Week 4 Anemia Flashcards
Reduction in number of RBCs, HgB and therefore lowered Hct- decreased ability to carry oxygen
Anemia
Garbage disposal of the RBCs
Spleen
Mechanical Heart Valve ca cause what?
Physical damage to RBCs
What causes anemia?
Iron
vitamin b12
folate deficiency
decreased erythropoietin
Cancer
Excess destruction of RBCs
Hemolytic
Caused by altered erythropoiesis, or other causes such as hypersplenism, drug induced, or auto immune processes, mechanical heart valves
Also caused by blood loss
Defect in production in RBCs
Hypoproliferative
Anemias
Lower than normal hemoglobin and fewer than normal circulating erythrocytes: sign of underlying disorder
Chewing or eating things with no nutritional value
Pica
ex chewing or craving ice
Pagophobia
Associated with iron deficiency anemia
Manifestations of Anemia
Depend on the rapid development of the anemia, metabolic requirements of the patient, concurrent problems, and concomitant features
Fatigue
Weakness, Malaise
Pallor, Jaundice
Cardiac and Respiratory Problems
Tongue and/ or nail changes
Pica
Manifestations of Anemia
Nail changes are known as
Koilonychia
Tongue changes are known as
Glossitis
Angular Cheilitis
Diagnostic Testing for Anemia
HgB testing- Carries o2 and Co2 and heps maintain RBC
HgB conists of
2 Alpha- globulin chains and 2 beta- globulin chains
Each globulin contains a what that contains what?
Heme; iron
What is Fe responsibility?
Iron responsible for carrying 02 and CO2
Fe gives RBCs their color
Hct is
Volume % of RBC in the blood
Term H and H is for Hemoglobin and Hematocrit
Reticulocyte Count is
Immature RBCs
RBC indices are part of
CBC
MCV
Mean Corpuscular Volume
- avg. RBC volume- size
(Low means RBCs are small and microcytic)
MCH
Mean Corpuscular HgB
Avg. mass of HgB per RBC
-Low in hypochromic anemias
MCHC
Mean Corpuscular Hgb Concentration
- Avg. concentration of Hbg inside a RBC
High Levels indicate macrocytic anemia- can be caused by Vit. B12 deficiency
Pernicious Anemia
Can’t absorb Vit. B12 effectively
Diagnostics of Anemia
Iron Studies- ability to carry O2
Vitamin B12- assist in formation of RBCs- enlarged and ova(macrocytic)
Folate- important for DNA synthesis- low causes macrocytic anemia
Schilling- Test for absorption of vit. b12 in intestines- test for pernicious anemias
Sickle Cell- Genetic most dominant in African Americans
Bone marrow aspiration- needed for aplastic anemia- bone marrow does not produce sufficient amount of RBCs
Iron Deficiency Anemia
Transferrin and Soluble Transferrin- Increased
Iron, Transferrin and Transferrin Saturation- Decreased
Anemia of Chronic Disease
Decrease in
Iron, Transferrin, transferrin saturation, ferritin soluble
Soluble transferring is normal- increased
Iron Studies used for
Transferrin, Ferritin, Iron
Folates
Assists in production of DNA, cellular replication
Schilling Test
Determines if absorbing adequate vitamin B12
Sickle Cell
Misshaped RBCs
Bone Marrow Aspiration
Diagnose aplastic anemia
Medical management
Correct and control the cause
Transfusion of PRBCs
Tx to specific anemia
Dietary therapy
Iron or Vitamin supplementation
Transfusions
Immunosuppressive
Other
Rightward Shift of ODC
Leftward shift of ODC
Assessment of Pt of Anemia
Health History and Physical Exam
Lab Data
Presence of symptoms and impact those symptoms on pt’s life, fatigue, weakness, malaise, pain
Nutritional Assessment
Medications
Cardiac and GI assessment
Blood Loss, menses, potential GI loss
Neurologic Assessment - Mentation changes due to lack of O2 carrying capacity
Pt with Anemia Nursing Dx
Fatigue
Activity Intolerance
Altered Nutrition
Altered Tissue Perfusion
Delayed Surgical Recovery
Impaired comfort
Deficient Knowledge
Risk for injury
Road Test Patient
While Patient walks or performs an activity - attach pulse oximetry and monitor SpO2
Interventions of Pt with Anemia
Balance physical activity, exercise, and rest
Maintain adequate nutrition and perfusion
Pt education to promote compliance with medications and nutrition
Monitor VS and pulse oximetry, provide supplemental oxygen
Monitor potential complications
Collaborative Problems
Heart Failure
Angina
Paresthesia - Tingling pins and needles
Confusion
Injury Related to Falls
Depressed Mood
Underproduction of RBCs by the bone marrow
Hypo proliferative Anemia
broadly refers to anemia
unusually large, structurally abnormal, immature RBCs
Megaloblastic Anemia
Megaloblasts
Cobalamin
Vitamin B12
Nutrient that keeps the body’s nerve and blood cells healthy and helps make DNA
Low iron in diet or malabsorption of nutrients
Iron deficiency Anemia
Anemia in Renal Disease
Deficiency in erythropoietin release
Aplastic Anemia
Deficiency in new RBC production
Megaloblastic Anemia
Caused by folic acid deficiency
Caused vitamin B12 deficiency
Disorder in which RBC are destroyed faster than they can be made
Hemolytic Anemia
Destruction of RBCs is called hemolysis
Thalassemia
Abnormal Hgb
-Mutation to beta- globulin
- Hereditary
Glucose 6- phosphate dehydrogenase deficiency
Enzyme protects RBCs from cell damage
- Hereditary
- Exacerbated by stress or medications
Immune hemolytic Anemia
Antibodies attack RBCs
Hereditary Hemochromatosis
Over absorption of Fe
Damages liver, tissues, and joints
Beta Thalassemia
Reduces production of hemoglobin
RF: Race and family history
Caused by defect in beta globulin chains
S/S: Pale skin, weakness, fatigue, and iron overload symptoms
Dx; Blood work up
Tx: severe cases involve transfusion therapy, iron chelation and splenectomy
Complications: Anemia, Blood clots, and spleen enlargement
Prognosis- Depends on clinical type and nature of long term Tx
Autoimmune Hemolytic Anemia
Disorder characterized by antibody production against own blood cells
- Shortening of RBC from months to few days
RF- Systemic lupus, rheumatoid arthritis, Crohns Disease, and Ulcerative Colitis
S/S: Fatigue, Pallor, breathing, dark urine, chills and backache
Dx: By blood investigation
Treated: Steroids, immunosuppression, and blood transfusion
Complications: Autoimmune disorders, weakness and spleen enlargement
Px: Worse in older adults
Sickle Cell Anemia Manifestations
Sickle Cell Crisis
Acute Chest Trauma
Pulmonary HTN
Assessment and Dx findings
Overall Life Expectancy reduced by 20-30 years
Medical Management
Pt with Sickle Cell Anemia Assessment
Health Hx and Physical Exam
Pain Assessment
Lab Data - S shaped Hemoglobin, Sickle Shaped RBCS
S/S- Swelling, fever, chronic pain,
Sickle Cell Crisis Assessment
- Determine how long Pt attempted to self manage symptoms
Early and aggressive hydration
Blood Loss: menses, potential GI loss
CV and Neurological Assessment- Hemodynamically stable- ability to oxygenate cells
Major Features and Symptoms of Sickle Cell Anemia
Fatigue and anemia
Pain Crisis
Dactylitis- swelling and inflammation of the hands/ feets
Arthritis
Bacterial Infections
Sudden pooling of blood in the spleen and liver congestion
Lungs and Heart injury
Aseptic Necrosis and bone infarcts- Death portions of bone
Eye Damage
Pt Sickle Cell Anemia Interventions
Hydration
Pain Management
Manage Fatigue
Infection Prevention
Promote Coping
Education of Disease
Monitor for Complications
Aplastic Crisis
Suppression of RBCs due to infection
Sickle Cell Tx
HOP
h- Hydration and Electrolytes
o- Oxygen and bed rest
p- Pain relief
Blood and Blood Products
Directed- Family and Friend donated blood
Standard- one pin tof blood that goes any pat
Autologus- donated blood to self for planned surgery
Pre Transfusion Assessment
Always obtain PT consent
Type and Cross match
Determine Blood type
Pt education
Transfusion Reactions
S+S
PRBCs
Made from a unit of whole blood by centrifugation and removal of plasma
Leaving the unit with about 60%
Used to treat Anemia or hemorrhage
FFP
Contains all factors of the soluble coagulation system
Clotting factors
Cryoprecipitate
Contains all concentrated subset of FFP components including VIII coagulant, vonwillebrand factor, and factorXIII( clotting factors)
Platlets are used to treat
Thrombocytopenia
Group O can donate to
Anyone
AB is the … recipient
Universal recipient
Febrile Transfusion Reaction
1 degree in temperature change
May have chills and malaise
Tx: Acetaminophen
Most common
Hemolytic Reaction
Fever, chills, and pain at the site of reaction, nausea and vomiting, shock, dark urine
Tx: Stop transfusion, lots of IV fluids +/- diuretics
Worst Reaction often blood compatibility issue
