RBC Disorders Flashcards
Role of Hemoglobin
-reversibly binds oxygen and CO2 for transport
-adequate Hgb necessary for oxygen delivery to the tissues
diseases of red blood cells
-relate to either quantity or quality
-all diseases of RBC’s mean less oxygen is able to be transported to the tissues
macrocytic-normochromic
-large, abnormally shaped erythrocytes
-hemoglobin concentrations normal
-B12 and folate deficiencies
microcytic-hypochromic
-small, abnormally shaped cells
-reduced hemoglobin concentrations
-Iron-deficiency
normocytic-normochromic
-normal size
-normal hemoglobin function
-blood loss, sickle cell, aplastic anemia
iron is essential for
normal hemoglobin function
folate and vitamin B12 are necessary for
normal DNA synthesis of RBC’s
normal Hemoglobin level
women: 12-16 g/dL
men: 14-18 g/dL
lab values in anemia: mild
hgb women: 10-12 g/dL
hgb men: 10-13.5 g/dL
lab values in anemia: moderate
hgb: 8- <10 g/dL
lab values in anemia: severe
hgb: <8 g/dL
clinical manifestations of ALL anemias
-decreased oxygen carrying capacity
-mild-may have no symptoms
-moderate: fatigue, weakness, tachycardia, dyspnea
-severe: increased HR and RR, hypotension, pallor, faintness, CV symptoms
iron deficiency anemia: etiology
-most common anemia
-decreased intake of iron
-impaired absorption of iron
-increased demand for iron
-excessive loss (GI bleed, menstruation, etc.)
iron deficiency clinical manifestations
-general s/s of anemia plus:
-smooth tongue/glossitis/mouth ulcers/cheilosis
-koilonychia “spoon nails”
-pica- craving non food items (ice mainly)
anemia from B12 deficiencies
also called megaloblastic /macrocytic
megaloblastic anemia
-condition in which the bone marrow produces unusually large, structurally abnormal, immature RBC’s
-leading cause is B12 and folic acid deficiency
-most common in the elderly
causes of anemia r/t deficiency of vitamin B12
-atrophic gastritis- stomach lining has thinned
-conditions that affect the small intestine, such as Crohn’s, celiac, bacterial growth, or a parasite
-autoimmune disorder-pernicious anemia (most common cause)
manifestations specific to B12 deficiency
-s/s of anemia plus:
-neuropathy
-ataxia
-glossitis
-dementia/psychosis
anemia r/t folate deficiency
-folate is a B9 vitamin that is needed for RBC formation
-problem with decreased intake (alcoholism, diet, cirrhosis)
-increased need (pregnancy)
anemia of CKD
-main etiology: impaired erythropoietin production
-hgb/hct correspond with the degree of kidney insufficiency
-clinical manifestations: general s/s of anemia
aplastic anemia
-primary condition of bone marrow stem failure
-autoimmune most common cause
-classified as: congenital or acquired
-characterized my PANCYTOPENIA
-treatment: blood transfusions, bone marrow transplant, immunosuppressants, corticosteroids, drugs to stimulate erythropoiesis
causes of aplastic anemia
-idiopathic
-high dose exposure to toxic agents
-autoimmune mechanisms
increased destruction of RBC’s
-abnormal hemoglobin: acquired hemolytic anemia; sickle cell anemia; thalassemia
acquired hemolytic anemia
premature destruction of RBC’s caused by some external agent
causes of acquired hemolytic anemia
-autoimmune attack
-blood incompatibilities
-drug reactions
hemolytic anemia
-formation of immune complexes
-lysis
-look for: low hgb, increased reticulocyte count, mild jaundice, hemoglobinuria
anemia r/t abnormal hemoglobin
-sickle cell diseases
-thalassemia
sickle cell anemia
-genetic disorder
-inability to bind hemoglobin normally
-hemoglobin S distorts shape, especially when oxygen is low
-easily clog blood vessels and break into pieces that disrupt blood flow leading to ischemia and necrosis
clinical manifestations: sickle cell anemia
-s/s general anemia
-swelling of hands and feet with a fever
-painful episodes/crisis from ischemia and necrosis from clogged vessels
-crisis triggers: dehydration, stress, high altitude, fever, extreme temps
sickle cell anemia treatment
-oxygen therapy
-hydration
-pain management
-infection control measures
-antimetabolite drug: hydroxyurea
-blood transfusions
-bone marrow transplants
thalassemia
-genetic- mostly mediterranean descent
-abnormal hgb makes erythrocytes microcytic, hypochromic, and of carrying size
-lack of one of two proteins that make up hemoglobin- alpha and beta globin
thalassemia treatment
-blood transfusions
-bone marrow transplants
-splenectomy
thalassemia clinical manifestations
-delayed growth
-fatigue
-dyspnea
-hepatomegaly (enlarged liver)
-splenomegaly (enlarged spleen)
-bone deformities
-jaundice
acute blood loss
-500 ml- sx are rare; possibly syncope
-1000 ml- increased HR with exercise
-1500 ml- flat neck veins when supine; increased HR with exercise; decreased bp when sitting up/standing
-2000 ml- increased HR, and decreased BP when supine; air hunger, cool, clammy skin
-2500 ml- shock and death
anemia due to blood loss
results from: gross or occult
-rate of blood loss is important- acute vs. rapid
disorder of too many RBC’s polycythemia risk factors
-chronic hypoxia
-living at high altitudes
-long term cigarette smoking
-familial and genetic predisposition
-long term exposure to CO2
relative polycythemia
-isolated decreased in plasma volume which elevates the Hgb, Hct, and RBC count
-etiology: severe dehydration
primary polycythemia
-polycythemia vera
-typically >60 years
-most often occurs in men
polycythemia vera patho
a single stem cell mutates into a cell that overproduces all blood cells except for the lymphocytes
polycythemia vera manifestations
-many complaints (headache, fatigue, weight loss, dyspnea)
-HTN
-clotting problems
-ruddy color
-intense/painful itching intensified by heat or exposure to water
-biggest concern is CV events- stroke/heart attack from clots
secondary polycythemia
-etiology: adaptive response to tissue hypoxia
-purpose: provide more oxygen carriers by increasing RBC production
secondary polycythemia manifestations
-increased blood viscosity and volume cause HTN (headache, inability to concentrate, dusky red coloring, possible cyanosis of lips, nails, mucous membranes
-hyper-metabolism causes: night sweats and weight loss
-increased RBC and h&h causes: itching and pain and fingers in fingers and toes
