Med Surg Blood And Immune

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most common type of anemia

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iron-deficiency

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acute anemia results from

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hemorrhage

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tissue hypoxia

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angina, fatigue, dyspnea on exertion and night cramps. stimulates erythropoietin release increasing bone marrow RBC production may cause bone pain.

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s/s circulatory shock

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hypotension, tachycardia, lowered level of consciousness and oliguria

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Blood loss anemia

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RBC's & iron are lost w/ acute circulating volume decreases. hrt rate increasesand peripheral blood vessels constrict. liver vessels constrict increasing circ. vol. fluid shift in from tissues and the volume loses viscosity

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Normocytic

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normal size and shape (RBC)

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microcytic

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small

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hypochromic

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pale

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Nutrients for RBC production

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#1-Iron, protein, B12 is important, Vit C and E folate

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types of nutritional anemia

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iron deficiency #1, Vit B12, folic acid

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Megablastic anemias

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Vitamin B12 and Folate anemias called this because of the enlarged nucleated RBC seen in these anemias.

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poikilocytosis

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malformed RBCs

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Causes of Iron Deficiency Anemia

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chronic bleeding #1. dietary deficiencies, decreased absorption, increased metabolic requirements, blood loss, and chronic hemoglobinuria

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Age group(s) more affected by iron deficient anemia

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women with menstrals, and occult blood in the elderly from peptic ulcers, GI inflammation, hemorrhoied ans cancer.

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Manifestations of iron deficiency anemia

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may lead to brittle, spoon shaped fingers, cheilosis, a smooth, sore tongue and pica

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cheilosis

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cracks at the corners or the mouth

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hemoglobin levels in the elderly

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low normal may be anemic for the elderly 20%+ of 80yr olds are anemic. nutrional, situational, chronic illness contributing factors.

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Vitamin B12 deficiency anemia

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B12 is essential for DNA synthesis. deficiency impairs cell division and nucleas maturation. macrocytic and misshapen are fragile and cannot carry hemoglobin shorter life span

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Pernicious anemia

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failure to absorb B12.

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pernicious anemia develops ?

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lack of intrinsic factor, secreted by gastric mucosa, that binds with B12 and travels with it to the ileum for absorption. dietary deficiency is rare for pernicious anemia

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B12 deficiency manifestations

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pallor or slight jaundice and weakness develop; sore beffy tongue. diarrhea, parathesis may develop int he extremities and probles wth proprioception develop treat w/n 6mn

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propioception

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the sense of one's position in space

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folic acid deficiency anemia

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required for DNA synthesis characterized by megoblastic cells. folic acid is found in green leafy veggies, fruits, cereals, and meats absorbed in the intestines

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folic acid deficiency anemia manifestations

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pallor, progressive weakness, fatigue, SOB, heart palpatations similiar to B12 w/ glossitis, cheilosis, and diarrhea. NO nuero systoms to help differentate form B12 deficiency

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Hemolyic anemias

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characterized by premature destruciton of RBC's.

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types of hemolytic anemias

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intrinsic-RBC cell membrane defects, hemoglobin strructure defects(sickle cell & thalassemia) Extrinsic-drugs, chemicals, toxins, venons, bacteria, trauma, burns,mechan damage

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Reticulocytes

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immature RBC's

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Sickle Cell anemia

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hereditary, chronic hemolytic anemia, episodes of sickling-crescent RBCs, autosomal recessive genetic defect. shortens life span die from infection.

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Sickle Cell trait

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7-13%of blacks carry the gene inhereting it from 1 parent. 40%of hemoglobin is HbS. asymptomatic unless stressed by severe hypoxia. <1% of blacks are homozygous. nearly all their blood is hbS

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Sickle Cell disease

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Homozygous for disorder. nearly all their Hb is HbS. thery are at risk for Sickle Cell Crisis

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Sickle Cell Crisis

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sever episodes of fever and intense pain that are the hallmark of this disorder.

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HbS on Hb structure

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changes the structure of the beta chain of the Hb molecule. when hypoxemia develops and HbS becomes deoxygenated, it crystalizes and tends to clump. life span is reduced

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conditions likely to trigger sickling

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hypoxia, low environmental or body temperature, excessive exercise, anesthesia, dehydration, infections, or acidosis.

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Manifestations of Sickle Cell

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general manifestations of hemolytic anemia, pallor, fatigue, jaundice, and irratability.

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Sequestration crisis

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pooling of large amounts of blood in the liver and spleen. this only occurs in children, but is thought to be the cause of sickle cell related deaths in early childhood

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pancytopenia

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a reduction in RBC, WBC, and platelets.

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Aplastic Anemia

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the bone marrow goes into pancytopenia. normal bone marrow is replaced by fat. it is rare

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Aplastic anemia

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Idiopathic aplastic anemia accounts for 50%. other cases follow stem cell damage casue by esxpose to radiation or ceratin chem subs, antibiotics, and HIV, hep c, mono

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stem cell counts with Aplastic anemia

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may be <1% of normal when disease is recognized.

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Aplastic anemia manifestations

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vary with severity of pancytopena. can be insudious or sudden onset. fatigue, pallor, progressive weakenss, exertional dyspnea, HA, and ultimatly tachycardia and hrt failure.

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Diagnosis of Anemias

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CBC, Iron levels and total iron-binding capacity, serum ferritin, sickle cell test, Hemoglobin elctrophoresis, Schilling tests measures B12 (24hr urine radioactive iron) Bone marrow examination,

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Ferritin

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is an iron-storage protein produced by the liver, spleen ,ad bone marrow. Ferritin mobilizes stored iron when metabolic needs are higher than dietary intake