Wk 1 Anemia Flashcards
What is the center of all hemoglobin molecules?
Iron
Hemoglobin reversibly binds to __ and __ for transport
oxygen and CO2
CO2 is a waste product and is usually in the form of
sodium bicarbonate in the plasma
What does hemoglobin bind to more readily than oxygen?
carbon monoxide
How is carbon monoxide poisoning treated?
100% oxygen and maybe ventilation
What permanently binds to hemoglobin?
Glucose
What is the lifespan of a RBC?
120 days / three months
Oxygen binds to __ on the hemoglobin molecule
heme
The more saturated with oxygen an RBC, the more
red it appears
Pulse oximetry looks at how __ the blood is
red
What is an absolute decrease in red blood cells?
Do not have enough number of red blood cells
What is a relative decrease in red blood cells?
Dilutional
Why does a pregnant woman have a relative decrease in red blood cells?
Plasma volume increases by 50%, but RBC count increases only 30%
What are two examples of relative decrease in RBCs?
Fluid volume overload and athletes
If someone is very dehydrated the could have a relative __ in RBCs
increase
Normal hematocrit = about
45%
Anemia hematocrit = about
30%
Polycythemia hematocrit = about
70%
8 causes of anemia
1) Inflammation
2) Neoplasia
3) Chronic disease
4) Marrow damage
5) Acute bleeding
6) Hemolytic anemia
7) Maturation disorders
8) Iron deficiency
What is the main cause in western culture of anemia?
Iron deficiency
What are hemolytic anemias?
Autoimmune diseases where our bodies attack our own RBCs and destroy them
What are maturation disorders?
Cells can’t carry oxygen effectively
With bone marrow damage you would also see a decrease in….
WBCs and platelets
Why does chronic kidney disease lead to anemia?
Kidneys are not secreting erythropoietin
What does erythropoietin do to red bone marrow?
Stimulates it to make red blood cells
What would someone with anemia look like?
Pale Fatigue quickly Hypotensive Tachycardia, especially with exertion Tachypnea
Why is someone with anemia tired?
Their muscles go into anaerobic metabolism due to the lack of oxygen, and create lactic acid and muscle fatigue
What are the symptoms of severe anemia?
Chest pain, angina, heart attack, worsening CHF, syncope
Anemia also has these neuro symptoms
Memory, cognition, insomnia
Moderate anemia symptoms
fatigue
weakness
tachycardia
dyspnea
Severe anemia symptoms
tachypnea
tachycardia
hypotension, pallor, faintness
cardiovascular symptoms, especially with exertion
What causes bone pain in a person with anemia?
Increased production of erythropoietin
Where is erythropoietin secreted?
Kidneys
An example of abnormal hemoglobin
sickle cell disease
Normal hematocrit for females
37-48
Normal hematocrit for males
45-52
With abnormal hemoglobin, the count of red blood cells would be __
normal
How do they test for abnormal shapes of red blood cells?
hemogram
Two examples of abnormal hemoglobin pathologies
Sickle cell anemia and Thalassemia
Misshapen RBCs have a __ life span
shorter
With sickle cell anemia, hemoglobin tend to become distorted and this occurs under __
stress
What are examples of stressors that can cause someone with sickle cell anemia to have misshapen hemoglobin
Infection, dehydration, hypoxia, anything that can cause stress on the body
RBCs can go back to their normal shape, so…
they can sickle and then return to the round shape
What is thalassemia?
A genetic disorder that causes defective hemoglobin, and hemolysis
Where are defective cells destroyed (in thalassemia)?
bone marrow or spleen
When RBCs are sickled they tend too…
Clump together and can block blood flow
If RBCs are clumped together and blocking off blood flow, what can this lead to?
Pain and ischemia distal to the clot
What are common sites for blockages in a patient with sickle cell anemia?
Liver, spleen, heart, kidneys, and retina
What nutrient deficiencies can cause anemia? (3)
Iron, folate, b12
Iron is essential to…
normal hemoglobin production
B12 and folate are required for normal __ __
DNA synthesis
How are anemias classified?
Size and shape of the red blood cell
What does mcv blood test stand for?
Mean corpuscular volume
What will the MCV be of someone with iron deficiency anemia?
Less than 80, so the RBC will be smaller
Iron deficiency anemia is a __ anemia
microlytic
If someone has a folate or vitamin b12 deficiency anemia, what will the MCV be?
Greater than 100, so the RBC will be larger
Folate and vitamin b12 deficiency anemias are __ anemias
macrolytic
What is a normal MCV?
80-100
What is a reticulocyte count?
Immature red blood cell count
If someone has a high reticulocyte count, what does that mean?
They have high immature RBCs, which means they are anemic or experiencing blood loss
What is the most prevalent type of anemia?
Iron-deficiency anemia
Only 10% of iron deficiency anemia is in where?
developed countries
What vitamin deficiency can cause an iron deficiency anemia?
Vitamin C
What two drinks decrease absorption of iron?
Tea and coffee
What is an example of an increased demand for iron, that can lead to iron deficiency anemia?
Pregnancy
What are two examples where excessive blood loss can lead to iron deficiency anemia?
Heavy mentsruation and GI bleeding (occult)
What is visible blood called?
frank blood
4 GI disorders that can cause iron deficiency anemia
Ulcerations
Inflammation
Hemorrhoids
Colon cancer
Why does iron deficiency lead to anemia?
Your body can’t make hemoglobin without iron
5 demographic factors that put someone at higher risk for iron deficiency anemia
Elderly Teenager Female Immigrant Widower
5 dietary factors that put someone at higher risk for iron deficiency anemia
Low iron intake Low vitamin C Excess phytate (phosphorous) intake Excess tea/coffee Fad diets
5 social factors that put someone at higher risk for iron deficiency anemia
Poverty Poor detention Alcohol abuse GIT disease depression
__ is needed to synthesize hemoglobin
Iron
Where is iron absorbed?
Duodenum
Why does it take a long time to become anemic from an iron deficiency?
Iron is reused when erythrocytes die
All anemias lead to… (3 things)
Fatigue
Weakness
Exercise intolerance
__ __ is a symptom specific to iron deficiency anemia
Epithelial atrophy
What is a sign of epithelial atrophy?
Brittle hair and nails
What are spoon shaped nails called?
Koilonychia
Why does iron-deficiency anemia cause epithelial atrophy?
It’s secondary to the tissues having a lack of oxygen
What are 3 GI symptoms of iron-deficiency anemia
Smooth tongue
Mouth sores
Dysphagia
What is a unique symptom of iron deficiency anemia related to appetite?
PICA
What is pagophasia?
Chewing or eating ice
What is cobalamin?
Vitamin b12
What does vitamin b12 do to folic acid?
It turns inactive folic acid to active folic acid
Why is active folic acid important?
It’s needed for normal maturation of erythrocytes
What is the problem with administering folic acid?
It can mask vitamin b12 deficiency because it bypasses the step of vitamin b12 converting inactive folic acid to active folic acid
Folic acid deficiency is a problem with…
red blood cell production
Folic acid deficiency is a __ anemia
megaloblastic
In megaloblastic anemias, the MCV is…
High
Inflammation of the __ is common with folic acid deficiency
tongue
Vitamin b12 is important in the synthesis of RBCs but also the…
synthesis of myelin sheath of neurons
B12 deficiency can lead to what 3 manifestations
Anemia
Glossitis
Neurologic disease/ subacute combined degeneration
What is glossitis?
Inflammation of the tongue
What are symptoms of a vitamin b12 deficiency
Balance/gait problems
Numbness and tingling in hands/feet
Memory loss
irritability
Folate deficiency is not a problem with __
absorption
The body can store a few __ worth of folate
months
3 reasons you might see decreased intake of folate in the diet
Alcoholism
Dieting
Cirrhosis
Who has an increased need of folate?
Pregnant women
The body can store __ worth of vitamin b12
years
What is vitamin b12 deficiency anemia called?
pernicious anemia
Where is vitamin b12 absorbed?
terminal ileum
What does vitamin b12 need to be able to be absorbed?
intrinsic factor
Where is intrinsic factor secreted?
in the gastric parietal cells
3 conditions that reduce the production of intrinsic factor
Gastric bypass
Gastrectomy
Bowel resection, especially if the terminal ileum
Pernicious anemia normal symptoms (6)
Fatigue Exercise intolerance Weakness Tachycardia Dyspnea Glossitis
Neurological symptoms of vitamin b12 deficiency (8)
Depression Paranoia Confusion Irritability Anxiety Balance issues Gait issues Memory loss
What 3 things lead to anemia
Abnormal hemoglobin
Decreased hemoglobin content on RBC
Decreased number of circulating erythrocytes
What is an example of abnormal hemoglobin cause of anemia?
Sickle cell disease
What are two example of causes of decreased hemoglobin content on RBC?
Loss or iron
Loss of key nutrients
What are three causes of decreased number in circulating erythrocytes?
Decreased production
Increased destruction
Blood loss
Why does chronic kidney disease lead to anemia?
In a healthy kidney, erythropoietin is secreted to stimulate bone marrow to create RBCs
A patient with chronic kidney disease may have very little symptoms despite having a very low h&h. Why?
Because kidney disease progresses so slowly that their body has time to compensate
It’s not uncommon to see a patient with chronic kidney disease have a hemoglobin of __-__
5-6
What is the treatment for patients with anemia who have chronic kidney disease?
Treat them with recombinant erythropoietin
Aplastic anemia is a __ cell disorder
stem
What is aplastic anemia characterized by?
pancytopenia
What is pancytopenia?
Reduction in RBCs, WBCs, AND platelets
What are the two classifications of aplastic anemia?
Congenital or acquired
Acquired aplastic anemia is often __
idiopathic
Acquired aplastic anemia can also be an __ __.
Autoimmune disorder
What is a possible trigger of acquired aplastic anemia?
Radiation/chemo treatment
A patient with aplastic anemia will be at high risk for __ and __
infection and bleeding
What are some autoimmune triggers for aplastic anemia?
Complications of infection such as hepatitis or mononucleosis
Absent or decreased production of hemoglobin is what type of anemia?
Thalassemia
Abnormal hemoglobin and decreased lifespan of RBC is what type of anemia?
Sickle cell
What are two types of thalassemia?
Alpha and beta
What is acquired hemolytic anemia?
Premature destruction of RBCs by some external agent
What are common causes of acquired hemolytic anemia? (4)
Blood incompatibilities
Drug reactions
Severe burns
Microangiopathy
Acquired hemolytic anemia is an __ attack
Autoimmune
What are examples of blood incompatibilities that can lead to acquired hemolytic anemia? (2)
Blood transfusion with wrong type
Rh factor issues with pregnancy
What 3 drug classes have been linked to hemolytic anemia?
Penicillins
Cephalosporins
NSAIDs
What happens in hemolytic anemia?
We get these immune complexes that amount a direct attack on the cell and cause lysis
Why is low hemoglobin a symptom of hemolytic anemia?
Because of the destruction of RBCs
What are specific signs/symptoms to look for in a patient with hemolytic anemia? (5)
Low hemoglobin Increased reticulocyte count Mild jaundice Hemoglobinuria Decreased haptoglobin
Why does a patient with hemolytic anemia have mild jaundice?
Some bilirubin escapes when RBCs are destroyed
Why does a patient with hemolytic anemia have increased reticulocyte count?
Bone marrow increases production to compensate for RBC destruction/low count
Where is haptoglobin made?
The liver
What does haptoglobin do?
It attaches to hemoglobin and helps carry it to the reticuloendothelial system
Blood loss anemia results from __ and __ blood loss
Gross and occult
What is a normal person’s normal blood volume?
About 5000 mL
If someone loses 10% (500ml) of their blood volume, what are their s/s?
Usually none, but maybe syncope or dizziness
If someone loses 20% (1000ml) of BV, what are their s/s?
No symptoms at rest but tachycardia with exercise
If someone loses 30% (1500ml) of BV, what are their s/s? (3)
Flat neck veins when supine
Tachycardia with exertion
Orthostatic hypotension
If someone loses 40% (2000ml) of BV, what is their s/s? (4)
Tachycardia
Hypotension when supine
Air hunger
Cool, clammy skin
If someone loses 50% (2500ml) of BC, what is their s/s?
Shock and death
What organs are important to watch with someone who is experiencing blood loss?
Heart
Brain
Lungs
Kidneys
A patient with chronic blood loss may be asymptotic until their hemoglobin reaches…?
8 or less
Someone with chronic blood loss will have the __ __ __ but less cells in it
same blood volume
What symptoms might someone have if their hemoglobin is 8 or less?
Pallor
Tachycardia
Tachypnea
What are potential issues a person may have that is causing their chronic blood loss?
GI erosion
Diverticulitis
Chronic blood loss can lead to what type of anemia?
iron deficiency anemia
What type of drug is epoetin alfa?
Erythropoietin stimulating agent
What are brand names for epoetin alfa?
Epogen and procrit
What is the MOA of epoetin alfa?
Mimics the function of human erythropoietin
What are some indications of epoetin alfa?
Maintains RBCs in patients with chronic kidney failure, HIV infection on drug therapy, preop for patients with anemia, anemia secondary to chemo
What routes if epoetin alfa given?
SQ
If you give a patient with chronic kidney disease epoetin alfa, what are the risks?
Puts them at increased risk for increased mortality and serious cardiovascular events
If you give a patient with cancer epoetin alfa, what are the risks?
Increased mortality and tumor progression
If you give a patient who is undergoing surgery epoetin alfa, what are the risks?
Puts them at risk for thromboembolic events and mortality
What does the CDC recommend for epoetin alfa? (3)
Weigh risks versus benefits
Do not administer if hgb about 10 or higher
Use lowest dose possible to reduce need for transfusion
What are nursing implications for epoetin alfa? (3)
Administer BP before and during therapy
Monitor Hgb levels
Teach patient to take iron supplements
When should you hold epoetin alfa?
Someone with uncontrolled hypertension
Hgb level of 10 or higher
What can happen concerning blood pressure when administering epoetin alfa?
Patient can become hypotensive
What are the two forms of dietary iron?
heme and non-heme iron
Heme iron makes up 40% of the iron in…
meat, fish, poultry
Heme iron is __ __
well absorbed
Non-heme iron is 60% of __ __
animal tissue
What type of iron is in plants?
Non-heme iron
Non-heme iron is what compared to heme iron?
not as well absorbed
What are iron rich vegetables?
Green leafy vegetables, broccoli, tomatoes, green beans
What is recommended for pregnant women so they don’t become iron deficient?
ferrous sulfate
What is the MOA of ferrous sulfate?
Taken up by bone marrow cells to make hgb
What are the adverse effects of ferrous sulfate? (3)
GI disturbances
teeth staining
tarry stools
What type of drug is ferrous sulfate?
iron replacement therapy
Ferrous sulfate only contains __% of elemental iron
20%
If a patient needs a 100mg dose of elemental iron, how much ferrous sulfate will they need to take?
500mg
__ reduce absorption of iron
Antacids
Food can help decrease the GI side effects of iron, but what adverse effect does this have?
Decreases the absorption of the iron
Food decreases absorption of iron by __-__%
50-70%
Recommend patients take iron on an __ __ if they can tolerate it
empty stomach
What is the leading cause of death in children concerning iron?
Iron toxicity, overdose
What is the parenteral iron therapy drug called?
Iron dextran
What is the brand name of iron dextran?
DexFerrum
What are the indications for iron dextran?
Iron deficiency or
Oral iron is intolerable or ineffective
Why is there a black box warning for iron dextran?
Potentially fatal anaphylaxis
What are three safety considerations for administering iron dextran?
Only use when absolutely necessary
Have epi and CPR equipment close by
Do a small “test” dose before each administration
What are the routes of iron dextran?
IV or IM
What are three adverse effects of iron dextran?
Persistent pain
Discoloration at the site
Tumors
When giving iron dextran IM, what is important to do?
Use the z track method
The discoloration on the skin caused by iron dextran is __
permanent
What is the drug called used for vitamin b12 replacement?
Cyanocobalamin
What is the preferred route for cyanocobalamin?
PO
What is an adverse effect of cyanocobalamin?
hypokalemia
Why use caution when administering cyanocobalamin with __ __ because it may mask b12 deficiency
folic acid
With oral cyanocobalamin, the doses need to be __
larger
What is the MOA of folic acid administration?
Converts to the active form of folic acid after administering
What are the 3 indications for folic acid admin?
Folic acid deficiency anemia
Prophylaxis to folic acid anemia
Initial treatment of severe anemia due to vitamin b12 deficiency
When taking folic acid a patient may report they feel…
flushed
