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55 Cards in this Set
- Front
- Back
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Anemia
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Anemia is not a specific disease, rather it is a manifestation of a pathologic process
Defined as: a deficiency in the number of RBC's (erythocytes) decrease in the quantity of hemoglobin (HGB) decrease in the volume of packed RBC's (HCT) |
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Normal Kidney Function
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1. Healthy kidney sends a hormone (erythropoietin) to the bone marrow to tell it to produce more red blood cells.
2. Bone marrow produces red blood cells 3. Red blood cells carry oxygen through the bloodstream. 4. Oxygen is made available to the organs throughout the body. |
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Hematologic Function
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Blood carries oxygen to the cells and removes CO2
Removes waste from the GI tract and carries nutrients Regulates body temperature, acid-base balance Provides protection from infection and bleeding Responsible to assist in hormone regulation by transporting hormones. |
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Review of Hematopoetic System
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Kidneys: produce erythropoetin which stimulates RBC production in the bone marrow
Bone Marrow: responsible for the production of the major blood components beginning with the stem cell |
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Blood Cells
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Erythrocytes (RBC) produced in the bone marrow, they have a life span of 120 days
Primary function is transport gases Plays a role in acid-base balance |
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Blood Cells
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Leukocytes (WBC's) also produced in the bone marrow have a life span of hours to days
Primary function is maintain homeostasis in particular related to infection and inflammation Types of White Cells Lymphocytes: B and T cells. Agranulocytes Granulocytes: polymorphonucleocytes mostly neutrophils (55-80%), also basophils and eosinophils Monocytes: mature into macrophages (big eaters) |
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Leukocytes
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Granulocytes:
Neutrophils - phagocytosis especially during early phases of inflammation Eosinophils - Also phagocytosis, allergic reactions Basophils - also inflammatory response, histamine release, heparin release |
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Leukocytes
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Agranulocytes
Lymphocytes - cellular and humoral immune response Monocytes - Phagocytosis and cellular immune response |
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Thrombocytes
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Also called platelets primarily function to aid in blood clotting
Also are produced in the bone marrow and may be stored in the spleen |
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Other structures of the Hematopoetic System
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Liver: filters blood and produces clotting factors
Spleen: filters foreign particles including RBC's -Returns iron to the bone marrow to support RBC production -Stores platelets |
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Other structures of the Hematopoetic System
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Lymphatic system: returns fluid from the interstitial space to blood
-Active in the immune response to infection and inflammation -Filters foreign particles |
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Anemia
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Anemia is not a specific disease, rather it is a manifestation of a pathologic process
Defined as: -a deficiency in the number of RBC's (erythrocytes) -decrease in the quantity of Hemoglobin (HGB) -Decrease in the volume of packed RBC's (HCT) |
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Anemia
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Grouped according to morphologic characteristics or etiologic factors
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Anemia Etiologic Classification
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Decreased RBC production
-Iron Deficiency -Thalassemias (decreased globulin synthesis) Defective DNA synthesis Vitamin B12 deficiency Folic Acid deficiency |
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Decreased RBC production
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Decreased number of erythrocyte precursors
-Aplastic Anemia -Leukemia -Myelodysplasia -Chronic Disease Chemotherapy |
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Blood Loss
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Acute
-trauma -blood vessel rupture -surgery Chronic -gastritis -menstrual flow -hemorrhoids |
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Increased Erythrocyte Destruction
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Intrinsic:
-Abnormal Hgb (sickle cell anemia) -Enzyme deficiency (G6PD) -Membrane abnormalities (paroxysmal nocturnal hemoglobinuria) |
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Increased Erythrocyte Destruction
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Extrinsic Factors
-physical trauma -autoimmune disorders -infectious diseases |
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NEED TO KNOW!
Modifiable factors to promote Erythrocyte production |
Iron: liver, whole grains, lean red meat, egg yolks, fish, dried fruits
Folic Acid: green leafy vegetables, legumes, whole grains, liver Vitamin B12: red meat, liver Vitamin C: citrus fruit, green leafy vegetables -Deep colored berries |
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NEED TO KNOW!
Modifiable factors to promote Erythrocyte production |
Amino Acids: eggs, meat, poultry, legumes, fish, nuts, milk
Vitamin B6: meats, legumes, cornmeal and wheat germ Supplements Growth factors |
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Nursing Assessment
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Recent blood loss?
History of chronic disease Past medical history Family history Nutrition history Recent surgery Medication use? -NSAID's -Aspirin -Anticonvulsants -Anticoagulants -Vitamin and iron supplements |
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Nursing Assessment: Functional Health Pattern
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Health perception: Malaise
Nutritional metabolic: N/V, anorexia, heartburn, dysphagia Elimination: Hematuria, melena (black, tarry stools), flatulence, diarrhea, constipation |
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Nursing Assessment: Functional Health Pattern
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Activity exercise: Fatigue, muscle weakness, decreased strength, dyspnea, cough, SOB
Cognitive Perceptual: H/A, abdominal, chest and bone pain, pruritis, sensitivity to cold, paresthesia Sexuality reproductive: Menorrhagia, male impotence |
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Objective Data
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General: Lethargy, fever, lymphdenopathy
Integumentary: pale, cool skin, petechiae, jaundice, icteric sclera, gingival bleeding Respiratory: tachypnea Cardiovascular: tachycardia, postural hypotension, bruits, intermittent claudication GI: glossitis, red beefy tongue, anorexia, hepatospenomegaly |
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Objective Data
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Neurologic: confusion, impaired judgement, irritability, ataxia, unsteady gait.
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Clinical Indices
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Hemoglobin (Hgb): important measure of anemia Hgb is responsible for gas transport.
Normal: Males: 13.5-18 g/dL Females: 12-16 g/dL |
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Clinical Indices
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Hematocrit (Hct) indication of the percentage of RBC's to total volume)
Normal: Males: 40-50% Females: 38-47% |
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DON'T NEED TO KNOW FOR TEST!
Clinical Indices |
MCV: Mean Corpuscular Volume (relates to the size of RBC's)
microcytic normocytic macrocytic Normal: 80-95mm3 MCHC: Mean Corpuscular Hgb Concentration -Saturation of RBC's with Hgb -May be Hypo Normo Normal: 32-36 g/dL |
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Clinical Indices
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MCH: Mean Corpuscular Hgb
-Average weight of Hgb in 1 RBC -Normal: 27-31 Reticulocyte Count: the number of immature RBC's, an indication of the rate of new RBC in the circulation .5-2% |
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Clinical Indices
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Serum Iron (fe)
-Measure of iron bound to transferrin, 70% of iron is circulated this way Normal: Male: 80-180 mcg/dL Female: 60-160 mcg/dL Ferritin: an indication of stored iron Normal: Male: 12-300 ng/mL Female: 10-150 ng/mL |
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Clinical Indices
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Blood Film (smear)
-examine a thin smear looking for shape, color, size of cells to determine what kind of anemia |
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Clinical Indices
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Total Iron Binding Capacity (TIBC): iron available to bind to transferrin
Normal: 250-460 mcg/dL Bilirubin: in anemia this is a measure of degree of hemolysis of RBC's Normal: .3-1.0 |
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Clinical Indices
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Serum B12: measures circulating B12, important in evaluating megaloblastic anemias
Normal: 160-960 Serum Folic Acid (folate) indication of nutritional status, important indicator of megaloblastic anemia Normal 5-25 ng/mL |
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Anemia
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Mild Anemia: Hemoglobin 10-12
Moderate Anemia: Hemoglobin 6-10 Severe Anemia: Hemoglobin <6 |
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Gerontologic Considerations
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Anemia is common in older adults
-Gradual reduction in Hct after age 50 Etiology: nutritional, decreased iron absorption Co-existing conditions make diagnosis difficult, symptoms may be more severe |
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Treatment Fundamentals (Nurse's Role)
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1. Dietary and lifestyle changes
2. Pharmacologic management: -Oxygen -Vitamin replacement/iron replacement -Erythropoetin alfa (Epogen/Procrit), or darbopoetin alfa (Aranesp) considered depending on cause of anemia -Transfusion *Note: the above drugs will not work if kidneys are not functioning properly or their iron isn't right. |
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Iron Deficiency Anemia
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Caused by poor diet, blood loss
Over 2 billion affected worldwide Over 200,00 deaths worldwide/yr. Most common type of anemia Most at risk: poor, elderly, young and women Malabsorption |
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KNOW THIS SLIDE!
Iron Therapy |
Oral iron supplements-Ferrous SO4 is preferred treatment
300 mg PO TID with orange juice (vitamin C) Don't take with caffeine or antacids (0 absorption) Best taken between meals Continue 3-6 months AFTER anemia resolved to restore body's "bank" **causes constipation and changes color of stool** |
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Iron Overload
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Hematochromatosis: hereditary defect - too much Fe absorbed from GI tract (too many RBC's)
Hemasiderosis: ingestion of too much Fe, especially with alcohol Accidental overdose: keep out of the reach of children |
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Nursing Considerations
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Nausea, GI distress
Heartburn Constipation Dark, tarry-black stools Staining of teeth with liquid preparation May be given parenterally or IM |
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Thalassemia Anemia
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Decreased Erythrocyte production
Characterized by thin fragile red blood cells, abnormal Hgb molecule Hereditary: affects Mediterraneans, Asians, and Central Africans Over 60 variations: Severity depends on type |
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NEED TO KNOW!
Thalassemia Major |
Homozygous: both genes affected
Profound anemia, poor prognosis |
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NEED TO KNOW!
Thalassemia Minor |
Heterozygous: only 1 gene affected
Mild anemia, life expectancy unchanged |
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NEED TO KNOW!
Thalassemia Major |
Jaundice, cholelithiasis (the presence or formation of gallstones)
Splenomegaly Lower extremity ulcers Cardiomegaly Fatigue Mongoloid appearance Anemia depends on type |
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NEED TO KNOW!
Thalassemia Minor |
Thalassemia minor: requires no treatment
Genetic counseling Possible splenectomy if sequestering red blood cells Only treatment is blood transfusions, goal to keep Hgb >10 |
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Megaloblastic Anemias
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Vitamin B12 deficiencies (Cobalamin)
Folic Acid Deficiency Drug Induced Suppression of DNA synthesis Inborn Errors |
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NEED TO KNOW!
Cobalamin Deficiency |
Caused by lack of, or poor absorption of extrinsic factor (EF) B12
Absent intrinsic factor (IF) stomach responsible for B12 absorption Untreated causes death, delayed treatment results in permanent neurological damage |
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NEED TO KNOW!
Pernicious Anemia |
Intrinsic factor: produced by parietal cells of gastric (stomach) mucosa, required for vitamin B12 absorption
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NEED TO KNOW!
Cobalamin Deficiency |
Gastric mucosal atrophy (with age)
Malabsorption caused by diseases of small intestine (surgery to stomach or GI tract) Gastrectomy, small bowel resection Proton pump inhibitors (decrease absorption of vitamin B12), some chemo. Dietary deficiency - rare |
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NEED TO KNOW!
Cobalamin Deficiency |
Usually diagnosed in elderly, >60
Family redisposition Northern European ancestry Tends to be more severe in African Americans, no known reason |
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NEED TO KNOW!
Cobalamin Deficiency |
Anemia with large immature red cells called megaloblasts
Gastric mucosal changes, anorexia Neurological manifestations: confusion, paresthesias, gait changes Cardiovascular: late-heart failure-death from severe anemia |
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Folic Acid Deficiency
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Low serum folate level
Normal schilling test Megaloblastic anemia Macrocytic Normochromo (normal color) |
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Folic Acid Deficiency
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Folic acid replacement (folate)
0.4mg-1mg daily PO, IV, SC, IM Alcoholics may require up to 5mg daily until anemia resolved No side effects Diet teaching: citrus, veggies, whole grains, avoid ETOH |
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Hemolytic Anemias (Genetic Disorders, RBC destruction)
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Sickle cell anemia
Glucose-6-phosphate Dehydrogenase deficiency Immune hemolytic anemia Characterized by shorter RBC life spans, increased RBC destruction, fragile RBC's |
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Anemia of Chronic Disease
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Most Common: End Stage Renal Disease
Cancer Arthritis Liver Disease HIV and treatment related Endocrine disorders: DM |
