Vascular - Anaemia

Question 1

Anaemia

Answer 1

• deficiency in the number or quality of red blood cells
• leads to generalised hypoxia due to a decrease in the amount of O2 being carried which leads to not enough O2 getting to cells
• is a symptom of other conditions, not a disease

Question 2

Anaemia - Types

Answer 2

• iron deficiency
• folate deficiency
• pernicious
• haemolytic
• aplastic

Question 3

Iron Deficiency Anaemia - Causes

Answer 3

• causes
  
  • dietary deficiencies
  • decreased absorption
  • increased metabolic requirements
  • blood loss
  • chronic haemoglobinuria (the presence of haemoglobulin in urine)

Question 4

Iron Deficiency Anaemia - Characteristics

Answer 4

• characteristics
  
  • low Hb (haemoglobin)
  • low haematocrit (percentage of RBC to total blood)
  • decreased iron stores
  • low serum iron & ferritin levels
  • RBC are reduced in number & are microcytic & hypochromic

Question 5

Iron Deficiency Anaemia - Clinical Manifestations

Answer 5

• pale skin, mucous membrane, conjunctiva & nail beds
• fatigue, tires easily
• palpations, tachycardia, possible angina
• tachypnoea, dyspnoea on exertion
• headaches, night cramps
• severe
• brittle, spoon shaped nails
• cheilosis, sore, smooth tongue
• Pica
• bone pain
• ventricular hypertrophy

Question 6

Iron Deficiency Anaemia - Investigations

Answer 6

• history
• physical presentation
• FBE, se iron
• gastroscopy / colonoscopy
• faecal occult blood

Question 7

Iron Deficiency Anaemia - Treatment

Answer 7

• locate the cause
• stop blood loss if present
• iron replacement
  
  • supplements (IV, IM, oral)
  • diet

Question 8

Megaloblastic Anaemia

Answer 8

• due to abnormal nucleic acid synthesis that results in enlarged RBC & deficient nuclear matruation
• pernicious anaemia
• folic acid deficiency anaemia

Question 9

Folic Acid Deficiency Anaemia

Answer 9

• folic acid is necessary for DNA production & RBC production & maturation, rely on dietary intake
• causes - inadequate dietary intake, increased metabolic requirements, folic acid malabsorption & impaired metabolism
• clinical manifestations - diarrhoea, nausea, anorexia, glossitis (inflamed tongue), cheilosis (cracks in side of mouth)
• treatment - diet, supplements

Question 10

Pernicious Anaemia

Answer 10

• caused by malabsorption of B12, which is due to intrinsic factor which is required for B12 to be absorbed across the gut (small intestine)
• B12 is necessary for synthesis of DNA, lack of B12 causes impairment of cellular division & maturation
• clinical manifestations - parasthesias of feet & fingers (anything that alters usual sensation), difficulty walking, ataxia & spasticity (if severe), anorexia, abdo pain, weight loss, sore, smooth, red tongue, enlarged liver, enlarged spleen, skin may be “lemon yellow”

Question 11

Haemolytic Anaemia

Answer 11

• caused by premature, accelerated destruction of erythrocytes & occurs when RBC are considered “foreign”, meaning RBC’s don’t last 120 days
• occurs in spleen, blood vessels or liver, to compensate bone marrow production increases & body retains iron & other products of Hb destruction
• causes - RBC cell-membrane defects, haemoglobin structure defects, inherited enzyme defects, drugs, chemicals, transfusion reactions, mechanical factors (prosthetic heart valves), toxins & venoms, infections, trauma, severe burns, renal disease

Question 12

Sickle Cell Disease

Answer 12

• chronic disorder resulting in anaemia, pain & organ failure due to vessel occlusion
• caused by abnormal HbS which upon deoxygenation turns the RBC a sickle shape

Question 13

Thalassaemia

Answer 13

• group of inherited disorders of Hb synthesis due to absent or defective synthesis of the alpha & beta chains of adult Hb
• beta - microcytosis & anaemia
• characterisation - severe anemia, ineffective production of RBC & haemolysis
• management - regular transfusions (have to replace RBCs)
• complications - organ dysfunction due to iron overload due to transfusions
• require regular chelation therapy

Question 14

Haemolytic Anemia

Answer 14

• abnormal breakdown of RBCs, bone marrow is unable to replace RBCs
• clinical manifestations - enlarged spleen, haemoglobinuria, may have jaundice & if severe, deformed bones & pathological fractures
• treatment - removing the cause, treating the underlying disorder, fluid & electrolyte replacement, splenectomy, steroids

Question 15

Aplastic Anaemia (Bone Marrow Depression)

Answer 15

• bone marrow fails to produce RBCs, WBCs and platelets, and there is fatty replacement of bone marrow
• anaemia occurs as bone marrow fails to replace RBCs as they are destroyed, have pancytopaenia (reduction of cells created by bone marrow)
• causes - idopathic (unknown cause), injury to stem cells in marrow, radiation, chemicals, toxins, medications
• clinical manifestations - general signs of anemia, bleeding problems, increased risk of infection (decrease in neutrophils)
• diagnosis - blood tests, bone marrow biopsy
• treatment - stem cell replacement by bone marrow or peripheral blood transplation, immunosuppressive therapy, blood transfusions to correct anemia, corticosteroids to minimize bleeding

Question 16

Nursing Management of Anemia

Answer 16

• focus on
  
  • patients response to decrease in circulating oxygen and tissue oxygenation
• nursing problems include
  
  • activity intolerance
  • risk of decreased cardiac output
  • nutritional deficiencies
  • altered oral mucous membrane
  • self care defecits (assess ability, assist, space ADL’s)