RBC Disorders

1
RBC Disorders

• Decreased Production of RBC
• Iron Deficiency Anemia
• Vitamin B12 Deficiency Anemia
• Folic Acid Deficiency Anemia
• Aplastic Anemia

2
Fe Deficiency Anemia

• Common world wide
• Affects 10-30 of population in US
• Common in premenapausal woman, infants, children,
  adolescents, elderly
• Develops slowly

3
AP

• Occurs when supply of Fe is too low for optimal
  RBC formation
• Iron RDA
• 10mg/d M,
• F 12-49 15 mg
• Typical American diet provides 10 to 20 mg/d
• Many woman consume only 12.4mg/d

4
Cause of Development

• Inadequate absorption or excess Fe loss
• Inadequate dietary intake of foods high in Fe
• Principal cause in adults acute or chronic
  bleeding
• Secondary to trauma
• Excessive menses
• GI bleeding
• Blood donation

5
Diagnostics

• Hgb Panic value lt 5g/dl
• Hgb level can drop to 3.6g/dl
• Total RBC count rarely below 3 million/dl
• MCH lt 27 pg
• MCHC 20 to 30 g/dl
• Serum Fe as low as 10mcg./dl

6
Diagnostics

• HCT lt 47 ml/dl M
• HCT lt 42 ml/dl F
• Fe binding capacity ?
• Serum ferritin level ?
• Bone marrow may also be indicated

7
Symptoms

• Pallor, glossitis
• Dizziness, irritability, numbness tingling in
  limbs, fatigue, decreased concentrated HA
• Tachycardia dyspnea on exertion
• Sensitivity to cold, brittle hair nails
• Atrophic glossitis, stomatitis, dysphagia

8
Treatment

• Diet high in Fe rich foods
• Red meats, organ meats, kidney beans, whole-wheat
  products, spinach, egg yolks, carrots raisins

9
Treatment

• Hematinic agents
• Ferrous Sulfate (Feosol) 0.2 g tid with meals
• Ferrous Gluconate (Fergon) 0.3 g bid
• Oral irritating to GI mucosa, GI upset, nausea,
  etc. blackish green stool, contraindicated in
  PUD, inflammatory bowel disease
• Liquid preparation taken mixed with H2O or juice
  sipped thought straw

10
Treatment

• Hematinic agents
• Iron-dextan (Imferon) 100 to 250 mg/d
• Ascorbic acid as indicated
• Deep IM use Z-track to prevent subcutaneous
  irritation discoloration from leaking med
• Can be given IV to pregnant or elderly with
  severe Fe deficiency anemia

11
Treatment

• Side effects Nausea, constipation, epigastric
  pain, black red tarry stools,
• Contraindicated with hypersensitivity, ulcerative
  colitis/regional enteritis, peptic ulcer
  disease, hemolytic anemia, cirrhosis
• ? absorption with antiacids, cimetidine,
  cholestramine, Vit E, dairy products, caffeine,
  eggs

12
Treatment

• False positive occult blood
• Toxicity nausea, vomiting, diarrhea,
  hematemesis, pallor, cyanosis, shock, coma
• Over dose Diarrhea, fever severe stomach pain,
  nausea, vomiting
• Fe binding Agent Deferoxamine

13
Nursing Care

• Oral hygiene dental care
• Preventing irritations infections in oral
  cavity
• Nail hair hygiene
• Assist with maintenance proper diet
• Fe supplement
• Aware of changes in stool
• Safety to prevent falls

14
Folic Acid Deficiency

• Vitamin B complex
• Seen in alcoholism, malabsorption syndromes, and
  pregnancy
• Most prevalent in infants, adolescents, pregnant
  lactating females, alcoholics elderly
• Increase incidence in drug use and pregnancy

15
Food Sources

• Found in asparagus spears, beef liver, broccoli,
  collards, mushrooms, oatmeal, peanut butter, red
  beans, wheat germ

16
Clinical Manifestations

• Develop slowly over a period of months
• Symptoms related to tissue hypoxia
• Glossitis
• Jaundice
• Splenomegaly

17
Treatment

• Administer folic acid every day until deficiency
  is corrected
• High dises to patients with malabsorption
  problems
• Folvite adults 250 to 1,000 mcg/d until
  hematological responses increases
• Maintainance 400 mcg/day X 2

18
Aplastic Anemia

• Inherited, but can be acquired from chemical
  exposure or radiation
• Failure of bone marrow to produce adequate
  amounts of RBCs, leukocytes, platelets
• Pancytopenia
• Usually seen in young individual, median age 25
  years

19
Aplastic Anemia, cont.

• BM supression, detruction or aplasia resulting in
  failure of BM to produce adequate stem cells

20
Clinical manifestations

• Fatigue
• Dyspnes
• Multipel infections
• ? temperature
• Headache
• Waskness
• Anorexia
• Gingivitis

• Epistaxia
• Purpra
• Petechiae
• Ecchymosis
• Pallor
• Palpitations
• Tachycardia
• Tachypnes
• Melena

21
Diagnostic Tests

• Prepheral blood smear
• pancytopenia
• Hemtoaplogy
• ? granulocutes, thrombocytes, RBC
• Stool for occult blood
• positive
• Uring chemistry
• hematuria
• Bone Marrow biopsey
• Fatty narrwo with ? of stem cells

22
Treatment of Aplastic Anemia

• Blood transfusion for disabled or bleeding
  thrombocytopenia
• Immunosuppressants for individual with disease
  causes similar to autoimmune problems
• Antilymphocyte globim (ALG)
• Antihymocyte globin (ATG)
• Cyclosporine (Sandimmune0

23
Treatment

• For severe, general immunosuppression agents
• Prednisone cylophosphamide
• Splenectomy considered in clients with enlarged
  spleen
• Either destroying normal RBCs or suppressing
  their development
• BMT replaces defective stem cells
• Cure for some patients

24
RBC Disorders

• Hyperplasia of bone marrow results in ?
  production
• Overproduction results in ? blood viscosity, ?
  total blood volume, severe congestion of all
  organs tissues

25
Polycythemia

• Myeloproliferative disorder that results in the
  increaed productions of
• Erthrocytes
• Hemoglobin
• Myelcytes
• Thrombocytes

26
Polycythemia Vera

• Hyperplasia of the bone marrow results in
  increased production
• Overproduction results inincreased blood
  viscosity, increased total blood volume, severe
  congestion of all organs tissues

27
Clinical Manifestations

• Ruddy complexion
• Dusky mucosa
• Vertigo
• Headaches
• Dyspnea orthopnea
• Tachycardia
• Ecchymosis

• Heaptomaeglay spelnomegaly
• ? gastric secretions
• Weakness fatigue
• Pururitus
• Epistaxis
• GI bleeding
• Angina

28
Diagnostic Tests

• Blood Chemistries
• ? UA, unconjugated bilirubin, vitamine B12,
  alkaline phosphatase, SGOT, SGPT, LDH
• Hematology
• ? RBCs, WBCs, platelets, Hct, Hgb,
• Bone Marrow biopsy
• ? of immature cells forms, ? Fe in marrow
• Urine chemistry
• hematuria

29
Management

• Soft diet, low Fe
• Antacids
• Histamine antagonists
• Antigout
• Radioactive phosphorus (P32)
• Phlebotomy
• Myelosuppressants