Monica - Week 2 - Exam 1 Flashcards
why do we make new RBCs every day?
because we have to replace the ones that die during normal processes or are destroyed due to illness.
where is red bone marrow and where it is found?
it is the red spongy tissue found in the middle of bone.
what is red bone marrow needed for?
hematopoiesis
what is hematopoiesis?
the production of stem cells, which are immature blood cells made in the red bone marrow.
Stem cells have the ability to ________?
differentiate, meaning become more specific
what are the 3 type of cells that stem cells can differentiate into?
RBCs, WBC, and platelets
Hematopoesis requires which 4 nutrients to make healthy functional blood cells?
Protein, B12, Iron and Folic acid
T/F. When deficient in any of these nutrients, we may not make healthy functional blood cells.
TRUE. they may be large, immature, or smaller than they need to be.
Hematopoeisis occurs in response to what?
regulatory hormones, like erythropoietin which is released by the kidneys
what is erythropoiesis?
the production of red blood cells and hemoglobin
what is erythropoiesis regulated by?
it is regulated by erythropoietin, which is 90% secreted by the kidney
how do the kidneys know when to secret more erythropoietin?
kidneys are stimulated by hypoxia – not enough oxygen; so they secret erythropoetin → travels to the bone marrow and interacts with stem cells to make more RBC → reverse hypoxia
T/F without hemoglobin the RBC can still be functional
FALSE. the RBC needs hemoglobin for O2/CO2 transport
Hemoglobin has 4 ______ and 1 _______.
four globulin chains; 1 heme molecule
Why is the heme important?
In the heme is the IRON - IRON transports oxygen in the blood; gives RBCs the red color
what are the two different definitions of anemia?
Anemia is a deficiency in the number of RBC; Also can be a deficiency in the quality and quantity of hemoglobin
Anemia is a sign of what?
sign of underlying disorder rather than disease process
Patients with anemia have a diminished capacity to deliver _____ to the body’s tissues?
OXYGEN
what are the s/sx of mild anemia?
mild anemia may be asymptomatic
what are the s/sx of moderate to severe anemia?
fatigue, weakness, pale skin, cold hands/feet, dizziness, headache, exercise intolerance, SOB, possibly cognitive problems d/t ↓ O2 to the brain, and chest pain d/t ↓ O2 to the ♥
what are the two characteristics of epoietin alfa?
blood forming agent and serves as a hematopoietic growth factor
what is the purpose of epoietin alfa?
the purpose is to elevate RBC count and create hemoglobin
what forms is epoietin alfa available in?
IV and SubQ
what are the two things that a patient is going to need for this drug to be effective?
functional bone marrow and sufficient/adequate iron stores needed to produce functional RBCs
when is this drug contraindicated and why?
not indicated for emergent anemia because this drug has an onset of 1-2 weeks
epoietin alfa may prevent those with chronic anemia from getting ____?
blood transfusions
review: where do we store our iron?
we store it in our liver as ferritin
if iron stores aren’t adequate, a patient may need _______?
iron supplementation
what are the indications of epoietin alfa?
anemia associated with stage 4/5 CKD and chemotherapy
what is the adverse effect of epoietin alfa?
hypertension - occurs in 30% of patients - may have to take an antihypertensive
what is the black box warning for epoietin alfa?
↑ risk of CV events and thromboembolic events`
what are the nursing implications for epoietin alfa?
- assess BP, Hgb, Hct
- do not initiate if Hgb greater than or equal to 10
- monitor for thromboembolic events
what is MCV?
mean corpuscular volume
what does mean corpuscular volume measure?
the average size of RBC
what is the normal range for MCV?
80-100 femtoliter
T/F: A MCV of < 80 is considered to be microcytic, while a MCV of > 100 is considered to be macrocytic
TRUE
Microcytic cells indicate which type of deficiency?
Iron deficiency
Macrocytic cells indicate which type of deficiency?
B12 or Folate deficiencies
what is MCH?
mean corpuscular hemoglobin
what does mean corpuscular hemoglobin measure?
the weight of hemoglobin within the cell
what is the normal range for MCH?
27 - 34 picograms
what does less than 27 pg mean?
less hemoglobin weight - microcytic - iron deficiency
what does more than 34 pg mean?
more hemoglobin weight - macrocytic - B12/Folate deficiency
what is MCHC?
mean corpuscular hemoglobin concentration
what does mean corpuscular hemoglobin concentration measure?
it measures the average concentration of hemoglobin in each RBC (the proportion of RBC taken by Hgb)
what is the normal range of MCHC?
32% - 36%
a RBC with a MCHC of 32 - 36% is considered to be ________?
normochromic - normal color
a RBC with an MCHC of < 32% is considered to be _______?
hypochromic - pale in color - iron deficient
how is a macrocytic - normochromic cell defined? what type of anemia would this indicate?
large RBC with a normal hemoglobin concentration - indicates folate anemia, B12 anemia, or pernicious anemia
how is a microcytic - hypochromic cell defined? what type of anemia would this indicate?
small RBC with decreased hemoglobin concentration - indicated iron deficient anemia
review: iron needs what kind of environment for absorption?
an acidic environment (at risk: elderly and chronic antacid users)
Iron is essential for ______ formation.
hemoglobin - 60-80% associated with hemoglobin in RBC to help us transport O2
T/F free iron is toxic to our body
TRUE; needs to bind to protein (ferritin)
What two characteristics determine iron deficiency anemia?
low serum iron levels and low serum ferritin levels
what do the cells of an iron deficiency anemia patient look like?
microcytic and hypochromic
list good sources of iron
liver, red meats, fish, fortified cereals, lima beans, leafy veggies, dried fruit,
who is majority at risk for iron deficiency anemia d/t dietary needs?
vegans and vegetarians
What are the s/sx of iron deficiency anemia?
anemia sxs, SORE TONGUE, BRITTLE NAILS, “CRAWLING FEELING IN LEGS” AND CAN DEVELOP RESTLESS LEG SYNDROME
how is an iron supplement chosen?
there are varying types or iron salts and elemental iron; based on amount needed and GI tolerance
when is iron best absorbed?
1 hour before or two hours after a meal - absorption can ↓ by 33 - 50% when taken concurrently with food
what are the adverse effects of iron supplement?
N + V, constipation, stomach cramps, abdominal discomfort
what is a common AE that we should educate patients about?
Iron supplements may turn stools dark green or black d/t iron being excreted
what decreases the absorption of iron?
antacids and calcium
what increases the absorption of iron
vitamin C - OJ, tomato juice - 30% ↑
why is B12 needed for in the body?
rapid and normal production of RBCs, cell maturation, normal cell division, and DNA replication
how is B12 important to neuromuscular conduction?
it helps maintain healthy nerve cells and is used to preserve the myelin sheath of nerves
review: how is B12 absorbed?
B12 needs to form a complex with intrinsic factor. Intrinsic factor is secreted by the parietal cells in the stomach.
if there is a deficiency in B12, which type of anemia is it?
megaloblastic anemia, which includes large, immature cells that have a diminished lifespan)
what dietary sources is B12 found in?
animal sources - chicken, fish, poultry, milk, cheese, eggs, fortified foods
who is at risk for B12 deficiency?
strict vegans and vegetarians
what’s the difference between B12 deficiency anemia and pernicious anemia?
B12 anemia is r/t the lack of the nutrient (vegans/vegetarians)
Pernicious anemia is r/t the fact that we aren’t absorbing B12 d/t the lack of intrinsic factor.
pernicious anemia is what type of anemia?
megaloblastic; d/t lack of intrinsic factor
what type of conditions can cause a lack of intrinsic factor?
gastric bypass, GI chronic inflammation disorders, and autoimmune disorders (antibodies block the complex binding of IF and B12) (ciliac disease)
Why are parenteral doses of B12 effective
because B12 is going directly into the blood stream; doesn’t need to bind with IF
what are the B12 deficiency sxs?
anemia sxs, numbness in the fingers and toes
what are the pernicious anemia sxs?
anemia sxs, numbness/tingling in hands/feet, loss of balance, confusion, memory loss, mood disturbances MORE NEUROLOGICAL - POTENTIALLY FATAL IF NOT TX
what forms are B12 - cyanocobalamin available in?
PO, SubQ, IM, topical, nasal
why is PO contraindicated for patients that have malabsorption issues? who should take PO?
because they won’t be absorbed; they should be used for those with dietary problems and have IF present, like vegans s
what is parenteral cyanocobalamin used for?
patients with pernicious anemia
What is the initial treatment and the follow up treatment for pernicious anemia?
initial tx: parenteral tx
follow up after remission from CNS involvement (n + t, etc): nasal spray or topical
T/F: those with pernicious anemia will have life long B12 replacement and periodic testing
TRUE; N+T may never resolve
why is folate important for the body?
needed for cell division, the production of new cells (RBC, WBC, and Platelets), maturation of cells, and aids in the production of heme
how long is folate stored in the liver?
3-6 months
which anemia is folate deficiency?
megaloblastic anemia
what are dietary sources of folate?
fortified cereals, grains, dark green leafy veggies, citrus fruits, and dried beans
what is another condition that interferes with folate?
alcoholism interferes with folate metabolism in the liver
what are the causes of folate deficiency?
insufficient dietary sources and alcoholism
what are the sxs of folate deficiency?
similar to B12 without neurologic signs, anemia sxs, BEEFY RED TONGUE, sore tongue
what is the treatment for folate deficiency
↑ dietary intake and folic acid supplement
what are 7 different chronic diseases that cause anemia?
- autoimmune disease (lupus - attacks healthy cells)
- alcoholism (interferes with folate metabolism - immature cells)
- inflammatory bowel disease (crohn’s - interferes with nutrient absorption)
- gastric resection (lack of IF → pernicious anemia)
- liver disease (unable to store iron or folic acid - underproduction of RBC)
- chronic kidney disease ( suppression of erythropoietin)
- osteomyelitis (bone marrow impairment)
what is neutropenia?
reduction in neutrophils, type of wbc that help fight against bacterial and fungal infections; predisposes pt to opportunistic pathogens
what is the range for neutropenia?
absolute neutrophil count < 1000 cells/mcl
T/F neutropenia has to do with life threatening infections with low absolute neutrophil count
TRUE
how do you calculate ANC?
WBC x (% of neutrophil +% of bands)
what does it mean if ANC is less than 1000?
risk of infection; assess for temp > 100.4
what are the causes of neutropenia?
chemotherapy, bone marrow depression, radiation
what is filgrastim?
colony stimulating factor; stimulates neutrophils to grow and mature by binding to receptors on stem cells and asking the to become, divide, and mature into functional neutrophils.
continued filgrastim therapy is based on what?
based on ANC - D/C once ANC > 10,000 cells/mm3
what are adverse effects of filgrastim?
medullary bone pain (bone marrow ↑ stem cells), acute respiratory distress (SOB, tachypnea)
what is the goal of filgrastim?
to raise neutrophil count
