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207 Cards in this Set
- Front
- Back
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Initially many hematologic conditions cause few symptoms and extensive laboratory tests are often required to establish a diagnosis |
True |
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The most common tests used in hematology are these two |
CBC and peripheral blood smear |
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Identifies total number of blood cells as well as hemoglobin, hematocrit and red blood cell indices |
CBC |
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A drop of blood is spread on a glass slide, stained, and examined under a microscope |
Peripheral Blood smear |
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In this diagnostic the shape and size of erythrocytes and platelets as well as the actual appearance of leukocytes provides useful information and identifying hematologic conditions |
Peripheral blood smear |
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These Diagnostics serve as useful screening tools for evaluating a patient's clotting ability and monitoring the therapeutic effectiveness of anticoagulant medications |
INR, aptt |
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For these diagnostic tests specific reagents are mixed into plasma samples, and the time taken to form a clot is measured |
INR, aptt |
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For these tests to be accurate, the test tube must be filled with the correct amount of patients blood. Either excess or inadequate blood volume in the tube can render results inaccurate |
INR, aptt |
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Diagnostic test for assessing how a patient's blood cells are being formed as well as quantity and quality of cells produced in the bone marrow |
Bone marrow aspiration |
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Diagnostic test used to document infection or tumors within the marrow. Can also help identify certain malignant conditions and occasionally help establish prognosis |
Bone marrow aspiration |
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Normal bone marrow is in a semi fluid state. In adults bone marrow is usually aspirated from the iliac crest and occasionally from the sternum. |
True |
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Aspirate alone may be adequate for evaluating conditions such as anemia. However if more information is required a biopsy is also performed. |
True |
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Biopsy samples are taken from the posterior iliac crest, occasionally a anterior approach is required. bone marrow biopsy shows the architecture of the bone marrow as well as its degree of cellularity |
Bone marrow biopsy |
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Before aspiration the skin is cleansed using aseptic technique. Then a small area is anesthetized with a local anesthetic agent through the skin and subcutaneous tissue to the periosteum of the bone. It is not possible to anesthetize the bone itself. A small volume, approximately 5 ml of blood and Marrow is aspirated |
Bone marrow aspiration |
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Patients typically feel a pressure sensation as the needle is Advanced into position. The actual aspiration always causes sharp but brief pain resulting from the suction exerted as the marrow is aspirated into the syringe, patients should be warned about this |
Bone marrow aspiration |
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If a bone marrow biopsy is necessary it is performed after the aspiration and in a slightly different location because the marrow structure may be altered after aspiration. A special biopsy needle is used. Because the needles are large the skin may be punctured first with a surgical blade to make an incision |
Bone marrow biopsy |
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The biopsy needle is Advanced well into the bone marrow cavity. When the needle is properly positioned a portion of marrow is cord out. The patient feels a pressure sensation but should not feel actual pain. |
Bone marrow biopsy |
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Hazards of these diagnostic tests include bleeding and infection |
Bone marrow aspiration and biopsy |
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The nurse applies pressure to the site for several minutes and then covers it with a sterile dressing. Most patients have no discomfort after this procedure. But the sight of this procedure may take for one to two days |
No discomfort after bone marrow aspiration After biopsy may take for one to two days |
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Warm tub baths and a mild analgesic agent such as Tylenol may be useful after this procedure. Aspirin containing analgesic agents should be avoided immediately post-procedure because they can aggravate or potentiate bleeding |
Bone marrow aspiration or biopsy |
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Bone marrow biopsy may have this kind of sedation used. |
Conscious sedation |
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What position is the patient placed into for a bone marrow biopsy |
Sims, lateral |
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Surgical removal of the spleen also called This, is a possible treatment for some hematologic disorders |
Splenectomy |
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An enlarged spleen may be the site of excessive destruction of blood cells. Enlarged spleen may also cause thrombocytopenia as a result of platelets being sequestered in the spleen. For these conditions this procedure may be performed |
Splenectomy |
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Postoperative complications of this procedure include atelectasis, pneumonia, abdominal distension and abscess formation |
Splenectomy |
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Although young children are at the highest risk after this procedure all age groups are vulnerable to overwhelming lethal infections and should receive the pneumococcal vaccine, Pneumovax, before undergoing the procedure |
Splenectomy |
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After this procedure the patient is instructed to seek prompt medical attention if even relatively minor symptoms of infection occur |
Splenectomy |
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Often patients with high platelet counts have even higher counts after this procedure, which can predispose them too serious thrombotic or hemorrhagic problems. However this increase is usually transient and therefore often does not warrant additional treatment. |
Splenectomy |
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This procedure can be done laparoscopically or by open laparotomy. The patient is more susceptible to infections after and this is a lifelong concern |
Splenectomy |
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Blood is taken from the patient and passed through a centrifuge where a specific component is separated from the blood and removed. The remaining blood is then returned to the patient. The entire system is closed, so the risk of bacterial contamination is low. |
Apheresis |
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When platelets or leukocytes are removed with this procedure the decrease in cells within circulation is temporary. However the temporary decrease provides a window of time until suppressive medications such as chemotherapy can have therapeutic effects |
Apheresis |
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This is also used to obtain larger amounts of platelets from a donor then can be provided from a single unit of whole blood. A unit of platelets obtained in this way is equivalent to 628 units of platelets obtained from six to eight separate donors via standard blood donation methods. |
Apheresis |
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Platelet donors can have their platelets apheresed as often as every how many days |
14 days |
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Leukocytes can be obtained typically after the donor has received growth factors to stimulate formation of additional leukocytes and thereby increase the leukocyte count. The use of growth factors also stimulates release of stem cells within circulation. This technique is used to harvest these stem cells for use in peripheral blood stem cell transplants |
Apheresis |
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This therapeutic option offers the possibility of cure for some patients with hematologic disorders such as severe aplastic anemia, some forms of Leukemia and thalassemia |
Stem cell transplant |
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This can provide longer remission from diseases even when no cure is possible such as multiple myeloma. |
Stem cell transplant |
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For most hematologic diseases this stem cell transplant is more effective. |
Allogenic transplant |
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Stem cell transplant in which donor cells who matched the patients are used |
Allogenic |
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Stem cell transplant in which the patient's own cells are harvested and then transplanted back in |
Autologous |
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A single unit of whole blood contains this many ml's of blood and this many ml's of an anticoagulant |
450 mL of blood 50 mL of anticoagulant |
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Because plasma is removed, a unit of packed red blood cells is very concentrated with a hematocrit of approximately this percentage |
65 to 85% |
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Packed red blood cells are stored at 4 degrees Celcius, 39.2 degrees Fahrenheit, with special preservatives they can be stored safely for up to this long before they must be discarded |
42 days |
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Platelets must be stored at room temperature because they cannot withstand cold temperatures and they last for this long before they have to be discarded |
5 days |
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To prevent clumping these are generally agitated while stored |
Platelets |
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Plasma is immediately Frozen to maintain the activity of clotting factors within it it lasts for about this long if it remains Frozen |
One year |
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Plasma can be pooled and processed into blood derivatives such as albumin, immunoglobulins, factor 8 and Factor 9 |
True |
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This component of blood plasma does not require double signing, it is considered a medication, a volume expander |
Albumin |
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To protect both the donor and the recipient all prospective donors are examined and interviewed before they are allowed to donate blood. The intent of the interview is to assess the general health status of the donor and to identify risk factors that may harm a recipient. There is no upper age limit to donation |
Blood blood donation |
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Body weight should be at least this amount for a standard 450ml donation. Donors weighing less than that donate proportionately less blood. People younger than 17 years require parental consent in some states |
50 kg or 110 lb, for blood donation |
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To donate blood the person's oral temperature should not exceed this |
37.5 degrees C or 99.6 degrees Fahrenheit |
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To donate blood the person's pulse rate should be regular in between this amount |
50 to 100 beats per minute |
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In order to donate blood the systolic and diastolic pressures should be between what |
90 to 180 systolic 50 to 100 diastolic |
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In order to donate blood the hemoglobin level should be what |
At least 12.5 for women 13.54 men |
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Friends and family of the patient may wish to donate blood for that person. These donations are called? They are not any safer than those provided by random donors because these donors may not be as willing to identify themselves as having risk factors. There for some centers no longer accept them |
Direct donations |
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Withdrawal of 450 mL of blood is done from a donor and usually takes less than 15 minutes. After needle removal donor is asked to hold arm straight up and apply pressure for two to three minutes. Donor remains recumbent until they feel okay to sit up. If they experience weakness or faintness they should rest for longer receive some food and fluid and then sit another 15 minutes |
Standard blood donation |
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If donor blood tests positive for cytomegalovirus it can still be used except in recipients who are negative for CMV and who are severely immunocompromised |
True |
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Previously it was thought that in an emergency situation in which the patient's blood type was not known type O blood could be safely transfused. This practice is no longer recommended |
True |
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The RH antigen, also referred to as D antigen, is present on the surface of erythrocytes in 85% of the population. Those who lack the antigen are referred to as being Rh negative. |
True |
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The majority of transfusion reactions are due to clerical error where the patient is transfused with incompatible blood products. Reactions other than those of error are most frequently due to the presence of donor leukocytes within the blood component unit. The recipient may form antibodies to the antigens present on those leukocytes |
Blood transfusion |
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Leukocytes from blood product are frequently filtered to diminish the likelihood of developing reactions to transfusions particularly in patients who have chronic transfusion needs. |
True |
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When a patient is immunocompromised as in the case following a stem cell transplant any donor lymphocytes must be removed from the blood components. In this situation the blood is exposed to low amounts of radiation that kill any lymphocytes within the blood component. Irradiated blood products are highly effective in preventing transfusion Associated graft-versus-host disease which is fatal in most cases. Irradiated blood has a shorter shelf life |
True |
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Although most blood products are able to be transfused in the outpatient setting the home is typically limited to transfusions of packed red blood cells and Factor components |
True |
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A systematic physical assessment and measurement of the Baseline _____ are important before transfusing any blood product |
Baseline vitals |
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Signs and symptoms of a reaction include fever, chills, respiratory distress, lower back pain, nausea, pain at IV site or anything generally unusual |
Reaction to blood transfusion signs and symptoms |
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Use a 20 gauge or larger needle for insertion in the large vein. use special tubing that contains a blood filter to screen out fibrin clots and other particular matter. Do not vent blood container. |
Transfusion of packed red blood cells |
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Use a 22 gauge or larger needle for placement in a large vein if possible. Use appropriate tubing per institution policy |
Transfusion of platelets or frozen fresh plasma |
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Transfusion reaction caused by antibodies to donor leukocytes that remain in the unit of blood or blood component. |
Febrile nonhemolytic reaction |
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The most common type of transfusion reaction |
Febrile nonhemolytic reaction |
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Signs and symptoms include chills, fever which typically begins within two hours after transfusion, muscle stiffness |
Febrile nonhemolytic reaction |
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Although this transfusion reaction is not life-threatening the fever and particularly the chills and muscle stiffness can be frightening to the patient |
Febrile nonhemolytic reaction |
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This transfusion reaction can be diminished or even prevented by further to depleting the blood component of donor leukocytes, this is accomplished by leukocyte reduction filter. Antipyretic agents can be given to prevent fever, however routine premedication is not advised because it can mask the beginning of a more serious transfusion reaction |
Febrile nonhemolytic reaction |
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The most dangerous and potentially life-threatening type of transfusion reaction |
Acute hemolytic reaction |
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Transfusion reaction that occurs when the donor blood is incompatible with that of the recipient. Antibodies already present on the recipients plasma rapidly combined with antigens on donor erythrocytes in the erythrocytes are destroyed in the circulation. |
Acute hemolytic reaction |
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The most rapid hemolysis occurs in ABO incompatibility. RH incompatibility often causes a less severe reaction. This reaction can occur after transfusion of as little as this much packed red blood cells |
Acute hemolytic reaction 10 mL |
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The most common cause of acute hemolytic reaction is errors in blood component labeling and patient identification |
TrueTrue |
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Fever, chills, low back pain, nausea, chest tightness, dyspnea and anxiety. Hemoglobinuria, hypotension, bronchospasm and Vascular collapse may result. Diminished renal perfusion results in acute renal failure and disseminated intravascular coagulation may also occur |
Acute hemolytic reaction |
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Patients develop uticaria (hives), or generalized itching during a transfusion the cause is thought to be a sensitivity reaction to plasma proteins within the blood component being transfused. |
Allergic reaction to transfusion |
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Urticaria, itching, Flushing. Reactions are usually mild and respond to antihistamines. If if symptoms resolved after administration of antihistamine the transfusion may be resumed. Rarely the allergic reaction is severe with bronchospasm, laryngeal edema and shock. These reactions are managed with epinephrine, corticosteroids and vasopressor support |
Allergic reaction to transfusion |
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Leukocyte filters are not useful to prevent these types of transfusion reactions because the offending plasma proteins can pass through the filter |
allergic reaction |
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If too much blood is infused too quickly, hypervolemia can occur. This condition can be aggravated in patients who already have increased circulatory volume. |
Circulatory overload with transfusion |
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PRBCs are safer to use than whole blood. If Administration rate is sufficiently slow this can be prevented. |
Circulatory overload with transfusion |
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For patients who are at risk or already in circulatory overload, diuretics are administered after the transfusion or between units of prbcs. |
Circulatory overload with transfusion circulatory overload with transfusion |
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Signs and symptoms include dyspnea, orthopnea, tachycardia and sudden anxiety. Jugular vein distention, crackles at the base of the lungs, increase in blood pressure can also occur. If transfusion is continued pulmonary edema can develop as manifested by severe dyspnea and coughing of pink frothy sputum |
Circulatory overload with transfusion |
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If circulatory fluid overload is mild the transfusion can often be continued after slowing the rate of infusion and administering diuretics. However if severe the patient is placed upright with feet in a dependent position the transfusion is discontinued and the primary provider is notified. The IV line is kept patent with a very slow infusion of normal saline solution or a saline lock to maintain access. Oxygen and morphine may be needed for dyspnea |
Circulatory overload with transfusion |
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Contamination can occur at any point during procurement or processing that often results from organisms on the donors skin. Many bacteria cannot survive in the cold temperatures used to store prbcs but some organisms can do so. |
Bacterial contamination with transfusion |
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Platelets are at greater risk of contamination because they are stored at room temperature. Recently Blood Centers have developed a rapid methods of culturing platelet units there by diminishing risk of using contaminated platelets for transfusion |
Bacterial contamination with transfusion |
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Preventive measures include meticulous care in procurement and processing of donated blood products. When prbcs or whole blood is transfused it should be in a ministered within a 4-Hour. Because warm room temperatures promote bacterial growth. Contaminated blood products may appear normal or may have abnormal color |
Bacterial contamination with transfusion |
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Signs of this are fever, chills and hypotension they might not manifest until after the transfusion is complete or even several hours later. |
Bacterial contamination with transfusionBacterial contamination with transfusion |
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If the condition is not treated immediately with fluids and broad-spectrum antibiotics sepsis can occur. |
Bacterial contamination with transfusion |
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Potentially fatal, idiosyncratic reaction that is defined as the development of acute lung injury occurring within 6 hours after a blood transfusion. |
Transfusion related acute lung injury, TRALI |
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This is the most common cause of transfusion related death |
Transfusion related acute lung injury, trali |
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All blood components have been implicated in developing this reaction to a transfusion |
Transfusion related acute lung injury, trali |
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Although the cause is not fully understood the end result of this process is interstitial and intra alveolar edema, as well as extensive sequestration of white blood cells within the pulmonary capillaries |
Transfusion related acute lung injury, trali |
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Abrupt onset usually within 6 hours of transfusion with symptoms such as acute shortness of breath, hypoxia, hypotension, fever and eventual pulmonary edema |
Transfusion related acute lung injury, trali |
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Although this can occur with transfusions of any blood component it is more likely to occur when plasma and to a lesser extent platelets are transfused. |
Transfusion related acute lung injury, trali |
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Preventive strategy includes limiting frequency and amount of blood products transfused. Using plasma and platelets only from men or from women who have never been pregnant. |
Transfusion related acute lung injury, trali |
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You must have another nurse to verify blood products before Administration |
True |
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Prior to blood product Administration make sure you have these two things done |
Informed consent, Baseline vitals |
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90% of transfusion reactions to blood are due to this |
Errors |
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May use a warmer with large transfusions to avoid dropping temperature. Always have a filter on tubing. Turn off saline once Blood starts running. |
Giving blood products |
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Stay with patient at least 5 to 15 minutes when giving / starting blood products to evaluate their response. |
True |
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Do not Y anything into a site with a Y Port IV when giving blood products. If multiple lumens are available the other lumens can be used |
True |
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How often are Vital Signs checked during blood transfusions |
Every hour |
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If transfusion is not emergent one unit is often given over this time |
2 to 4 hours |
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Start transfusion slowly then after the 15-minute vitals are taken the rate can be increased. The rate is up to the nurse to decide with an average speed around this much |
100 to 120 ml per hour |
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6 guidelines to blood transfusion |
Assess, Baseline vitals, consent Ideally 18 GAA or larger needle Y tubing w/micro aggregate filter connected to NS Verify with second RN Monitor frequently especially first 15 minutes Watch for signs of adverse reactions |
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5 other complications of blood transfusion |
Hepatitis B&C AIDS Cytomegalovirus Graft-versus-host disease Kruetzfeldt Jacob disease |
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Transmittal risk with transfusions is greater for immunocompromised recipients who are negative for this, blood products rendered leukocyte reduced help reduce transmission of this |
Cytomegalovirus from transfusion |
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This complication of transfusion occurs only in severely immunocompromised recipients. |
Graft-versus-host disease |
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In this complication of transfusions lymphocytes engraft in recipient and attack host lymphocytes or body tissues. Prevention includes irradiation of blood products to inactivate donor lymphocytes and processing donor blood with leukocyte reduction filters |
Graft-versus-host disease |
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This complication of transfusions is a rare and fatal disease that causes irreversible brain damage. There is no evidence of transmittal by transfusion. All blood donors must be screened for positive family history |
Creutzfeldt-jakob disease |
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Potential donors who spent three months or more in the United Kingdom or six months or more in Europe since 1980 cannot donate blood. Blood products from a donor Who develops this are recalled |
Creutzfeldt-jakob disease, complication of transfusion |
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Measures the rate at which red blood cells settle out of unclotted blood in 1 hour |
Erythrocyte sedimentation rate |
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Increase in this diagnostic is seen in inflammatory conditions. |
Erythrocyte sedimentation rate |
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If a blood transfusion reaction is suspected the transfusion Must Be Stopped immediately in the primary provider notified. A thorough patient assessment is crucial because many complications have similar signs and symptoms |
True |
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If hemolytic transfusion reaction or bacterial infection is suspected the nurse should do these three things |
Obtain blood specimens from patient Collect urine sample to detect hemoglobin Document reaction according to policy |
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Pharmacologic agents that stimulate production of one or more types of blood cells by the marrow are commonly used for those who will not have transfusions. Researchers continue to seek blood substitutes that are practical and safe. Manufacturing of artificial blood is difficult given the functions of blood components. There are none of these products available for use currently in the United States |
Alternatives to blood transfusion |
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Give two examples of hematopoietic growth factors for erythropoietin |
Epogen and procrit |
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This is an effective alternative treatment for patients with chronic anemia secondary to diminished levels of erythropoietin as in chronic renal disease |
Erythropoietin, epogen or procrit |
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This medication stimulates erythropoiesis. It is also been used for patients who are anemic from chemotherapy or AZT therapy and for those who have diseases involving bone marrow suppression |
Epogen and procrit |
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These medications effectively increase erythrocyte counts |
Epogen and procrit |
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How can epogen and procrit be administered |
Buy IV or subcutaneously. Plasma levels are better sustained with subcutaneous route |
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Side effects with these medications are rare but they can cause exacerbation of hypertension. If anemia is corrected too quickly or overcorrected the elevated hematocrit can cause headache and potentially seizures |
Epogen and procrit |
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With these medications thrombosis has been noted in some patients whose hemoglobin levels were raised to a high-level thus it is recommended that a Target hemoglobin level of less than 12 be used |
Epogen and procrit |
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Glycoprotein hormone, alternative to blood transfusions for religious beliefs, often given in chronic anemia |
Erythropoietin, epogen or procrit |
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Produced in the proximal tubules of the kidneys, in medication form it must be stored in a refrigerator and has no significant side effects |
Erythropoietin |
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Condition in which the hemoglobin concentration is lower than normal, it reflects the presence of fewer than normal number of erythrocytes within circulation. |
Anemia |
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This is not a specific disease state but a sign of an underlying disorder. It is by far the most common hematologic condition |
Anemia |
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This classification of anemia is characterized by defective or decreased red blood cell production |
Hypoproliferative |
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This classification of anemia occurs due to loss of red blood cells |
Blood loss anemia |
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This classification of anemia is due to increased destruction of rbc's |
Hemolytic anemia |
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Explain the hemoglobin levels and symptoms with mild anemia |
HGB 10 to 12 No symptoms, or palpitations, dyspnea, diaphoresis |
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Explain HGB levels and symptoms of moderate anemia |
HGB 6 to 9 Symptoms with activity and at rest |
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What are the hemoglobin levels for severe anemia |
Less than 6 |
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Multiple body systems affected, pallor, jaundice, Puritis, tachycardia, murmurs, tachypnea, chest pain, sensitivity to pain |
Symptoms of severe Anemia |
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Inadequate production of erythrocytes may result from bone marrow damage due to these three factors |
Medications Chemicals Lack of necessary factors for formation |
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In these types of anemia premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma, the released hemoglobin is converted in large part to bilirubin and therefore the bilirubin concentration Rises |
Hemolytic anemias |
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In these anemias increased erythrocyte destruction leads to tissue hypoxia which in turn stimulates erythropoietin production. The increased production is reflected in an increased reticulocyte count as the bone marrow response to the loss of erythrocytes |
Hemolytic anemias |
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In general the more rapidly anemia develops the more severe its symptoms will be. |
True |
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People who customarily are very active or have have significant demands on their lives are more likely to have symptoms, and those symptoms are more likely to be pronounced then in more sedentary people |
Anemia |
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Patients with hypothyroidism with decreased oxygen needs may be asymptomatic. Patients with coexistent cardiac or pulmonary problems May develop more pronounced symptoms. |
Anemia |
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Initially hemoglobin, hematocrit, reticulocyte count and RBC indices, particularly the mean corpuscular volume and red cell distribution width are useful |
Diagnostics for anemia |
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Management of this condition is directed toward correcting or controlling the cause of it, if severe, erythrocytes lost or destroyed may be replaced with a transfusion of packed red blood cells. |
Anemia |
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This is the most common hematologic condition affecting older patients, particularly those admitted to hospitals or long-term care facilities |
Anemia |
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Older adults often cannot respond to this condition as well as younger individuals, in that heart rate and cardiac output do not increase as quickly less fatigue, dyspnea and confusion may be seen more rapidly in the older adult who has this |
Anemia |
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Weakness, fatigue and general malaise are common as are pallor of the skin and mucous membranes |
Anemia |
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People with this may crave ice, starch, dirt |
Pica associated with iron deficiency anemia |
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Strict vegetarians are at risk for this condition characterized by the presence of abnormally large nucleated red blood cells, if they do not supplement their diet with vitamin B12 |
Megaloblastic anemia |
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Cardiac status should be carefully assessed. When HGB level is low the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue. This increased workload can result in symptoms such as tachycardia, This increased workload can result in symptoms such as tachycardia, palpitations, dizziness and dyspnea among other things. Heart failure may eventually develop |
Anemia |
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The most common symptom and complication of anemia is this |
Fatigue |
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This is often the symptom of anemia that has the greatest negative impact on the patient's level of functioning and consequent quality of life |
Fatigue |
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Focus on assisting the patient to prioritize activities and to establish a balance between activity and rest that is acceptable to the patient. It is important to maintain some physical activity and exercise to prevent the deconditioning that may result |
Fatigue related to anemia |
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Dietary changes such as adequate nutrition and hydration in anemia should also include these 4 things |
Iron B12 Folic acid Protein |
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The nurse should inform the patient that alcohol interferes with the utilization of essential nutrients and should advise moderation in intake. |
Anemia |
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A significant complication of this condition is heart failure from chronic diminished blood volume in the hearts compensatory effort to increase cardiac output |
Anemia |
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In megaloblastic forms of anemia the significant potential complications are |
Neurological |
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Drug therapy for anemia may include these three things |
Vitamin supplements erythropoietin medications such as procrit, epogen, aranesp Oxygen therapy |
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This is a long-acting form of erythropoietin medication |
Aranesp |
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Anemia in pregnancy is characterized by hemoglobin level of this amount in pregnant and postpartum women |
Less than 10 |
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Occurs in pregnancy commonly due to hemoglobin production or iron or folic acid deficiency or genetic disorders |
Anemia in pregnancy |
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Three areas of teaching for anemia in pregnancy |
Iron-rich foods or supplements requires more with twins folic acid supplements |
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Anemia during pregnancy leaves the mother at higher risk of this. |
Infection |
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With anemia in pregnancy the baby is not usually anemic at Birth |
True |
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This anemia typically results when the intake of dietary iron is inadequate for hemoglobin synthesis |
Iron deficiency anemia |
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The body can store about 1/4 to 1/3 of its iron, and it is not until those stores are depleted that iron deficiency anemia actually begins to develop |
True |
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This is the most common type of anemia in all age groups and the most common anemia in the world. 30% of the population has this form of anemia |
Iron deficiency anemia |
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The most common cause of iron deficiency anemia is this. In fact it should be considered the cause of iron deficiency anemia until proven otherwise |
Bleeding |
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Three causes of iron deficiency anemia |
Inadequate dietary intake Malabsorption Blood loss |
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The definitive method of establishing a diagnosis of iron deficiency anemia is this |
Bone marrow aspiration, which is used to detect iron |
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After iron stores are depleted the hemoglobin levels fall. The diminished iron stores cause small erythrocytes to be produced by the marrow. Therefore as this anemia progresses the MCV which measures the size of erythrocytes also decreases |
Iron deficiency anemia |
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This lab test measures the size of erythrocytes |
MCV |
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Why is a patient instructed to take iron supplements an hour before meals? |
Because iron is best absorbed on an empty stomach |
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Pallor, headache, fatigue |
Iron deficiency anemia |
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Glossitis, inflammation of the tongue |
Iron deficiency anemia |
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Chelitis, inflammation and cracking of the lips |
Iron deficiency anemia |
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Burning sensation of the tongue |
Iron deficiency anemia |
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Brittle ridged nails |
Iron deficiency anemia |
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If iron deficiency anemia is severe a transfusion of this may be necessary |
Packed red blood cells |
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If iron is hung by IV it must be done this way |
Hang it by itself |
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This type of anemia is both hypoproliferative and megaloblastic |
Megaloblastic anemia |
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Deficiencies of B12 or folic acid lead to changes in bone marrow in peripheral blood because both vitamins are essential for normal DNA synthesis. The erythrocytes are produced abnormally large |
Megaloblastic anemia |
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Name two kinds of megaloblastic anemia |
Pernicious anemia And folic acid deficiency |
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Anemia resulting in a deficiency of intrinsic factor |
Pernicious anemia |
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Intrinsic factor is normally secreted by cells in the gastric mucosa, it binds with dietary vitamin B12 and travels with it to the ilium where it is absorbed. Without intrinsic factor orally consumed B12 cannot be adequately absorbed and erythrocyte production is eventually diminished |
Pernicious anemia |
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This anemia tends to run in families and is primarily a disorder of adults particularly older adults |
Pernicious anemia |
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The body normally has large stores of vitamin B12 so years may pass before the deficiency results in anemia. Because the body compensates so well be anemia can be severe before the patient becomes symptomatic |
Pernicious anemia |
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Patients with this anemia have a higher incidence of gastric cancer than the general population |
Pernicious anemia |
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Occurs more in African Americans, Scandinavians and those of northern European descent |
Pernicious anemia |
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Onset usually is 60 years old and this can be genetic |
Pernicious anemia |
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Symptoms of folic acid and vitamin B12 deficiencies are similar and the two anemias May coexist. However the neurologic manifestations of B12 deficiency do not occur with folic acid deficiency |
Megaloblastic anemia |
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Difficulty walking, weakness, Ataxia and impaired thought processes |
Pernicious anemia. B12 is important to nerve cells! |
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Sore tongue and paresthesias |
Pernicious anemia |
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Red blood cells are large and abnormally shaped |
Pernicious anemia |
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Without treatment this anemia can become fatal |
Pernicious anemia |
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Diagnostic study unique to pernicious anemia |
Schilling test |
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The classic method of determining the cause of B12 deficiency in pernicious anemia is this |
Schilling test |
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*Patient receives small oral dose of radioactive B12 *A few hours later non-radioactive parenteral dose of B12 to Aid in renal excretion of the radioactive dose * if the oral vitamin is absorbed more than 8% is excreted in the urine within 24 hours * if no radioactivity is present in urine the cause is a GI malabsorption of B12 * later when this is run again intrinsic factor is given, if the radioactivity is now present in the urine it is diagnosed as pernicious anemia |
True |
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Another test used for this condition is the intrinsic factor antibody test. A positive test indicates the presence of antibodies that bind the vitamin B12 intrinsic factor complex and prevent it from binding to receptors in the ilium, thus preventing its absorption |
Pernicious anemia |
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Vegetarians can prevent or treat this deficiency with oral supplements, with vitamins or fortified soy milk |
B12 deficiency |
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When deficiency is due to the more common defect in absorption or the absence of intrinsic factor, replacement is by monthly intramuscular injections. |
B12 for pernicious anemia |
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A small amount of an oral dose of vitamin B12 can be absorbed by passive diffusion even in the absence of intrinsic factor, however large doses are required if vitamin B12 is to be replaced orally |
B12 for pernicious anemia |
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As vitamin B12 is replaced through supplementation the reticulocyte count Rises within one week, and in several weeks the blood counts are all normal. The tongue feels better and appears less red and several days. However the neurologic manifestations require more time for recovery and if there is severe neuropathy the patient may never recover fully |
Pernicious anemia |
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Vitiligo, which is patchy loss of skin pigmentation, and premature greying of the hair are often seen in patients with this anemia |
Pernicious anemia |
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With this anemia the nurse needs to pay particular attention to ambulation and should assess the patient's gait instability as well as need for assistive devices. Of particular concern is a shirring safety when position sense, coordination, and gate are affected. If sensation is altered the patient needs to be instructed to avoid excessive heat and cold |
Pernicious anemia |
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Because mouth and tongue soreness May limit nutritional intake the nurse advices the patient to eat small amounts of bland, soft foods frequently |
pernicious anemia |
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The patient must be taught about the chronicity of the disorder and the need for monthly vitamin B12 injections or daily oral B12 even in the absence of symptoms |
Pernicious anemia |
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The gastric atrophy associated with this anemia increases the risk for gastric carcinoma |
Pernicious anemia |
