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105 Cards in this Set

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How is a hemorrhage diagnosed through lab values
decreased number of RBC-levels stay low until blood volume is replenished
What illnesses can cause a decreased Hct level?
Anemia-reduced RBC
Bone marrow failure
Prostetic valves
Renal disease d/t erythropoietin made in the kidne is a strong RBC production stimulant.
Hemorrhage
Dietary Deficiency- certain vitamin or mineral deficiencies and RBC decreased
Normal pregnancy
Rheumatoid
Lymphona
Multiple myelona
Leukemia
Hodgkins
What is WBC's major funtion?
Fight infection
What are the 2 sets of info received from labs? What are the normal values?
Total -Over 11,000=infection, inflammation, tissue injury or death, malignancies
Less than 4000 indicates bone marrow depression with leukemia

Differential count-measures the count of each type of leukocyte-helps to determine cause of illness
How many types of WBC's are there?
What are they?
What is their purpose?
1. Neutrophils-most common, produced in 7-14 days and circulate for 6 hours-function-phagocytosis. Acute bacterial infections and trauma stimulate production
2. Lymphocytes (T-Cells & B-Cells) T-mature in Thymus-responsible for cellular type immune reactions
B- mature in bone marrow - responsible for humoral immunity which is antibody production
3. Monocytes- phagocytic cells that fight bacteria- remove necrotic debris and microorganism from blood- produce inferon an endogenous immunostimulant
4. Eosinophils- engulf antigen-antibody complexes formed during an allergic response- defend against parasitic infections
5. Basophils- mast cells-involved in the allergic reaction especially eosinophils- capable of phagocytosis and antigen-antibody complexes- parasitic infections stimulate production of these cells
What are normal WBC values?
Adult/child>2 years
Child<2 years Newborn:
Critical?
Adult/child>2 years-5000-10,000/mm3
Child<2 years 6200-17,000/mm3
Newborn: 9000-30,000/mm3
Critical <2500 or 30,000/mm3
What are the WBC differential normal values?
Neutrophils 55-70%
Lymphocytes 20-40
Monocytes 2-8
Eosinophils 1-4
Basophils 0.5-1.0
What are nursing managment for Aplastic Anemia?
Identify and remove causative agent
Supportive care until pancytopenia resolves
Prevent complications from infection and hemorrhage
If untreated prognosis poor( 75% fatal)
Treatment bone marrow transplant <45 years
>45 without match, immunosuppressive therapy
What happens when there is blood loss as a result of anemia?
Reduction total blood volume
Hypovolemic shock- acute loss
Gradual loss-body increases plasma leads to normal volume with less erythrocytes to carry 02 Table 30-10 page 715
Labs may not be accurate in severity for 2-3 days Hg/Hct low
Pain-localized or referred
Symptoms vs. lab values
Look at client, do they appear to be in pain
Internal hemorrhage causes pain d/t tissue distention, organ displacement, nerve compression
Retroperitoneal bleed- no abdominal pain, may have numbness in lower extremity
What items can be included in collaborative care for anemia?
Replace blood volume ( LR,dextran,albumin)
Stop blood loss
Correct RBC loss, takes 2-5 days to manufacture RBC
Supplemental Fe-2ml blood loss 1 mg of Fe loss
What are 3 causes of chronic blood loss?
Bleeding ulcer, hemorrhoids, menstrual or postmenopausal blood loss
How is Chronic Blood Loss treated?
find source of bleeding and stop it. Supplemental Fe if needed
Depletion of Fe stores- considered Fe deficient anemia
What Chronic Disease's can cause anemia?
Underproduction of RBC and shorter RBC survival time
End stage renal disease, degree anemia vs. severity of uremia ( retention in the blood of nitrogenous substances normally excreted by the kidney)
Primary factor- decreased erythropoietin production, hormone made in kidney for erythropoiesis
What are causes of chroninc anemia?
Chronic liver disease
Folic acid def from poor nutrition
Abusers of alcohol
Blood loss from chronic gastritis
Splenomegaly
Hepatitis
Chronic inflammation and malignant tumors
Chemotherapy agents
HIV and its treatments
Chronic endocrine diseases
What is aplastic anemia?
What are 2 major types?
Peripheral blood pancytopenia- which is a decrease of all blood cell types

Congenital-chromosomal origin
Acquired-exposure to agents, infections, medications
What is the etiology of Aplastic Anemia?
What is the incidence of aplastic anemia?
Incidence low- 4 persons in 1 million
2 major groups- congenital (idiopathic) or acquired
Congenital- chromosomal alterations
Acquired- exposure to ionizing radiation, chemical agents, drugs, viral and bacterial infections (hepatitis, paravirus, miliary tuberculosis), medications,d pregnancy, idiopathic
How does Aplastic Anemia manifest?
Develops insidiously
Symptoms from suppression of bone marrow elements
Fatigue
Dyspnea
Cardiovascular and cerebral responses
How does aplastic anemia affect diagnostic tests?
Hg/Hct low
MCV N
MCH N
Reticulocytes low
Serum Fe +N
TIBC +N
Bilirubin N
Platelets low
Other findings low WBC
Fe studies-serum and TIBC elevated d/t erythropoiesis suppression
Bone marrow is hypocellular, increased yellow marrow (fat and connective tissue) term dry tap
What does a left shift in lab values mean?
A right shift?
Bacteria: Segs & Bands are increased, Lymph are decreased
Viral: Segs & Bands are decreased, Lymph are increased
What are symptoms of low Hb?
Skin and nail beds pallor, cyanosis, conjuctival pallor, gingical and mucous membrane pallor, weakness
What are symptoms of increased Hb?
Flushing that is transient and episodic around the face and neck
How is low Hb treated?
Correct the underlying disease or cause.
How is increased Hb treated
Treatment is directed towards reducing blood volume, viscosity and bone marrow activity.
What are Nursing Dx's for low Hb?
Activity intolerance; imbalanced nutrition:less than body requirements; ineffective therapeutic regimen management; potential for hypoxemia r/t decreased Hb
What are some nursing Dx. for increased Hb?
imbalanced nutrition:less than body requirements; deficient fluid volume or excess fluid volume
What is the abreviation for hemoglobin?
Hematocrit?
Hb
Hct
What is the Hct a measure of?
What is a normal Hct value?
Separation of the erythrocytes and plasme by spinning the blod in a centrifuge
Erythrocytes are heavier and settle to the bottom.
3XHg value
What can dehydration do to the Hct value?
False high because of RBC's making up greater portion of total blood value. Large RBS's can also give a false high value.
What are normal values of Hct for males?
Females?
Elderly?
Pregancy?
Newborn?
2-8 weeks?
2-6 months?
6 months-1 year?
1-6 years?
6-18 years?
Males 42-52%
Females 37-47%
Elderly slightly decreased
Pregancy >33%
Newborn 44-64%
2-8 weeks 39-59%
2-6 months 35-50%
6 months-1 year 29-43%
1-6 years 30-40%
6-18 years 32-44%
What is the abreviation for hemoglobin?
Hematocrit?
Hb
Hct
What is the abreviation for hemoglobin?
Hematocrit?
Hb
Hct
What are medical problems that result in and increased Hct level?
Erythrocytosis- RBC# increased
Congenital healt disease-d/t canotic heart with chronically low PO2 levels which increases RBC
Polycythemia-increases RBC
Severe dehydration-blood volume decreases but RBC stay same so total blood volume dominated by RBC
COPD- chronic hypoxia-increases RBC
What is the normal RBC count for males?
Females?
Elderly?
Pregnancy?
Newborn?
0-2 weeks?
2-6 months?
6 months-6 years?
6 years to 18 years?
Males 14-18g/dl
Females 12-16g/dl
Elderly slightly decreased
Pregnancy >11g/dl
Newborn 14-24 g/dl
0-2 weeks 12-20 g/dl
2-6 months 10-17 g/dl
6 months-6 years 9.5-14 g/dl
6 years to 18 years 10-15.5 g/dl
What is the disease when RBC, WBC and platelets are all decreased
Pancytopenia
What are the 3 major blood cells that are formed in the bone marrow?
RBC, WBC and platelets
What are RBC values based on?
Body Mass
What can reduce the hemoglobin count?
What is the hemoglobin count a count of?
What can increase the hemoglobin count?
Anemia, hemorrage, hemodilution
RBC
Polycythemia, hemoconcentration related to dehydration concerns
What is anemia?
Reduction, below normal number of erythrocytes (RBCs)

Reduction, below normal quantity of hemoglobin (Hgb) (Hb)

Reduction, below normal volume of packed red cells ( hematocrit) (Hct)
What are the 2 groups of anemia?
Morphologic (cellular characteristic)- descriptive, objective lab info regarding erythrocyte size and color. Most accurate. (Table 30-2 page 706)

Etiologic- clinical conditions such as decreased erythrocyte production, increased erythrocyte destruction, blood loss. Client care focus. (Table 30-1 page 706)
What is Etiologic Anemia?
Intrinsic?
Extensic?
Decreased Erythrocyte Production
Decreased Hgb synthesis:
Fe deficiency
Thalassemia (decreased globin synthesis)
Sideroblastic anemia (decreased porphyrin)
Defective DNA synthesis:
Cobalamin (vit B12)
Folic acid deficiency
Decreased number of erythrocyte precursors:
Aplastic anemia
Anemia of leukemia and myelodysplasia
Chronic diseases or disorders
Chemotherapy
Blood Loss
Acute
Trauma
Blood vessel rupture
Chronic
Gastritis
Menstrual flow
Hemorrhoids
Increased erythrocyte destruction (hemolytic)
Intrinsic
Abnormal Hgb (Hbs sickle cell anemia)
Enzyme deficiency
Membrane abnormalities (paroxysmal nocturnal hemoglobinuria)
Extrinsic
Physical trauma (prosthetic heart valves)
Antibodies (isoimmune and autoimmune) Infectious agents and toxins (malaria)
What causes Anemia?
Rapid blood loss

Impaired production of erythrocytes

Increased destruction of erythrocytes
What are 2 clinical manifestations of anemia?
Tissue Hypoxia
Hb levels determine severity
What are symptoms of anemia?
Mild anemia Hb 10-14
Palpitations
Dyspnea
Diaphoresis
Moderate anemia Hb 6-10
Cardiopulmonary symptoms increased
Experience while at rest as well as with exercise

Severe anemia Hb <6
Pallor
Smooth tongue
Table 30-3 page 707
What are integumentary changes as a result of anemia?
Pallor- reduced amounts Hg and reduced blood flow to skin
Jaundice-Increased concentration of serum bilirubin d/t hemolysis of RBC’s
Pruritus-Increased serum and skin bile salts
Sclera and mucous membranes-evaluated for jaundice, especially dark skinned clients. Reflect skin changes more accurately
What are 4 cardiopulmonary manifestations of anemia?
Severe anemia- heart and lungs try to provide adequate oxygen to tissues
Cardiac maintained with increased heart rate
Systolic murmurs and bruits from low viscosity of blood
Angina pectoris or MI if cardiac needs can not be met
What secondary cardia illnesses can occur from anemia?
Why do these occur?
CHF
Cardiomegaly
Pulmonary and systemic congestion
Ascites
Peripheral edema

Heart is overworked.
What are nursing goals/ planning for a patient with anemia?
Assume normal ADL’s
Maintain adequate nutrition
Develop no complications R/T anemia
What 6 issues should a nurse implement for a anemic patient?
Dietary and lifestyle changes
Blood transfusions
Drug therapy
Oxygen therapy
Assessment of client knowledge and compliance
Main goal-correct etiology of the anemia
What would 3 nursing diagnosis' be?
Outcomes?
ND: Activity intolerance R/T weakness and malaise M/B difficulty in tolerating increased activity (e.g., increased pulse, respiration)
Expected outcomes: participation in activities of daily living
VS within acceptable range

Altered nutrition: Less than body requirements R/T anorexia and treatment M/B wt. loss, low serum Albumin, decreased Fe levels, vit. deficiencies, below usual body wt.
Outcomes: maintenance of body weight
H/H and serum Albumin within normal range

Ineffective management of therapeutic regimen R/T lack of knowledge about life style adjustments, appropriate nutrition and medication regimen M/B questioning about life style adjustments, diet medication prescriptions
Outcome: knowledge about lifestyle changes, nutrition, and medication regimens
What collaborative problems could occur as a result of anemia?
Potential for hypoxemia r/t decreased Hg
What are 5 Gerontologic Considerations when dealing with Anemia?
Common in older adults-chronic disease
Second-poor nutritional intake, decreased intestinal absorption or Fe
Women over 60 years, increased prevalence
Nutritional deficiencies cause majority of anemia. Depression, physical decline factors
S/S: confusion, ataxia, fatigue, worsening angina, CHF all easily contributed elsewhere
What is the length of RBC's cycle
120 days
How is anemia erthrocyte production affected?
Significant alterations that decrease RBC production
Decreased Hg synthesis- Fe deficiency, thalassemia, sideroblastic anemia
Defective DNA synthesis-Cobalamin
(Vit B 12) deficiency, folic acid deficiency
may lead to megaloblastic anemia
Diminished availability of erythrocyte precursors- aplastic anemia, anemia of chronic disease
Table 30-1
What nutrients are needed for erythropoiesis and why?
Vit B 12: RBC Maturation,
Folic Acid: RBC Maturation, Vit B 6: Hg synthesis,
Amino acids: Synthesis of nucleoproteins,
Vit C: Conversion of folic acid to its active forms aids in Fe absorption,
What foods contain Vit B12?
Folic Acid?
Iron?
Vitamin B6?
Amino Acids?
Vitamin C?
Vit B 12: RBC Maturation, Red meats
Folic Acid: RBC Maturation, Green leafy veggies, meat, fish, legumes, whole grains
Iron: Hg synthesis, liver and muscle meats, eggs, dried fruits, enriched breads & cereals, potatoes
Vit B 6: Hg synthesis, meats, wheat germ, legumes, potatoes, cornmeal, bananas
Amino acids: Synthesis of nucleoproteins, eggs, meat, milk and milk products, poultry, fish, legumes, nuts
Vit C: Conversion of folic acid to its active forms aids in Fe absorption, citrus fruits, leafy green veggies, strawberries, cantaloupe
What is the most common type of anemia?
What percentage of the world have this?
Who is the most susceptible?
Iron Deficiency Anemia.
30% of World population
Very young, poor diet and women of reproductive age.
How is iron used by the body?
1/3 Fe stored- as ferritin and hemosiderin in macrophages, bone marrow, spleen, and liver
1 mg of Fe lost daily in feces, sweat, urine
About 1 mg of every 10-20mg of ingested Fe is absorbed in the duodenum
Only 5-10% of ingested Fe is absorbed
Absorption occurs primarily in duodenum
How is iron obtained?
Dietary intake
What causes Malabsorption of Fe?
GI surgeries, malabsorption syndromes
Surgical procedures that remove or bypass duodenum
Disease of the duodenum
Altered or destroyed absorptive surface
What is the major cause of Iron Deficiency Amenia?
What is the ml/mg ratio of blood and iron?
Blood loss major cause in adults
2ml of whole blood contain 1mg of Fe
Major sources of blood loss in adults: GI,GU
How is iron obtained?
Dietary intake
What is the ratio of blood to iron?
2 ml whole blood/1mg Iron
What is the major source of blood loss in adults?
GI & GU bleed
How long can a GI bleed go undetected?
What is the initial symptom?
How much blood is usually lost before symptoms appear?
3-5 days
Black stools-caused by Fe in RBC
50-70ml of blood before stool appears black or melena
What are 6 common causes of GI bleeds in adults?
peptic ulcer, gastritis, esophagitis, diverticuli, hemorrhoids, neoplasia
What is GU?
What is the average blood loss with GU?
Genitourinary (GU)
blood loss primarily menstrual bleeding. Avg. monthly loss 45ml with 22mg loss of Fe
What are 3 causes of Iron Deficiency Anemia?
Genitourinary (GU) blood loss primarily menstrual bleeding. Avg. monthly loss 45ml with 22mg loss of Fe
Pregnancy with diversion of Fe to fetus, delivery, and lactation
Chronic renal failure and dialysis
What are clinical manifestations of Iron Deficiency Anemia?
What causes these symptoms?
Chronic disease symptoms- pallor most common (Table 30-3)

Glossitis (inflammation of the tongue)- second most common
Cheilitis (inflammation of the lips)

Other symptoms- headache, paresthesia (sensation of numbness, tingling, prickling), or burning sensation of the tongue

All caused by lack of Fe in tissues
What is Glossitis?
Inflamation of tongue
What is Cheilitis?
Inflammation of the lips.
What is Mean Corpuscular Hg a measure of?
Hg content of average RBC
What do MCH- MCHC- MCV-N- TIBC- &
WBC-stand for?
MCH- mean corpuscular hemoglobin
MCHC- mean corpuscular Hg.concentration
MCV-mean corpyscular volume
N- normal
TIBC- total iron binding capacity
WBC-white blood count
What lab values would reflect Iron Deficiency?
Hg/Hct- low
MCV- low
MCH-low
MCHC-low
Reticulocytes-N or low
Serum Fe- low
TIBCH-high
Bilirubin- N to low
Platelets- N or high
What is the main goal of iron deficiency treatment?
treat the underlying cause, i.e. malnutrition, alcoholism
Increase the intake of iron
Nutrition and drug therapy
Oral Fe therapy first as is least expensive
What are 3 factors of Iron Drug Therapy?
Dose provides 150 to 200mg elemental Fe daily
Best absorbed in duodenum and proximal jejunum . Give 1 hour prior to meal to prevent food binding with Fe, take with ascorbic acid to enhance absorption, enteric coated may be ineffective due to where absorbed.
Undiluted liquid Fe may stain teeth, use straw
What side effects does Iron have?
How is iron supplement supplied.
GI- pyrosis (heartburn), constipation, diarrhea
May have to adjust dose
Alert client that stools will be black
Parenteral Fe- malabsorption, intolerance of oral Fe, need beyond oral limits, poor client compliance
Given IM (Z-track due to staining of the skin) or IV. Do not mix IV with other meds, flush line with NS.
What are issues to address for nursing management?
Identify groups at risk- premenopausal and pregnant women, low socioeconomic background, older adults, blood loss
Teaching- diet foods high in Fe, supplements for pregnant women
Follow up- labs, compliance with diet and drug therapy and may have to take for long time
What is Thalassemia?
Symptoms?
Anemia
decreased erythrocyte production. Fe deficiency, inadequate production of Hg.
Autosomal recessive genetic disorder, found in ethnic groups of Mediterranean Sea
Minor/occasionally-splenomegaly, mild jaundice, chronic bone marrow hyperplasia leading to thick cranium giving appearance of Down syndrome
What causes Megaloblastic Anemia?
impaired DNA synthesis, presence of large RBC’s
Defective maturation of RBC-megablasts
Easily destroyed due to fragile cell membrane
Result of Cobalamin (vit. B12) and folate deficiencies, or suppression of DNA synthesis from drugs Table 30-8 page 712
What are symptoms of Cobalamin Deficiency?
Protein- intrinsic factor (IF), secreted by parietal cells of the gastric mucosa
IF is required for Vit B12 absorption
Normally absorbed in the distal ileum
Pernicious anemia one cause of Vit B12 Def.
What is Cobalamin?
vit. B12
What is the etiology of Cobalamin deficiency?
Insidious onset (without symptoms) begins in middle or later age often past 40
IF (intrinsic factor) secretion fails d/t gastric mucosal atrophy usually from destruction of parietal cells
Decreased hydrochloric acid secretion in stomach, acid environment needed for the secretion of IF
Autoimmune disease
Northern European ancestry-Scandinavians, African-Americans (begins early, high frequency with women, often severe)
Gastrectomy, small bowel resection involving ileum, Crohn’s disease, IF loss
What are Manifestations of Cobalamin Deficiency?
General symptoms d/t tissue hypoxia
GI Symptoms-sore tongue, anorexia, nausea, vomiting, abd. pain
Neuromuscular symptoms-weakness, paresthesias of feet and hands, ataxia, muscle weakness, impaired thought processes confusion to dementia
Insidious onset
If there was a Vit B12 deficiency how would it affect lab values?
Hg/HCT low
MCV high
MCH N or slight low
MCHC high
Reticulocytes low
Serum Fe N
TIBC N
Bilirubin N
Platelets low
Other findings low B12, +Schilling test, achlorhydria (absence of free HCL in stomach)
What are long-term symptoms of Vit. B12 deficiency?
IF lacking or impaired absorption-dietary management not treatment of choice
Parenteral administration- treatment of choice
If no tx will die in 1-3 years
Typical tx.-1000mg Cobalamin IM daily for
2 weeks, then weekly till normal, then monthly for life
Longstanding neuromuscular problems, not reversible
What is nursing management for Vit B12 deficiency?
Familial predisposition
Early detection essential for reversal of symptoms
d/t decreased sensitivity to heat and pain-protect from heat and trauma
Encourage compliance with
POC (plan of care)
What are Common causes of Folic Acid Deficiency?
Poor nutrition-need leafy green veggies. Liver fruit, yeast, dried beans, nuts, grains
Malabsorption- particularly small bowel disorders
Drugs impede absorption-methotrexate, oral contraceptives, phenobarbitol
Alcohol abuse, anorexia
Hemodialysis clients-lost during dialysis
What drugs impede the absorption of folic acid?
methotrexate, oral contraceptives, phenobarbitol
How is folic acid deficiency clinically manifested?
Similar to Cobalamin deficiency
Develops insidiously
Symptoms can be attributed to other illness
Lack of neurologic problems important-differentiates folic acid def from Vit B12 def.
Treated by replacement therapy-1mg/day PO
Malabsorption states-up to 5mg/day PO
Duration of treatment-depends on deficiency

Other illness- cirrhosis or esophageal varices
GI disturbances-dysprpsia, smooth beefy red tongue
What lab values would indicate Folic Acid Deficiency?
Hb/Hct low
MCV high
MCH N or slight low
MCHC high
Reticulocytes N
Serum Fe N
TIBC N
Bilirubin N
Platelets -
Other findings low folate
What is the 3rd major cause of anemia?
How is it manisfested?
What are the 2 types
Hemolytic anemic
Hemolysis or destruction of RBC faster than the rate of production.
Intrensic- abnormal Hg enzyme deficiencies that alter glycolysis or RBC abnormalities. (Hereditary)
Extrensic- more common (acquired) RBC are normal-damage is caused by external factors
What is the most common disease that causes anemia?
What chronic diseases cause anemia?
End stage renal disease, degree anemia vs. severity of uremia ( retention in the blood of nitrogenous substances normally excreted by the kidney)
Primary factor- decreased erythropoietin production, hormone made in kidney for erythropoiesis

Chronic liver disease
Folic acid def from poor nutrition
Abusers of alcohol
Blood loss from chronic gastritis
Splenomegaly
Hepatitis
Chronic inflammation and malignant tumors
Chemotherapy agents
HIV and its treatments
Chronic endocrine diseases
What is Peripheral blood pancytopenia?
What are the 2 Major groups?
decrease of all blood cell types
Congenital-chromosomal origin
Acquired-exposure to agents, infections, medications
Table 30-9 page 714
What is the etiology of Peripheral blood pancytopenia?
Incidence low- 4 persons in 1 million
2 major groups- congenital (idiopathic) or acquired
Congenital- chromosomal alterations
Acquired- exposure to ionizing radiation, chemical agents, drugs, viral and bacterial infections (hepatitis, paravirus, miliary tuberculosis), medications,d pregnancy, idiopathic
What are the clinical manisfestations of Peripheral blood pancytopenia?
Develops insidiously
Symptoms from suppression of bone marrow elements
Fatigue
Dyspnea
Cardiovascular and cerebral responses
What are the effects on lab values of peripheral blood pancytopenia?
Hg/Hct low
MCV N
MCH N
Reticulocytes low
Serum Fe +N
TIBC +N
Bilirubin N
Platelets low
Other findings low WBC
Fe studies-serum and TIBC elevated d/t erythropoiesis suppression
Bone marrow is hypocellular, increased yellow marrow (fat and connective tissue) term dry tap
Nursing and Collaborative Management for the treatment of peripherial blood pancytopenia?
Identify and remove causative agent
Supportive care until pancytopenia resolves
Prevent complications from infection and hemorrhage
If untreated prognosis poor( 75% fatal)
Treatment bone marrow transplant <45 years
>45 without match, immunosuppressive therapy
What happens when someone suffers an acute blood loss?
Hypovolemic shock
Gradual loss of blood is manisfested how?
body increases plasma leads to normal volume with less erythrocytes to carry 02 Table 30-10 page 715
Symptoms vs. lab values for Anemia Blood Loss.
Look at client, do they appear to be in pain
Internal hemorrhage causes pain d/t tissue distention, organ displacement, nerve compression
Retroperitoneal bleed- no abdominal pain, may have numbness in lower extremity
How is anemia treated?
Replace blood volume ( LR,dextran,albumin)
Stop blood loss
Correct RBC loss, takes 2-5 days to manufacture RBC
Supplemental Fe-2ml blood loss 1 mg of Fe loss
What are the Two sites of hemolysis?
Where are the old RBC destroyed?
Intravascular- occurs within the circulation
Extravascular- takes place within the macrophages of the spleen, liver, bone marrow
Spleen primary of destruction of RBC’s that are old, defective, or moderately damaged
Figure 30-1 Page 716
Erythrocyte Destruction can cause what illnesses?
Jaundice d/t destruction of RBC causes bilirubin to rise.
Spleen and liver enlarge
Focus to maintain renal function d/t kidneys filter damaged Hg molecules. Accumulation can obstruct, to necrosis renal tubule
What is Sickle Cell Disease (SCD)?
Who suffers from SCD?
Is SCD curable?
Group, inherited, autosomal
Abnormal Hg- hemoglobin S (HbS)
Predominantly African-American
1 in 350-500 births
Also Mediterranean, Caribbean, South and Central American, Arabian, East Indian
Incurable, often fatal by mid age
Major cause of mortality-renal and pulmonary failure
What are the types of SCD?
What is the most severe?
What is SCD?
Sickle cell anemia, sickle cell-thalasssemia, sickle cell HbC disease, sickle cell trait

Sickle cell anemia most severe of the SCD syndromes
Autosomal recessive genetic disorder
Person is homozygous for Hemoglobin S (HbSS), inherited Hbs from both parents