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57 Cards in this Set
- Front
- Back
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What are causes of anemia?
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decreased RBC production
-deficient nutrients (iron, B12, folic acid) -decreased erythropoietin -decreased iron availability blood loss -chronic hemorrhage (bleeding duodenal ulcer, colon cancer) -acute trauma increased RBC destruction -hemolysis (sickle cell disease, medication ie methyldopa, incompatible blood, trauma ie cardiopulmonary bypass) |
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Classification of severity of anemia
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mild Hb 10-14 g/dL
moderate Hb 6-10 g/dL severe Hb less than 6 g/dL |
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s/s severe anemia (Hb less than 6)
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pallor, jaundice, pruritus
icteric conjunctiva and sclera, retinal hemorrhage, blurred vision glossitis, smooth tongue tachycardia, increased PP, systolic murmurs, intermittent claudication, angina, HF, MI tachypnea, orthopnea, dyspnea at rest H/A, vertigo, irritability, depression, impaired thought processes anorexia, hepatomegaly, splenomegaly, dysphagia, sore mouth bone pain sensitivity to cold, weight loss, lethargy |
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s/s anemia in the older adult
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pallor
confusion ataxia fatigue worsening angina HF |
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What nutrients are necessary for erythropoeisis?
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cobalamin (vit B12) - RBC maturation
folic acid - RBC maturation vit B6 - hemoglobin synthesis amino acids - synthesis of nucleoproteins vit C - activate folic acid, iron absorption |
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s/s specific to iron-deficiency anemia
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pallor
glossitis (inflammation of the tongue) cheilitis (inflammation of the lips) H/A, paresthesias, burning sensation of the tongue |
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Five factors to consider c iron administration:
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-do not use enteric-coated or sustained-release
-daily dosage should provide 150-200mg elemental iron -take an hour ac c acidic juice vit c enhances absorption -dilute oral iron and ingest c straw to avoid staining teeth -GI side effects - heartburn, constipation (take stool softeners), diarrhea, black stools |
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IM administration of iron
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0.5mL air to be left in syringe to completely clear iron from syringe
give deep IM in upper outer quadrant of buttocks 2-3in 19-20-gauge no more than 2mL per injection use Z-track do not massage IV - do not dilute, flush c NS |
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Pts at risk for iron-deficiency anemia are:
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premenopausal women
pregnant women low SES older adults persons experiencing blood loss |
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What is thalassemia?
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a group of diseases that have an autosomal recessive genetic basis involving inadequate production of normal hemoglobin
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s/s thalassemia
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s/s develop by age 2y
growth retardation, physical and mental pale pronounced splenomegaly/hepatomegaly jaundice chronic bone marrow hyperplasia and expansion of bone marrow space, possibly leading to thickening of cranium and maxillary cavity |
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tx thalassemia
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blood transfusions or exchange infusions
IV deferoxamine (Desferal-binds to iron to reduce iron overloading that occurs c chronic transfusion therapy) transfusions administered to keep Hb at 10 g/dL zinc vit c splenectomy b/c RBCs are sequestered in the enlarged spleen do not give iron supplements |
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deferoxamine (Desferal)
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a chelating agent that binds to iron
to reduce hemochromatosis (high iron level) that occurs c chronic infusion therapy Hb level should be kept at 10g/dL side effects - visual blurring, hearing loss, tinnitus, knock-knees |
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What are megaloblastic anemias?
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a group of disorders caused by impaired DNA synthesis and char by presence of large RBCs(megaloblasts)
two types - cobalamin (B12) deficiency and folic acid deficiency |
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pernicioius anemia
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most common cause of cobalamin deficiency
a disease caused by absence of IF - from either gastric mucosal atrophy or autoimmune destruction of parietal cells, resulting in decreased HCl in stomach, and acidity is required for IF secretion begins in middle age or later |
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s/s cobalamin deficiency
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general s/s of anemia d/t tissue hypoxia
GI - sore tongue, anorexia, n/v, abd pain neuromuscular - weakness, paresthesias of hands and feet, reduced vibratory and position senses, ataxia, muscle weakness, impaired thought processes insidious onset, may take several months for s/s to develop |
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tx cobalamin defiency
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parenteral (cyanocobalamin or hydroxocobalamin) or intranasal (Nascobal) cobalamin
typical tx 1000mg cobalamin IM daily for 2wks, then weekly until hct is normal, then monthly for life |
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tx cobalamin defiency
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parenteral (cyanocobalamin or hydroxocobalamin) or intranasal (Nascobal) cobalamin
typical tx 1000mg cobalamin IM daily for 2wks, then weekly until hct is normal, then monthly for life |
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Common causes of folic acid deficiency are:
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lack of leafy green vegetables, liver, citrus fruits, yeast, dried beans, nuts, grains
malabsorption syndromes - small bowel disorders methotrexate, antiseizure drugs (phenobarbital, diphenylhydantoin-Dilantin), trimethoprim, sulfasalazine alcohol abuse and anorexia hemodialysis pts |
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s/s folic acid deficiency
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similar to cobalamin deficiency
GI-dyspepsia, smooth, beefy red tongue *absence of neurologic problems |
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tx folic acid deficiency
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replacement therapy
1mg QD PO |
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Describe anemia of chronic disease
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underproduction of RBCs
mild shortening of RBC survival RBCs are normocytic, normochromic, and hypoproliferative tx - correction of underlying disorder |
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What is aplastic anemia?
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disease in which the pt has peripheral blood pancytopenia (decrease of all blood cell types) and hypocellular bone marrow
congenital and acquired |
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s/s aplastic anemia
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suppression of bone marrow elements
fatigue, dyspnea tx - antithhymocyte globulin (ATG) and cyclosporinor high-dose cyclophosphamide (Cytoxan) - to treat aplastic anemia as an immune-mediated disease tx - hematopoietic stem cell transplant(HSCT) |
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Treatment of anemia caused by acute blood loss
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1) replace blood volume to prevent shock, IV
2) identify source of hemorrhage and stop blood loss, transfusion, replacement therapy |
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What is hemolytic anemia?
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condition caused by destruction or hemolysis of RBCs at a rate that exceeds production
two sites - intravascular (within the circulation), and extravascular (in macrophages of spleen, liver, bone marrow) s/s jaundice, splenomegaly, hepatomegaly tx - maintain renal function - hb can obstruct renal tubules and lead to acute tubular necrosis |
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What is sickle cell disease?
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genetic disorder char by presence of an abnormal form of hemoglobin in the erythrocyte, this abnormal hemoglobin causes the erythrocyte to stiffen and elongate taking on a sickle shape in response to low 02 levels
infection - most common precipitating event sickle cells cause vascular occlusion, hemostasis promotes cycle of hypoxia, deoxygenatin of more cells, and more sickling |
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Sickle cell crisis
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severe, painful, acute
exacerbation of RBC sickling vasoocclusive crisis severe capillary hypoxia, plasma loss, hemoconcentration, thrombi development, circulatory stagnation tissue ischemia, infarction, necrosis fever swelling tenderness tachypnea hypertension n/v |
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s/s sickle cell disease
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chronic pain and health problems d/t organ tissue hypoxia and damage (kidneys, liver)
typically asymptomatic except during episodes pallor of mucous membranes fatigue decreased exercise tolerance grayish skin jaundice prone to gallstones *pain r/t tissue ischemia |
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sickle cell complications
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infection, pneumonia
acute chest syndrome |
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acute chest syndrome
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acute pulmonary complications that include pneumonia, tissue infarction, fat embolism
fever, chest pain, cough, pulmonary infiltrates, dyspnea |
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What is hemochromatosis?
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genetic disease char by increased intestinal iron absorption resulting in increased tissue iron deposition
iron in body WNL 2-6g iron in body c hemochromatosis 50g |
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s/s hemochromatosis
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fatigue
arthralgia impotence abd pain weight loss hepatomegaly and cirrhosis dm bronzing cardiomyopathy arthritis testicular atrophy |
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labs hemochromatosis
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elevated serum iron
elevated TIBC elevated serum ferritin |
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tx hemochromatosis
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goal: to remove excess iron from body
remove 500mL blood Qweek for 2-3y until iron stores in body are depleted avoid vit C, iron supplements, uncooked seafood, iron-rich foods |
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What is polycythemia?
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the production and presence of increased numbers of RBCs
hyperviscosity hypervolemia 2 types: polycythemia vera and secondary polycythemia |
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s/s polycythemia
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h/a
vertigo dizziness tinnitus visual disturbances generalized pruritis paresthesias erythromelalgia angina HF intermittent claudication thrombophlebitis hemorrhage hepatomegaly splenomegaly hyperuricemia/gout |
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labs polycythemia
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elevated Hb and RBC count c microcytosis
low to normal EPO level (secondary polycythemia will have a high level) elevated WBC count c basophilia elevates platelets (thrombocytosis) and platelet dysfct elevated leukocyte alkaline phosphatase, uric acid, and cobalamin levels elevated histamine levels bone marrow shows hypercellularity of RBCs, WBCs, and platelets |
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tx polycythemia
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goal: reduce blood volume and viscosity and bone marrow activity
phlebotomy - to reduce hct to less than 45-48% remove 300-500ml blood QOD until hct is WNL avoid iron supplementation hydration therapy myelosuppressive agents - busulfan(Myleran), hydroxyurea(Hydrea), melphalan(Alkeran), radioactive phosphorus - to inhibit bone marrow activity for erythromelalgia (paroxysmal peripheral dilation of peripheral blood vessels) - paroxetine(Paxil) or low-dose aspirin for pruritis - interferon alpha to reduce platelet count and inhibit platelet aggregation - anagrelide(Agrylin) to reduce acute gouty attacks - allopurinol |
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What is thrombocytopenia?
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a reduction of platelets below 150,000
prolonged bleeding |
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types of thrombocytopenia:
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immune thrombocytopenic purpura (ITP) - abnormal destruction of circulating platelets; platelet survival reduced to 1-3d
thrombotic thrombocytopenic purpura (TTP) - assoc c enhanced agglutination of platelets forming thrombi that deposit in arterioles and capillaries s/s hemolytic anemia, thrombocytopenia, neurologic abnomalities, fever in absence of infection, renal abnormalities heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) - venous thrombosis, arterial thrombosis, DVT, pulmonary emboli |
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s/s thrombocytopenia
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usually asymptomatic
mucosal or subq bleeding epistaxis petechiae, purpura, large bullous hemorrhages prolonged bleeding p routine procedures blood loss - weakness, fainting, dizziness, tachycardia, abd pain, hypotension |
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tx ITP
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therapy if platelets <30,000
corticosteroids to suppress phagocytic response of splenic macrophages, depress antibody formation, increases lifespan of platelets, reduces bleeding time methylprednisone (Solu-Medrol) - IV splenectomy high dose IV immunoglobulin (IVIG) and anti-Rh (WinRho) - raise platelet count temporarily danazol (Danocrine) - androgen to increase CD4 T cells, reducing immune response immunosuppressive therapy - rituximab (Rituxan), cyclophosphamide (Cytoxan), azathioprine (Imuran), cyclosporine, mycophenolate mofetil (CellCept) platelet infusion if <10,000; premedicate c diphenhydramine and hydrocortisone |
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tx TTP
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treat underlying disorder/causative agent
corticosteroids plasmapheresis - to reverse process splenectomy dextran (anti-platelet agent) vincristine (Oncovin) vinblastine (Velban) platelet administration contraindicated |
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What is hemophilia/von Willebrand disease?
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genetic disorder caused by defective or deficient coagulation factor
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s/s hemophilia/von Willebrand
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slow, persistent, prolonged bleeding from minor trauma and small cuts
delayed bleeding p minor injuries uncontrollable hemorrhage p dental retraction GI bleeding - ulcers and gastritis hematuria from GU trauma splenic rupture from falls/abd trauma ecchymoses/subq hematomas neurologic signs (pain/anesthesia/paralysis) - from nerve compression caused by hematoma formation hemoarthosis (bleeding in joints) |
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tx hemophilia/von Willebrand
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prevent/stop the bleeding
administer deficient clotting factor - monitor for hypersensitivity joint bleeding - total rest joint, pack in ice, analgesics, NO aspirin |
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What is DIC?
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a serious bleeding and thrombotic disorder
abnormal response of the normal clotting cascade stimulated by disease process/disorder abnormally initiated and accelerated clotting subsequent decreases in clotting factors and platelets ensue leading to uncontrolled hemorrhage profuse bleeding results from depletion of platelets and clotting factors |
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s/s DIC
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bleeding
pallor, petechiae, purpura, oozing blood, hematomas, occult hemorrage tachypnea, hemoptysis, orthopnea, tachycardia, hypotenson upper/lower GI bleed, abd distention, bloody stools hematuria vision changes, dizziness, h/a, change in mental status, irritability bone/joint pain thrombotic cyanosis, ischemic tissue necrosis, hemorrhagic necrosis tachypnea, dyspnea, pulmonary emboli, ARDS ECG changes, venous distention abd pain, paralytic ileus kidney damage, oliguria, leading to renal failure |
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labs DIC
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fibrin split products (FSPs) elevated
factor assays reduced D-dimers elevated |
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tx DIC
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blood product support c platelets
cryoprecipitate - replaces factor VIII and fibrinogen, given if fibrinogen <100mg/d fresh frozen plasma - replaces all clotting factors except platelets and provides source of antithrombin heparin or Lovenox |
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What is neutropenia?
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reduction of neutrophil count <1000-1500
severe <500 WNL 4000-11000 |
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s/s neutropenia
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predisposed to infection c nonpathogenic organisms and opportunistic pathogens
lack of classic signs of inflammation - redness, heat, swelling lack of pus formation low-grade fever is now significant - assumed to be d/t infection requiring stat tx infection: sore throat dysphagia ulcerative lesions in mucosal membranes vaginal itching/discharge SOB nonproductive cough |
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tx neutropenia
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determine cause
ID offending organism if infection prophylactic, empiric, therapeutic antibiotic therapy administer hematopoietic growth factors protective environmental practices - hand washing, visitor restrictions, private room |
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What is myelodysplasatic syndrome (MDS)?
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group of hematologic disorders char by change in quantity of bone marrow elements
peripheral blood cytopenias in combination c hypercellular bone marrow exhibiting dysplastic changes a clonal disorder - some bone marrow stem cells continue to fct normally while others do not, abnormal cells eventually replace the bone marrow |
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s/s MDS
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infection and bleeding - inadequate numbers of ineffective functioning circulating granulocytes or platelets
often discovered in elderly as result of testing for anemia, thrombocytopenia, neutropenia |
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tx MDS
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goal: improve hematopoiesis and ensure age-related quality of life
hematologic monitoring antibiotic therapy transfusions c blood products azacitidine (Vidaza) - restore normal growth control and differentiation of hematopoietic cells nrsg care similar to anemia |
