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Your blood contains three major cell types: platelets, white blood cells and red blood cells. Platelets clump together to form blood clots or scabs to begin healing after an injury, while white blood cells make up a part of your immune system and fight infection. Red blood cells, also called erythrocytes, carry oxygen from your lungs to tissues throughout your body. Red blood cells live about four months, so your body must constantly create new ones to replace the aged and dying cells. Proper nutrition helps ensure your body can make the red blood cells it needs, with specific vitamins and minerals playing a role in red blood cell production.

Vitamins B6, B9 and B12

Several B vitamins help produce functional red blood cells. Vitamins B6, B9 and B12 all contribute to the production of hemoglobin, a protein abundant in erythrocytes. Each hemoglobin molecule contains four heme chemical groups, with each group able to carry oxygen. Vitamins B6, B9 and B12 activate enzymes that you need to properly form heme; a deficiency in any of these vitamins prevents healthy red blood cell formation. Get 2.4 micrograms of vitamin B12, 400 micrograms of vitamin B9 and 1.3 milligrams of vitamin B6 each day, recommends the University of Maryland Medical Center.

Iron and Copper
The minerals iron and copper are pivotal in making healthy red blood cells. Iron makes up the active part of heme; the iron molecule in each heme group directly binds to and carries oxygen. If you don't eat enough iron, you cannot produce enough heme to make functional red blood cells. You also need copper to make heme; it helps make sure your cells have access to the chemical form of iron needed for red blood cells. All adults need 900 micrograms of copper daily, according to the Linus Pauling Institute. Men need 8 milligrams of iron each day, and women need 18 milligrams.

Vitamin A
Vitamin A, or retinol, helps support red blood cell development. All three types of blood cells originate from stem cells found in bone marrow. The presence of chemical factors determines if these stem cells form red blood cells, white blood cells or platelets. Vitamin A helps stems cells develop into red blood cells, ensuring that your body can produce enough red blood cells to replace those that die due to age. It also makes sure your developing red blood cells have access to the iron needed for hemoglobin. Women need 700 micrograms of vitamin A daily, according to the Linus Pauling Institute, while men require 900 micrograms.

Foods for RBC Production
Several foods contain one or more nutrients important to red blood cell production. Incorporate kale into your diet. The leafy greens contain vitamins A, B6 and B9, as well as copper and iron. Fortified cereals, such as bran cereal, contain vitamins B6, B9 and B12, and might also contain iron, while lean meats provide sources of B vitamins and iron. Eat more oysters; they are a rich source of iron and copper as well as vitamin B12.
What is it?
Anemia occurs when a person has lower-than-normal levels of red blood cells (RBCs) in the blood. According to the American Society of Hematology, there are many factors that can contribute to lower-than-normal RBC counts, including age, viral infections, and certain chronic diseases (ASH, 2010).

Iron-deficiency anemia is the most common type of anemia, which occurs when your body does not have enough of the mineral iron. Your body needs iron to produce a protein called hemoglobin, which is responsible for carrying oxygen to your body's tissues. Your tissues and muscles need oxygen to function effectively.

In women of child-bearing age, the most common cause of iron-deficiency anemia is loss of iron in blood due to heavy menstruation or pregnancy. Iron-deficiency anemia can also be caused by a poor diet or by certain intestinal diseases that affect how the body absorbs iron. The condition is normally treated with iron supplements.

According to the Centers for Disease Control and Prevention (CDC), iron deficiency is the most common nutritional deficiency in the United States. It is also the most common cause of anemia (CDC, 2011).

There are many reasons why a person might become deficient in iron. These include:
Inadequate Iron Intake

Eating too little iron over an extended amount of time can cause a shortage in your body. Iron can be found in foods such as meat, eggs, and some green vegetables. Pregnant women and young children may need even more iron in their diet, as it is essential during times of rapid growth and development.
Pregnancy or Blood Loss Due to Menstruation

In women of child-bearing age, the most common causes of iron-deficiency anemia are heavy menstrual bleeding or blood loss during childbirth. The CDC found that about nine percent of women ages 12 to 49 years are deficient in iron (CDC, 2012).
Internal Bleeding

Certain medical conditions can cause internal bleeding, which can lead to iron-deficient anemia. Examples include an ulcer in your stomach, polyps (tissue growths) in the colon or intestines, or colon cancer. Regular use of pain relievers, such as aspirin, can also cause bleeding in the stomach.
Inability to Absorb Iron

Certain disorders or surgeries that affect the intestines can also interfere with how your body absorbs iron. Even if you get enough iron in your diet, Celiac disease or an intestinal surgery such as gastric bypass may limit the amount of iron your body can absorb.
shape and size. There are some shaped like sickles, and I bet you can guess what disease is associated. Pernicious anemia, folate deficiency, and liver disease can cause megaloblastic anemias, in which the cells are bigger and fatter than normal.
Classic iron deficiency, on the other hand, gives you little, pale cells. A peek at a smear is useful. The Coulter counter helps you out by measuring MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin), and MCHC (mean corpuscular hemoglobin concentration), collectively known as RBC indices.


Anisocytosis: this is a variation in size of RBCs; it may be an indication of anemia
Macrocytosis: large RBCs that may be due to a vitamin B12 or folate deficiency. They are seen in megaloblastic anemia (e.g., pernicious anemia), chronic alcoholism, and myelodysplastic syndrome.
Microcytosis: this is the presence of small RBCs that may be due to an iron deficiency anemia or to an inherited disorder such as thalassemia.

SHAPE -- Poikilocytosis is a variation in the shape of an RBC and may include several different abnormalities at the same time.

Acanthrocytes (spur, thorn or spiculated cells): irregular shaped cells with 5-10 spicules; may be present in the blood of people who have had their spleen removed (splenectomy) and with, for example, chronic alcoholism (cirrhosis), hemolytic anemia, or thalassemia. They are also present in an inherited disorder called abetalipoproteineimia.
Echinocytes (burr, crenated or berry cells): may have 10-30 blunt projections and often seen in people with renal failure; may be an artifact - something caused during sample preparation.
Elliptocytes (ovalocyte): elliptical-shaped RBC seen in hereditary elliptocytosis and various anemias, myelofibrosis.
Fragmented cells (Schistocytes, Keratocyte, Helmet cell): fragmented RBC of various shapes that may be seen in people with disseminated intravascular coagulation (DIC) or a vascular artificial device (prosthesis) such as a heart valve.
Rouleaux: RBCs that appear as a stack of coins and seen in people with multiple myeloma or Waldenstrom macroglobulinemia.
Sickle cells: crescent-shaped RBCs that are characteristic of sickle cell anemia.
Target cells (leptocytes or codocytes): RBCs that resemble a bull's-eye; commonly seen in people with abnormal inherited forms of hemoglobin (hemoglobinopathies), thalassemia, and various anemias.
Teardrop cells (dacrocytes): RBCs that resemble a teardrop; often seen in people with myelofibrosis and thalassemia.
Spherocytosis: sphere-shaped RBCs that are often present in hereditary spherocytosis or due to an immune hemolytic anemia.


Hypochromasia: this may be seen in a variety of disorders including thalassemia and iron deficiency. The RBC is pale in color due to insufficient hemoglobin and contains a large, hollow middle (central pallor) of the cell.
Hyperchromasia: the RBC is darker in color than normal; this may be due to dehydration or presence of spherocytes.
Polychromasia: blue-staining RBCs, indicating that they are immature due to early release from the bone marrow.

Intracellular Structure (nuclear material, remnants, and inclusions inside the RBC)

Nucleated RBCs (NRBC, normoblasts): a very immature form of RBCs seen when there is a severe demand for RBCs to be released by the bone marrow or marrow involvement by fibrosis or tumor; may be seen in severe anemia, myelofibrosis, thalassemia, miliary tuberculosis, cancers that involve the bone marrow, and in chronic low oxygen levels (hypoxemia). Nucleated RBCs can be normal in infants for a short time after birth.
Reticulocytes: these are immature RBCs that are usually a blue-staining (polychromatic) color. A few of these young red blood cells are normal in the circulation. Elevated numbers may be seen with acute blood loss, hypoxia, RBC destruction, sickle cell disease, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and autoimmune hemolytic anemia.
Siderocyte, sideroblast, ring sideroblast: When RBCs are stained with Prussian blue dye, iron granules may be seen. Sideroblasts are immature siderocytes and may actually form a ring pattern indicative of sideroblastic anemia.
Basophilic stippling is dark blue dots inside the RBC; due to abnormal aggregation of ribosomes and polyribosomes and may be present in heavy metal poisoning (such as lead), nutritional deficiencies, or myelofibrosis.
Heinz bodies: large inclusion bodies (granules) in the RBCs when stained with crystal violet; may be due to an enzyme (G6PD) deficiency, unstable hemoglobin variant, thalassemia, and autoimmune hemolytic anemia.
Howell-Jolly bodies (small, round remnants of nuclear DNA inside cell): present in sickle cell anemia, hemolytic or megaloblastic anemias, and may be seen after a splenectomy.
Cabot's Rings: threadlike inclusions that form a ring within the RBC; may be seen in a variety of anemias.
Malarial parasites: in people with malaria, these parasites live inside RBCs and may be visible on a blood smear. This is not a routine finding; these parasites are usually found in those who live in or have traveled to areas where the disease is endemic.
Iron is a mineral. Most of the iron in the body is found in the hemoglobin of red blood cells and in the myoglobin of muscle cells. Iron is needed for transporting oxygen and carbon dioxide. It also has other important roles in the body.

People take iron supplements for preventing and treating low levels of iron (iron deficiency) and the resulting iron deficiency anemia. In people with iron deficiency anemia, the red blood cells can't carry enough oxygen to the body because they don't have enough iron. People with this condition often feel very tired.

Iron is also used for improving athletic performance and treating attention deficit-hyperactivity disorder (ADHD) and canker sores. Some people also use iron for Crohn's disease, depression, fatigue, and the inability to get pregnant.

Women sometimes take iron supplements to make up for iron lost in heavy menstrual periods. Iron-rich foods, such as pork, ham, chicken, fish, beans, and especially beef, liver, and lamb are also used.

How does it work?

Iron helps red blood cells deliver oxygen from the lungs to cells all over the body. Once the oxygen is delivered, iron then helps red blood cells carry carbon dioxide waste back to the lungs to be exhaled. Iron also plays a role in many important chemical reactions in the body.

effective for?
Anemia caused by chronic disease. Many diseases such as cancer, kidney problems, or heart problems can cause anemia. Taking iron along with other medications such as epoetin alfa (erythropoietin, EPO, Epogen, Procrit) can help build red blood cells and reverse anemia in people with kidney problems or being treated for cancer with chemotherapy. Receiving iron intravenously (by IV) is more effective than taking supplements by mouth.
Iron deficiency. Taking iron supplements is effective for treating and preventing iron deficiency and anemia caused by too little iron in the body.
Coughs caused by ACE inhibitors. Medications used for high blood pressure called ACE inhibitors can sometimes cause coughing as a side effect. Some research shows that taking an iron supplement might reduce or prevent this side effect. The ACE inhibitor medications include captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), and many others.
Learning problems. Taking iron might help improve thinking, learning, and memory in children with low levels of iron.
Iron deficiency during pregnancy. Taking iron might reduce the risk of anemia caused by too little iron in the body when taken by women who are pregnant.

Iron is LIKELY SAFE for most people when it is taken by mouth in appropriate amounts. However, it can cause side effects including stomach upset and pain, constipation or diarrhea, nausea, and vomiting. Taking iron supplements with food seems to reduce some of these side effects. However, food can also reduce how well the body absorbed iron. Iron should be taken on an empty stomach if possible. If it causes too many side effects, it can be taken with food. Try to avoid taking it with foods containing dairy products, coffee, tea, or cereals.

There are many forms of iron products such as ferrous sulfate, ferrous gluconate, ferrous fumarate, and others. Some products, such as those containing polysaccharide-iron complex (Niferex-150, etc), claim to cause fewer side effects than others. But there is no reliable evidence to support this claim.

Some enteric coated or controlled release iron products might reduce nausea for some people; however, these products also have less absorption by the body.

Liquid iron supplements may blacken teeth.

High doses of iron are LIKELY UNSAFE, especially for children. Iron is the most common cause of poisoning deaths in children. Doses as low as 60 mg/kg can be fatal. Iron poisoning can cause many serious problems including stomach and intestinal distress, liver failure, dangerously low blood pressure, and death. If you suspect an adult or child has taken more than the recommended amount of iron, call your healthcare professional or the nearest poison control center immediately.

There is some concern that high intake of iron might increase the chance of developing heart disease. Some studies show that people with high intake of iron, especially from food sources such as red meat, are more likely to have heart disease. This may be especially true for people with type 2 diabetes. But this is controversial. Other studies do not show that iron increases the chance of heart disease. It is too soon to tell for sure if iron increases the chance of heart disease.

Special Precautions & Warnings:
Pregnancy and breast-feeding: Iron is LIKELY SAFE for pregnant and breast-feeding women who have enough iron stored in their bodies when used in doses below the tolerable upper intake level (UL) of 45 mg per day of elemental iron. The UL is the highest level of intake at which no harmful side effects are expected. However, iron is LIKELY UNSAFE when taken by mouth in high doses. If you do not have iron deficiency, do not take more than 45 mg per day of elemental iron per day. Higher doses frequently cause stomach and intestinal side effects such as nausea and vomiting. High levels of hemoglobin at the time of delivery are associated with bad pregnancy outcomes. Hemoglobin is the molecule in red blood cells that contains iron.

Diabetes: There is concern that a diet that is high in iron might increase the risk of heart disease in women with type 2 diabetes, although this has not been proven. If you have diabetes, discuss your iron intake with your healthcare provider.

Stomach or intestinal ulcers: Iron might cause irritation and make these conditions worse. Use iron with care.

Intestinal inflammation, such as ulcerative colitis or Crohn's disease: Iron might cause irritation and make these conditions worse. Use iron with care.

Hemoglobin disease, such as thalassemia: Taking iron might cause iron overload in people with these conditions. If you have a hemoglobin disease, don't take iron unless directed to do so by your healthcare provider.

Premature infants: Giving iron to premature infants with low blood levels of vitamin E can cause serious problems. The vitamin E deficiency should be corrected before giving iron. Talk with your healthcare provider before giving iron to a premature infant.
Nursing care plan aplastic anemia with a primary nursing diagnosis of Risk for infection related to inadequate secondary defenses (decreased hemoglobin and leukopenia), immunosuppression, pharmaceutic agents, chronic disease, malnutrition, or invasive procedures.

Aplastic, or hypoplastic, anemia is a bone marrow failure that is characterized by a decrease in all formed elements of peripheral blood and its bone marrow. If all elements are suppresse —resulting in loss of production of healthy erythrocytes, platelets, and granulocytes—the condition is known as pancytopenia. Onset is often insidious and may become chronic; however, onset may be rapid and overwhelming when the cause is a myelotoxin (a poison that damages the bone marrow).

With complete bone marrow suppression, leukocytic failure may result in fulminating infections, greatly reducing the chances for complete recovery. Less severe cases may have an acute transient course or a chronic course with ultimate recovery, although the platelet count may remain subnormal, thus requiring a lifetime of precautions against bleeding. Aplastic anemia may produce fatal bleeding or infection, however, especially if it is idiopathic or stems from chloramphenicol or infectious hepatitis. Approximately one-third of patients do not respond to immunotherapy; even the responders risk relapse and late-onset disease such as leukemia.
Nursing care plan
Aplastic anemia often develops from an injury or damage to the stem cells that inhibit red blood cell (RBC) production. A less common development occurs when damaged bone marrow microvasculature creates an unfavorable environment for cell growth and maturation, resulting in aplastic anemia. Approximately 80% ofAplastic anemias are acquired; it is caused by drugs such as antibiotics and anticonvulsants, toxic agents such as benzene and chloramphenicol, pregnancy, or radiation. Other causes include severe disease such as hepatitis, viral illnesses, and preleukemic and neoplastic infiltration of the bone marrow. Some forms of aplastic anemia are congenital.

Nursing care plan assessment and examination
Determine if the patient has recently been exposed to known risk factors, such as recent treatment with chemotherapeutic drugs or antibiotics known to cause bone marrow suppression, radiation therapy, or accidental exposure to organic solvents. Establish a history of dyspnea, headache, intolerance for activity, progressive fatigue, malaise, chills and possibly fever, easy bruising, or frank bleeding.

Examine the patient's skin for pallor or a jaundiced appearance. Inspect the patient's mucous membranes for bleeding. Inspect the patient's mouth and throat for lesions. Palpate the patient's lymph nodes to see if they are enlarged. Palpate the patient's liver and spleen, and note any enlargement. Auscultate the patient's chest for tachycardia and adventitious lung sounds.

Assess the patient's mental status as an indicator of cerebral perfusion; assess the sensorimotor status to evaluate nervous system oxygenation. Patients may be anxious or fearful because of their low level of energy. Discomfort caused by mouth pain may cause the patient to feel irritable. The parents of an infant with a congenital form of aplastic anemia may be quite agitated over the child's illness.

Nursing care plan intervention and treatment
Perform meticulous hand washing before patient contact. If protective isolation is required, use gloves, gown, and mask, and make sure that visitors do the same. Report any signs of systemic infection, and obtain the prescribed cultures. Provide frequent skin care, oral care, and perianal care to prevent both infection and bleeding. Avoid invasive procedures, if possible. When invasive procedures are necessary, maintain strict aseptic techniques and monitor the sites for signs of inflammation or drainage. Teach the patient and significant others symptoms of infection and to report them immediately to healthcare providers.

To help combat fatigue and conserve patient energy, plan frequent rest periods between activities. Instruct the patient in energy-saving techniques. Encourage the patient to increase activities gradually to the level of maximum tolerance. Some patients withaplastic anemia undergo bone marrow transplants. Preoperatively, teach the patient about the procedure. Explain that chemotherapy and possible radiation treatments are necessary to remove cells that may cause the body to reject the transplant. Offer support and reassurance.

Nursing care plan discharge and home health care guidelines
Teach the patient the importance of avoiding exposure to individuals who are known to have acute infections. Emphasize the need for preventing trauma, abrasions, and breakdown of the skin. Be sure the patient understands the need to maintain a good nutritional intake to enhance the immune system and resistance to infections. Teach the patient the potential for bleeding and hemorrhage, and offer instruction in measures to prevent bleeding, including the use of a soft toothbrush and an electric razor. Discuss the need for regular dental examinations. Explain the importance of maintaining regular bowel movements to prevent straining and rectal bleeding. Instruct the patient to avoid enemas and rectal thermometers because of the risk of rectal perforation.
Prevent a sickle cell crisis:

Take vitamins and minerals as directed. Folic acid can help prevent blood vessel problems that can occur with sickle cell anemia. Zinc may decrease how often you have pain.

Drink liquids as directed. Dehydration can increase your risk for a sickle cell crisis. Ask how much liquid to drink each day and which liquids are best for you.

Balance rest and exercise. Rest during a sickle cell crisis. Over time, increase your activity to a moderate amount. Exercise regularly. Avoid exercise or activities that can cause injury, such as football. Ask about the best exercise plan for you.

Stay out of the cold. Do not go quickly from a warm place to a cold place. Do not go swimming in cold water. Stay warm in the winter.

Do not smoke cigarettes or drink alcohol. These increase your risk for a sickle cell crisis. Smoking can also delay healing after treatment. Ask your healthcare provider for information if you currently smoke and need help quitting.

Ask about which vaccinations you need. Vaccinations can help prevent a viral infection that may lead to a sickle cell crisis. Get a flu shot every year as directed. You may need a pneumonia vaccine every 5 years.

Follow up with your healthcare provider as directed:

You may need ongoing screening for conditions that can develop because of sickle cell disease. Examples include kidney disease, hypertension (high blood pressure), retinopathy (eye problems), and problems with your lungs. Write down your questions so you remember to ask them during your visits.
The most common cause of hemolytic reactions is transfusion of ABO-incompatible blood.

Antibodies in the recepients serum react with antigens on the donors RBC's resulting in agglutination of cells which can obstruct capillaries and block blood flow; hemolysis of the RBC's releases free hemoglobin into the plasma; Hb is filtered by kidney and may be found in the urine and may obstruct renal tubules resulting in acute renal failure, DIC, and death

Blood is classified into different blood types called A, B, AB, and O.

Your immune system can usually tell its own blood cells from blood cells from those of another person. If other blood cells enter your body, your immune system may already have antibodies against them. These antibodies will work to destroy the blood cells that your immune system does not recognize.

Another way blood cells may be classified is by Rh factors. People who have Rh factors in their blood are called "Rh positive." People without these factors are called "Rh negative." Rh negative people form antibodies against Rh factor if they receive Rh positive blood.

There are also other factors to identify blood cells, in addition to ABO and Rh.

Blood that you receive in a transfusion must be compatible with your own blood. This means that your body does not have antibodies against the blood you receive.

Most of the time, blood transfusion between compatible groups (such as O+ to O+) does not cause a problem. Blood transfusion between incompatible groups (such as A+ to O-) causes an immune response. This can lead to a serious transfusion reaction. The immune system attacks the donated blood cells, causing them to burst.
Back pain
Bloody urine
Fainting or dizziness
Flank pain
Flushing of the skin

Symptoms of a hemolytic transfusion reaction most often appear during or right after the transfusion. Sometimes, they may develop after several days (delayed reaction).
Exams and Tests

This disease may change the results of these tests:

Coombs' test, direct
Coombs' test, indirect
Fibrin degradation products
Partial thromboplastin time
Prothrombin time
Serum bilirubin
Serum creatinine
Serum hemoglobin
Urine hemoglobin


Therapy can prevent or treat the severe effects of a hemolytic transfusion reaction. If symptoms occur during the transfusion, the transfusion must be stopped immediately. Blood samples from the person getting the transfusion and from the donor may be tested to tell whether symptoms are being caused by a transfusion reaction.

Mild symptoms may be treated with:

Acetaminophen, a pain reliever to reduce fever and discomfort
Fluids given through a vein (intravenous) and other medicines to treat or prevent kidney failure and shock.

Outlook (Prognosis)

The outcome depends on how bad the reaction is. The disorder may disappear without problems. Or, it may be severe and life-threatening.
Possible Complications

Acute kidney failure
Lung problems

When to Contact a Medical Professional

Tell your health care provider if you are having a blood transfusion and you have had a reaction before.

Donated blood is put into ABO and Rh groups to reduce the risk of transfusion reaction.

Before a transfusion, patient and donor blood are tested (crossmatched) to see if they are compatible with each other. A small amount of donor blood is mixed with a small amount of patient blood. The mixture is checked under a microscope for signs of antibody reaction.

Before the transfusion is given, the health care provider will usually check again to make sure you are receiving the right unit of blood.
increase in number of red blood cells, elevated hematacrit, and elevated levels of hemoglobin
Central venous hematocrit > 65

anemia - Any pathological deficiency in the oxygen-carrying component of the blood (RBCs & hemoglobin), resulting in tissue hypoxia of some degree; measured in unit volume concentrations of hemoglobin, red blood cell volume, or red blood cell number; many specific disorders are recognized; for most types, fatigue is the most common complaint, along with malaise (vague feeling of physical discomfort or uneasiness), sensitivity to cold, shortness of breath, dizziness and restless legs syndrome (uncomfortable feeling in legs, sensations of pulling, tingling, crawling, accompanied by a need to move the legs).

polycythemia - A pathological increase in red blood cells (Hct >50) due to a benign proliferative disorder ("cancer") of the red bone marrow; less often due to oversecretion of erythropoietin from the kidney.

iron-deficiency anemia (IDA) - A deficiency of hemoglobin synthesis where one has inadequate amounts of iron to meet body demands, especially common during periods of rapid growth or pregnancy; it is usually due to a diet insufficient in iron or, less often, to a gastrointestinal malabsorption problem, and it may also develop as a component of hemorrhagic anemia.

pernicious anemia - A severe deficiency of red blood cells most often affecting older adults, caused by failure of the intestines to absorb vitamin B12 and characterized by abnormally large red blood cells, gastrointestinal disturbances, and neurological problems including lesions of the spinal cord; the failure to absorb vitamin B12 may be due to (1) a diet insufficient in vitamin B12 or (2) a failure of the stomach to synthesize intrinsic factor, a necessary carrier of vitamin B12 across the intestinal lining.

intrinsic factor - A glycoprotein that is secreted by the parietal cells of the gastric mucous membrane which is essential for the absorption of vitamin B12 in the intestines.

hemorrhagic anemia - A deficiency of red blood cells due to loss of RBCs; characteristics depend on the amount and time frame of the loss; chronic hemorrhagic anemia produces a secondary iron-deficiency anemia because normal intestinal iron absorption is inefficient.

hemolytic anemia - A deficiency of red blood cells resulting from the lysis of red blood cells, e.g., in response to certain toxic or infectious agents and in certain inherited blood disorders.

aplastic anemia - A deficiency of red blood cells in which the capacity of the bone marrow to generate red blood cells is defective; this may be caused by bone marrow disease including cancers or exposure to toxic agents, e.g., radiation, chemicals, or drugs.

sickle cell anemia - A chronic, usually fatal deficiency of red blood cells marked by sickle-shaped red blood cells, occurring frequently in Black people of Africa or of African descent, and characterized by episodic pain in the joints, fever, leg ulcers, and jaundice; the disease occurs in individuals who are homozygous recessive for a mutant hemoglobin gene; heterozygous carriers have fewer symptoms and are defined as having the sickle cell trait.
latelets are the tiny blood cells that help stop bleeding by binding together to form a clump or plug at sites of injury inside blood vessels.

A normal platelet count is between 150,000 and 450,000 platelets per microliter (one-millionth of a liter, abbreviated mcL). The average platelet count is 237,000 per mcL in men and 266,000 per mcL in women.

A platelet count below 150,000 per mcL is called thrombocytopenia, while a platelet count over 450,000 is called thrombocytosis. Platelets seem to have a large backup capacity: blood typically still clots normally as long as the platelet count is above 50,000 per mcL (assuming no other problems are present). Spontaneous bleeding doesn't usually occur unless the platelet count falls to 10,000 or 20,000 per mcL.

Platelets are constantly being produced in the bone marrow. A low or high platelet count is not often a problem by itself, but can frequently be a sign of another medical condition. For this reason, high or low platelet counts require additional medical attention.

Sometimes the number of platelets in the blood is lower than normal. This may be because of illness such as cancer, leukaemia or certain blood disorders, or because of a side effect of chemotherapy treatment. If your bone marrow is not working normally, the number of platelets in your blood (known as the 'platelet count') may drop. How low the number of platelets gets depends on how much the illness or the chemotherapy has affected the cells in the bone marrow.

The normal platelet count in an adult is between 150 and 400. A slightly low platelet count won't usually cause any problems. The risk of bleeding increases as the platelet count drops, but it rarely happens unless the count is lower than 80-100. Signs of a low platelet count include nosebleeds, bleeding gums, heavy periods, bruising and tiny blood spots in the skin known as petecheia. You should tell your doctor straightaway if you have any of these symptoms.

Very rarely, more serious bleeding - for example, into the brain or the digestive system - can occur. Serious bleeding is very rare and usually only happens if the platelet count drops below 10. Although it may happen at higher levels (perhaps up to 30) if you also have a high temperature because of infection. It's important that you contact the hospital if you know that your platelets are low and you develop a temperature above 38°C (100.4ºF).

In hospitals, platelet transfusions are often used to prevent the platelet count from dropping too low. Your doctors will check your platelet count regularly and will be aware of when it's falling. If you do have a low platelet count, it may be necessary to have a platelet transfusion. This is particularly important before certain procedures where there is a risk of bleeding, such as a lumbar puncture or bone marrow aspiration. The platelet transfusion will reduce the risk of any bleeding during or after the procedure.
• Blood component therapy is frequently used in managing hematologic diseases. However, blood component therapy only temporarily supports the patient until the underlying problem is resolved.

• When the blood or blood components have been obtained from the blood bank, positive identification of the donor blood and recipient must be made. Improper product-to-patient identification causes 90% of hemolytic transfusion reactions.

• The blood should be administered as soon as it is brought to the patient. It should not be refrigerated on the nursing unit.

• Autotranfusion, or autologous transfusion, consists of removing whole blood from a person and transfusing that blood back into the same person. The problems of incompatibility, allergic reactions, and transmission of disease can be avoided.

• A blood transfusion reaction is an adverse reaction to blood transfusion therapy that can range in severity from mild symptoms to a life-threatening condition. Blood transfusion reactions can be classified as acute or delayed.

Acute Transfusion Reactions
• The most common cause of hemolytic reactions is transfusion of ABO-incompatible blood.

• Febrile reactions are most commonly caused by leukocyte incompatibility. Many individuals who receive five or more transfusions develop circulating antibodies to the small amount of WBCs in the blood product.

• Allergic reactions result from the recipient's sensitivity to plasma proteins of the donor's blood. These reactions are more common in an individual with a history of allergies.

• An individual with cardiac or renal insufficiency is at risk for developing circulatory overload. This is especially true if a large quantity of blood is infused in a short period of time, particularly in an elderly patient.

• Transfusion-related lung injury is characterized by the sudden development of noncardiogenic pulmonary edema (acute lung injury).

• An acute complication of transfusing large volumes of blood products is termed massive blood transfusion reaction. Massive blood transfusion reactions can occur when replacement of RBCs or blood exceeds the total blood volume within 24 hours.

Delayed Transfusion Reactions
• Delayed transfusion reactions include delayed hemolytic reactions, infections, iron overload, and graft-versus-host disease.

• Infectious agents transmitted by blood transfusion include hepatitis B and C viruses, HIV, human herpesvirus type 6, Epstein-Barr virus, human T cell leukemia, cytomegalovirus, and malaria.
Immobilization of the affected limb and the application of ice packs are helpful in diminishing swelling and pain. Early infusion upon the recognition of initial symptoms of a joint bleed may often eliminate the need for a second infusion by preventing the inflammatory reaction in the joint.

Joint Damage

The most common complication of hemophilia is joint disease. A joint is an area where two bones come together. People with hemophilia can bleed into the joint space after an injury or, at times, without obvious cause. The pressure of blood filling the joint cavity causes significant pain and can lead to chronic swelling and deformity. Joint damage can occur after repeated bleeding into the same joint or after one serious joint bleed. The joints typically affected include the elbows, ankles and knees.
How does joint damage occur?knee joint picture

Joint damage in people with a bleeding disorder is similar to joint damage of a person with arthritis. The damage occurs in the synovium and the cartilage around the bones.

The synovium is a lining that lubricates and feeds the joint; it also removes fluid and debris from the joint. There are blood vessels in the synovium and that is why bleeding into the joints is common in people with a bleeding disorder. One of the synovium's functions is to remove fluid from the joint. When there is blood in the joint, the synovium absorbs it. Blood has iron and it is believed that the iron in the blood causes the the lining to get thicker. As the synovium gets thicker, it contains more blood vessels and therefore subsequent bleeding is more likely.

Joints have two types of cartilage, cartilage around the ends of the bones and cartilage to absorb shock. The cartilage affected when bleeding occurs is the cartilage around the bone area. This cartilage is a smooth surface on the ends of the bones and allows the two bones connecting in that joint to move without friction on each other. When bleeding occurs, enzymes from the swollen synovium destroy the cartilage that covers the ends of the bones. As the cartilage erodes and becomes pitted, the rubbing of bone on bone is very painful. The cartilage that absorbs shock in a joint is usually not affected by bleeding, but rather by injuries in sports or other physical activities.

As described, joint bleeding can become more likely even after one joint bleed. Joints that bleed often are usually referred to as "target joints". As joint damage progresses, movement may become restricted in that joint.
What are the symptoms of a joint bleed?

Tingling inside the joint
Loss of motion

Small children may not be able to describe the symptoms above. Below are some signs to watch for in small children:

Favoring a limb - a baby may hold bottle with opposite hand than usual, toddler may use opposite hand to eat
Refusing to walk - child may not want to move or may walk trying to avoid bearing weight on the affected leg

What should be done when a joint bleed is suspected?

It is very important not to ignore the signs of a joint bleed. Early treatment with factor concentrate is crucial to reduce the risk of joint damage. If you suspect a joint bleed, call your doctor immediately to avoid complications.

In addition to factor treatment, the following can help a bleeding joint feel better and minimize damage:

Apply ice to the area
Rest the joint
Elevate the limb

What is the treatment for damaged joints?

Over time, joints can become severely damaged and the person suffers from acute pain and restricted range of motion in that joint. Surgery can be effective in managing pain and improving movement of the joint. It is important to note that a hemotologist must be involved in the planning of all invasive procedures to ensure proper clotting levels during and after surgery. The following are common surgical procedures used to aleviate pain and improve function of damaged joints:

A syncovectomy is the removal of the synovium. Removing the synovium stops the bleeding cycle caused by the thick synovium. The procedure doesn't make the joint "like new", but it helps aleviate pain and improve function of the joint. There are three synovectomy techniques used:

Radioactive - A radioactive fluid is injected into the joint, which reduces the swelling in the synovial membrane.
Arthroscopic - The synovium is removed through surgical incisions in the area. A small camera is inserted into the joint to help guide the removal of the synovium.
Open - The joint is opened surgically and the synovium removed.

Joint replacement

Joint replacement is a surgical procedure that helps people who suffer from chronic pain that interferes with their daily activities. During this surgical procedure, the damaged joint and bone are removed and replaced with plastic and metal components. Joint replacement surgery is more common on knee and hip joints than on elbows, shoulders and ankles. After surgery and physiotherapy, most people are left with a pain-free joint and improved range of motion. Replacement of the artificial joint is sometimes necessary as it can wear out or become loose. Ninety percent of hip and knee replacements should last 10 years.f
leukemia = a malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leukocytes. These suppress the production of normal blood cells, leading to anemia and other symptoms.

risk factors for developing leukemia

Previous cancer treatment. People who've had certain types of chemotherapy and radiation therapy for other cancers have an increased risk of developing certain types of leukemia.
Genetic disorders. Genetic abnormalities seem to play a role in the development of leukemia. Certain genetic disorders, such as Down syndrome, are associated with increased risk of leukemia.
Certain blood disorders. People who have been diagnosed with certain blood disorders, such as myelodysplastic syndromes, may have an increased risk of leukemia.
Exposure to high levels of radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing leukemia.
Exposure to certain chemicals. Exposure to certain chemicals, such as benzene — which is found in gasoline and is used by the chemical industry — also is linked to increased risk of some kinds of leukemia.
Smoking. Smoking cigarettes increases the risk of acute myelogenous leukemia.
Family history of leukemia.

Fever or chills
Persistent fatigue, weakness
Frequent or severe infections
Losing weight without trying
Swollen lymph nodes, enlarged liver or spleen
Easy bleeding or bruising
Recurrent nosebleeds
Tiny red spots in your skin (petechiae)
Excessive sweating, especially at night
Bone pain or tenderness
Risks for leukemia

Gender: Men are more likely to develop CML, CLL and AML than women.
Age: The risk of most leukemias, with the exception of ALL, typically increases with age.


Family history: Most leukemias have no familial link. However, first degree relatives of CLL patients, or having an identical twin who has or had AML or ALL, may put you at an increased risk for developing the disease.
Genetic diseases: Certain genetic abnormalities, such as Down syndrome, may play a role in the development of leukemia.


Smoking: Although smoking may not be a direct cause of leukemia, smoking cigarettes does increase the risk of developing AML.


Exposure to high levels of radiation: Exposure to high-energy radiation (e.g., atomic bomb explosions) and intense exposure to low-energy radiation from electromagnetic fields (e.g., power lines).
Chemical exposure: Long-term exposure to certain pesticides or industrial chemicals like benzene is considered to be a risk for leukemia.


Previous cancer treatment: Certain types of chemotherapy and radiation therapy for other cancers are considered leukemia risk factors.
Hodgkin's Lymphoma
• Hodgkin's lymphoma, also called Hodgkin's disease, is a malignant condition characterized by proliferation of abnormal giant, multinucleated cells, called Reed-Sternberg cells, which are located in lymph nodes.

• Although the cause of Hodgkin's lymphoma remains unknown, the main interacting factors include infection with Epstein-Barr virus, genetic predisposition, and exposure to occupational toxins. The incidence of Hodgkin's lymphoma is increased in incidence among human immunodeficiency virus infected patients.

• The nursing care for Hodgkin's lymphoma is largely based on managing problems related to the disease (e.g., pain due to tumor), pancytopenia, and other side effects of therapy.

Painless swelling of one or more lymph nodes, without a recent infection.
Symptoms stemming from pressure of swollen lymph nodes on nearby organs or structures. They may include a cough, shortness of breath, abdominal pain or swelling, a Horner's syndrome (a neurological problem affecting the face and eyes, due to damage to nerves in the neck), nerve pain, and leg swelling.
Fever, either persistent or alternating with periods of normal temperatures, for 14 consecutive days or longer. These fevers usually occur twice daily, usually in the late afternoon and early evening, and rarely are greater than 102 degrees Farenheit.
Pain in lymph nodes or abdomen after drinking alcohol.
Drenching night sweats and/or chills lasting for 14 consecutive days or longer.
Unintentional weight loss (more than 10% over six months).
Bone pain.
Increased susceptibility to infections.
Total body itching.

The symptoms of fever, chills, night sweats, and weight loss, occur in 30% of people with Hodgkin lymphoma, usually older adults. These symptoms are usually associated with a more advanced, and more aggressive, disease, with a poorer prognosis.


Chemotherapy is a drug treatment that uses chemicals to kill lymphoma cells. Chemotherapy drugs travel through your bloodstream and can reach nearly all areas of your body.

Chemotherapy is often combined with radiation therapy in people with early-stage classical type Hodgkin's lymphoma. Radiation therapy is typically done after chemotherapy. In advanced Hodgkin's lymphoma, chemotherapy may be used alone or combined with radiation therapy.

Chemotherapy drugs can be taken in pill form, through a vein in your arm or sometimes both methods of administration are used. Several combinations of chemotherapy drugs are used to treat Hodgkin's lymphoma.

Side effects of chemotherapy depend on the specific drugs you're given. Common side effects include nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia.

Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. For classical Hodgkin's lymphoma, radiation therapy can be used alone, but it is often used after chemotherapy. People with early-stage lymphocyte-predominant Hodgkin's lymphoma typically undergo radiation therapy alone.

During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease.

Radiation therapy can cause skin redness and hair loss at the site where the radiation is aimed. Many people experience fatigue during radiation therapy. More-serious risks include heart disease, stroke, thyroid problems, infertility and other forms of cancer, such as breast or lung cancer.
Stem cell transplant

A stem cell transplant is a treatment to replace your diseased bone marrow with healthy stem cells that help you grow new bone marrow. A stem cell transplant may be an option if Hodgkin's lymphoma returns despite treatment.

During a stem cell transplant, your own blood stem cells are removed, frozen and stored for later use. Next you receive high-dose chemotherapy and radiation therapy to destroy cancerous cells in your body. Finally your stem cells are thawed and injected into your body through your veins. The stem cells help build healthy bone marrow.


• Non-Hodgkin's lymphomas (NHLs) are a heterogeneous group of malignant neoplasms of primarily B or T cell origin affecting all ages. A variety of clinical presentations and courses are recognized from indolent (slowly developing) to rapidly progressive disease.

• NHLs can originate outside the lymph nodes, the method of spread can be unpredictable, and the majority of patients have widely disseminated disease at the time of diagnosis.

• Treatment for NHL involves chemotherapy and sometimes radiation therapy. Nursing care is largely based on managing problems related to the disease (e.g., pain due to the tumor, spinal cord compression, tumor lysis syndrome), pancytopenia, and other side effects of therapy.

Non-Hodgkin's lymphoma symptoms may include:

Painless, swollen lymph nodes in your neck, armpits or groin
Abdominal pain or swelling
Chest pain, coughing or trouble breathing
Night sweats
Weight loss
Non-Hodgkin's treatment
f your non-Hodgkin's lymphoma is aggressive or causes signs and symptoms, your doctor may recommend treatment. Options may include:

Chemotherapy. Chemotherapy is drug treatment — given orally or by injection — that kills cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or combined with other treatments.
Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancerous cells and shrink tumors. During radiation therapy, you're positioned on a table and a large machine directs radiation at precise points on your body. Radiation therapy can be used alone or in combination with other cancer treatments.
Stem cell transplant. A stem cell transplant is a procedure that involves very high doses of chemotherapy or radiation with the goal of killing the lymphoma cells that may not be killed with standard doses. Later, healthy stem cells — your own or from a donor — are injected into your body, where they can form new healthy blood cells.

Medications that enhance your immune system's ability to fight cancer. Biological therapy drugs help your body's immune system fight cancer.

For example, one biological therapy called rituximab (Rituxan) is a type of monoclonal antibody that attaches to B cells and makes them more visible to the immune system, which can then attack. Rituximab lowers the number of B cells, including your healthy B cells, but your body produces new healthy B cells to replace these. The cancerous B cells are less likely to recur.
Medications that deliver radiation directly to cancer cells. Radioimmunotherapy drugs are made of monoclonal antibodies that carry radioactive isotopes. This allows the antibody to attach to cancer cells and deliver radiation directly to the cells. One radioimmunotherapy drug — ibritumomab tiuxetan (Zevalin) — is used to treat lymphoma.
What Is Multiple Myeloma?

Multiple myeloma is a cancer that affects plasma cells, a kind of white blood cell found in the soft insides of your bones, called marrow. Plasma cells are part of your body's immune system. They make antibodies to help fight off infections.

There is no cure for multiple myeloma, but treatment can often help you feel better and live longer. To make the best possible choices about your treatment and care, you'll want to learn as much as you can about the disease.

With this cancer, your plasma cells multiply and grow out of control. They crowd out healthy cells, including red and white blood cells and those that keep bones strong.

Over time, plasma cells spill out of your bone marrow and travel to other parts of your body, which can damage your organs.

The disease can weaken your immune system, lead to anemia, and cause kidney and bone problems.

You may not notice any symptoms until the cancer is advanced, meaning it has spread inside your body.

Getting this kind of diagnosis is hard for you and the people in your life. It's important that you and your family get support to manage this disease.


Scientists don't know exactly what causes multiple myeloma. In some people, it may be brought on by changes (mutations) in genes that control how cells grow.

You may be more likely to get this cancer if you are:

Age 65 or older
Overweight or obese

Your chances go up if you have other family members with multiple myeloma.

Other conditions can play a role, too. The diseases MGUS (monoclonal gammopathy of uncertain significance) and solitary plasmacytoma also affect plasma cells. People with these conditions need to watch for multiple myeloma.

You may not have any symptoms at first. As this cancer develops and plasma cells build up, though, you might have:

Loss of appetite
Bone pain and weakness
More thirst
Bruising or purple-colored rash
Shortness of breath
Weakness and fatigue
Weight loss