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Unit XI: Anemias

Terms in this set (48)

Red blood cells (erythrocytes)
Cells that transport oxygen to tissue via 95% hemoglobin
-Bone marrow needs Iron, B12, folate, B6, & protein to produce more of this
120 days
Lifespan of RBCs/erythrocytes:
Some HGB breaks down to form bilirubin
Most Hbg and iron is recycled in the spleen & liver which remove old RBCs to be used in new RBCs, what is the rest of Hbg turn into?
Anemia
Decrease in red blood cell count
-Most common hematologic condition in the elderly
Chronic: Not many s&s because body can compensate
Acute: s&s can be very severe and noticeably appear
What is the difference between chronic and acute anemia?
Fatigue!!
-Weakness
-Malaise
Most common and BIGGEST symptom of anemia
Women: 4.2 - 5.4
Men: 4.6 - 6.4

-4.1 - 5.1 (women)
-4.5 - 5.3 (men)
LAB VALUES

Normal erythrocyte count for women and men
Women: 12 - 16
Men: 13 - 18
LAB VALUES

Normal hemoglobin count for women and men
Women: 35 - 47%
Men: 42 - 52%
LAB VALUES

Normal hematocrit count for women and men:
Reticulocyte count
-Hemolytic anemia assessment
LAB VALUES

Laboratory test that assesses percentage of immature RBCs in blood
-Assesses the TYPE of anemia
0.5 - 2.5
LAB VALUES

Normal reticulocyte count for adults
Mean corpuscle volume
LAB VALUES

Laboratory test that assesses the average RBC size
Women: 78 - 120
Men: 78 - 100
LAB VALUES

Normal mean corpuscle volume for women and men
Serum B12 & folate
LAB VALUES

Laboratory test that measures amount of vitamins that are needed for hemo/hematopoiesis are available
Iron studies
-Serum iron
-Total iron binding capacity
-Transferrin saturation, Ferritin
LAB VALUES

Laboratory test that evaluates iron metabolism and storage
-Looks at nutrients available to the bone marrow that allow it to create healthy RBCs
Hypo-proliferative
CLASSIFICATIONS

Anemia that involves a defect in the production of RBCs
-Not making enough or making unhealthy cells
Blood loss
CLASSIFICATIONS

Anemia that is acute and d/t loss of blood via hemorrhage, GI bleed, etc.
Hemolytic
CLASSIFICATIONS

Anemia that involves an increase in destruction of RBCs
-Can be genetic or d/t other conditions
Iron deficiency anemia
HYPOPROLIFERATIVE ANEMIA

Anemia that involves a deficiency of iron either d/t poor oral intake or poor absorption in IG tract which leads to decrease hbg synthesis
-Most common type
-Smooth red tongue
-Brittle ridged nails
-Cracks in corners of mouth

Cardinal sx is FATIGUE
HYPOPROLIFERATIVE ANEMIA

Symptoms of iron deficiency anemia:
Bone marrow aspiration, ferritin, H&H, low iron, elevated transferrin
HYPOPROLIFERATIVE ANEMIA

What diagnostic studies are done to dx iron deficiency anemia?
High iron diet & iron supplementation (easy tx)
HYPOPROLIFERATIVE ANEMIA

Treatment for iron deficiency anemia:
-Take on empty stomach & preferably with orange juice, vitamin C helps iron absorption
-Cannot take with dairy
-Build up to the full dose b/c iron supplements can cause GI distress
-Warn that iron supplements will darken the stool and liquid forms can stain the teeth
HYPOPROLIFERATIVE ANEMIA

Nursing considerations for iron supplement administration:
Normocytic anemia
-Few symptoms(chronic), hbg is rarely > 9
Tx: Treat underlying disease, supplements not beneficial b/c there is no vitamin deficiency
HYPOPROLIFERATIVE ANEMIA

Anemia of chronic disease such as renal failure, chronic inflammation, chronic infection, malignancy (advanced age)
-Sx, Tx?
Aplastic anemia
HYPOPROLIFERATIVE ANEMIA

Anemia where the immune system causes damage to stem cells & bone marrow → decreased RBC production
-Rare
-Stem cell transplant & immunosuppressive drugs
HYPOPROLIFERATIVE ANEMIA

Treatment for aplastic anemia:
Megaloblastic anemia
HYPOPROLIFERATIVE ANEMIA

Anemia that involves abnormally large RBCs d/t lack of B12 and folate which are needed to produce healthy cells
-Pancytopenia, abnormally shaped cells
-Low B12 will cause confusion, N/T in extremities, balance issues
-Sx may take years to show b/c body has many stores of B12 to compensate

-Red sore tongue
-Jaundice
HYPOPROLIFERATIVE ANEMIA

Symptoms of megaloblastic anemia:
Pregnancy and ETOH abuse
HYPOPROLIFERATIVE ANEMIA

What are risk factors for developing megaloblastic anemia?
-Low folate is d/t poor diet; foods high in folate include green leafy vegetables and beef liver
-Low B12 is d/t poor GI absorption or being a strict vegetarian
HYPOPROLIFERATIVE ANEMIA

What are folic acid and B12 deficiencies usually due to?
Folate or B12 replacement, diet changes
HYPOPROLIFERATIVE ANEMIA

Treatment for megaloblastic anemia:
-Trauma
Surgery
-Bleeding disorders
BLOOD LOSS ANEMIA

Examples of risk factors that involve a sudden loss of large blood volume
-Dizziness
-Falls
-Hypotension, tachycardia
-SOB
-Hypoxia

Pts are usually very symptomatic d/t this being acute and blood loss is rapid
BLOOD LOSS ANEMIA

Symptoms of blood loss anemia:
§Treat underlying condition/cause of bleeding
§Transfuse PRBCs
- Takes about 7 days to make mature RBCs so this is the fastest way for the body to replace the lost RBCs
BLOOD LOSS ANEMIA

Treatment:
Decreased O2 → Hypoxia → Erythropoietin stimulation → Premature RBCs (reticulocytes) release which cannot carry oxygen → Spleen and liver are overwhelmed and cannot recycle the nutrients quick enough → Increased bilirubin instead of nutrient recycling → jaundice!
HEMOLYTIC ANEMIA

Pathophysiology:
Reticulocyte count
HEMOLYTIC ANEMIA

After knowing the pathophysiology, what diagnostic test is used to diagnose this type of anemia?
Sickle cell anemia
HEMOLYTIC ANEMIA

Severe anemia from an inherited sickle cell hemoglobin gene that causes abnormal shape to cell
-RBC lifespan 4-10 days
-Jaundice
-Tachycardia, murmurs, cardiomegaly, heart failure d/t heart working extra hard to disperse oxygenated blood to tissue
-Pain d/t cells clogging up blood vessels to an area by getting tangled up in capillaries → stoppage of blood flow which stops oxygenation to tissues →
-Hypoxia
HEMOLYTIC ANEMIA

Symptoms of sickle cell anemia:
-Life expectancy - 50s
-Clots, CVA
-Pulmonary HTN d/t lungs trying to compensate with the heart
HEMOLYTIC ANEMIA

Complications of sickle cell anemia:
Sickle cell crisis
HEMOLYTIC ANEMIA

Complication of sickle cell anemia that is a flare up caused by all of the blood clots → hypoxia → tissue necrosis → lots of pain
-Stem cells transfusion
-Blood transfusions which give normal shaped RBCs
-Hydroxyurea: chemo drug that decreases sickle formation of cells
HEMOLYTIC ANEMIA

Treatment for sickle cell anemia including pharmacological intervention:
Hydration, oxygen, pain medication (LOTS)
-These will all help prevent cell death and prevent pain
HEMOLYTIC ANEMIA

Symptom management of sickle cell crisis:
-HF & chest pain d/t heart being overworked
-Paresthesia & confusion d/t megaloblastic anemia
-Falls & activity Intolerance are biggest complaints by patients, elderly are at an increased high risk
Complications of anemia:
-Manage fatigue; allow pt to rest and assist with ADLs
-Maintain nutrition; diet rich in iron, B12, folic acid, protein which are building blocks of RBCs
-Assure proper administration of iron supplements
-Maintain perfusion; may need O2 to prevent hypoxia, monitor HR, BP, pulse ox to evaluate body's compensatory mechanisms
Monitor for cardiac, neurological and safety complications

§Cardiac complications like HF as body tries to increase its cardiac output
§Neurological complications for B12 deficiency anemia
§Safety complications s falls are always common with weakness and fatigue
Nursing care for all anemias:
-Can lead to significant loss of function, slower bone marrow response to anemia d/t advance age
-Pre-existing chronic illness can increase risk of getting anemia
-Increased complications and mortality
Gerontologic considerations for anemia:
-Spinach
-Blackstrap molasses
High iron diet for iron deficiency includes:
-Liver
-Leafy green vegetables
-Cereals
High B12 and folate diet for megaloblastic anemia includes:
3 types of anemias
-Hypoproliferative: iron deficiency, anemia of chronic disease, aplastic, megaloblastic
-Blood loss anemia
-Hemolytic anemia: RBCs are being destroyed early as seen in Sickle cell anemia
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