss
Balance ensures that adequate number of RBCs
is always available
RBC Production
Life span of an RBC is 120 days
-3 problems that lead to decreased RBC production:
Decreased Hgb synthesis
Defective DNA synthesis in RBCs
Diminished availability of RBC precursors
Iron-Deficiency Anemia
Most common nutrition disorder in the world
**Most susceptible
Very young
Poor diet
Women in reproductive years
Inadequate diet intake
Normally diet intake is enough
Need more with menstruation, pregnancy
Malabsorption
Iron absorption occurs in the duodenum
Diseases or surgery that alter, destroy, or remove
absorption surface of this area of intestine cause
anemia
Blood loss
Major cause of iron deficiency in adults
Chronic blood loss most commonly through GI and
GU systems
* GI bleeding often not apparent
* May take time to identify
Postmenopausal bleeding, chronic kidney disease,
and dialysis may contribute
Iron-Deficiency Anemia Clinical Manifestations
General manifestations of anemia
Pallor is most common
Glossitis is second
* Inflammation of tongue
Cheilitis is also found
* Inflammation of lips
Headache, paresthesias
Diagnosing Iron-Deficiency Anemia
Laboratory findings
Hgb, Hct, MCV, MCH, MCHC, reticulocytes, serum
iron, TIBC, bilirubin, platelets
Stool occult blood test
Endoscopy and colonoscopy
Bone marrow biopsy
Iron-Deficiency Anemia Drug Therapy
Oral iron
Inexpensive
Convenient
Factors to consider
* Enteric-coated or sustained-release capsules are
counterproductive
* Daily dose is 100 to 200 mg
Factors to consider
* Best absorbed in an acidic environment
Vitamin C or orange juice
* Undiluted liquid iron may stain teeth
Should be diluted and drank through a straw
* Side effects
Heartburn, constipation, diarrhea
Parenteral iron
Indicated for malabsorption, oral iron intolerance,
need for iron beyond normal limits, poor patient
compliance
Can be given IM or IV
* Give IV test dose and observe for anaphylaxis
IM may stain skin
* Z-track
Thalassemia
Etiology
A group of diseases involving inadequate production
of normal Hgb
Results in decreased RBC production
Due to absent or reduced globulin protein
Abnormal Hgb synthesis
Hemolysis occurs
Autosomal recessive genetic basis
1 thalassemic gene
Thalassemia minor
2 thalassemic genes
Thalassemia minor
Thalassemia major
Thalassemia Clinical Manifestations
Thalassemia minor (Thalassemia trait)
Often asymptomatic
Mild to moderate anemia
* Microcytosis (RBCs are smaller than normal), hypochromia (RBCs have less hemoglobin than normal and are paler under microscope)
* Mild splenomegaly (slight enlargement of the spleen), bronzed skin color, and bone
marrow hyperplasia (increased production of bone marrow cells, reactive to anemia)
Body adapts to reduction of Hgb—thus no treatment
is indicated
Thalassemia major
Life-threatening disease
Growth and developmental deficits
Jaundice is prominent
Splenomegaly (enlarged spleen), hepatomegaly (enlarged liver), cardiomyopathy (group of diseases that make it harder for heart to pump blood, can lead to heart failure)
Symptoms develop in childhood
Bone marrow responds to the reduced O2-carrying
capacity of the blood by increasing RBC production
Marrow becomes packed with immature erythroid
precursors that die
Chronic bone marrow hyperplasia
Cardiac complications from iron overload, lung
disease, HTN
Endocrine problems, thrombosis (blood clot)
Thalassemia Care
Thalassemia major
Blood transfusions or exchange transfusions with
chelating agents that bind to iron to reduce iron
overloading
luspatercept-aamt (Reblozyl), may be given
subcutaneously every 21 days.
* Improves hemoglobin levels and reduces transfusion needs.
* Blocks inhibitors of late-stage RBC production
Splenectomy
Hematopoietic stem cell transplantation (HSCT) is the
only cure
Megaloblastic Anemias
Characterized by abnormally large RBCs
(megaloblasts)
caused by impaired DNA synthesis, resulting in
defective RBC maturation
Majority result from deficiency in
-Cobalamin (vitamin B12)
-Folic acid
Cobalamin Deficiency
Etiology
Cobalamin deficiency, also known as vitamin B12 deficiency, can lead to a range of hematological and neurological disorders. One of the most common causes of cobalamin deficiency is pernicious anemia, which is an autoimmune condition characterized by the following features:
Caused by Absence of Intrinsic Factor (IF)
-body’s inability to produce intrinsic factor (IF), a protein secreted by the stomach lining. Intrinsic factor is essential for the absorption of vitamin B12 (cobalamin) in the small intestine. Without intrinsic factor, vitamin B12 cannot be effectively absorbed, leading to deficiency
-Insidious onset - gradual, therefore tougher to diagnose
-begins in middle age or later
-Predominant in Scandinavians and Blacks
Cobalamin deficiency can result from a variety of factors other than pernicious anemia, including dietary insufficiency (common in strict vegetarians and vegans since B12 is primarily found in animal products), gastrointestinal surgeries, certain medications, and gastrointestinal disorders that affect B12 absorption. Regardless of the cause, cobalamin deficiency can lead to significant hematological abnormalities, such as megaloblastic anemia, and neurological complications, including neuropathy and cognitive disturbances.
Can also occur:
Surgery or chronic diseases of the GI tract
Excess alcohol or hot tea intake
Smoking
Long-term users of H2 histamine receptor blockers
and proton pump inhibitors
Strict vegetarians
Familial predisposition
Cobalamin Deficiency
Clinical Manifestations
General manifestations of anemia develop slowly
due to tissue hypoxia
GI problems:
* Sore, red, beefy, and shiny tongue, anorexia, nausea,
vomiting, and abdominal pain
Neuromuscular problems:
* Weakness, paresthesias of feet and hands, decreased
vibratory and position senses, ataxia, muscle
weakness, and impaired cognition
Cobalamin Deficiency
Diagnostic Studies
Macrocytic RBCs have abnormal shapes and
fragile cell membranes
Serum cobalamin levels are low
Normal serum folate levels and low cobalamin
levels suggest megaloblastic anemia is due to
cobalamin deficiency
Upper GI endoscopy with biopsy of gastric
mucosa to rule out gastric cancer
Cobalamin Deficiency Treatment
Parenteral or intranasal administration of cobalamin
is treatment of choice
Patients will die in 1 to 3 years without treatment
Anemia can be reversed with ongoing treatment but
long-standing neuromuscular complications may not
be reversible
Megaloblastic Anemia
Folic Acid Deficiency
Causes megaloblastic anemia
Folic acid is needed for DNA synthesis
RBC formation and maturation
Manifestations are similar to cobalamin deficiency,
but if neurologic symptoms present, may be caused
by thiamine deficiency
Common causes include
Diet deficiency, malabsorption syndromes
Alcohol use and anorexia
Loss during hemodialysis
Folic Acid Deficiency
Serum folate level is low
Normal is 5 to 25 ng/mL (11 to 57 nmol/L)
Serum cobalamin level is normal
Treated with replacement therapy
Usual dose is 1-5 mg/day by mouth
Encourage patient to eat foods with large amounts
of folic acid
Anemia of Inflammation
Can be caused by
Cancer
Autoimmune and infectious disorders
* HIV, hepatitis, malaria
Chronic inflammation
Heart failure
Bleeding episodes
Associated with
Underproduction of RBCs
Mild shortening of RBC survival
* Normocytic, normochromic, and hypoproliferative RBCs
Usually develops after 1 to 2 months of disease
activity
Can become more severe if the underlying disorder
is not treated