Anemia

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Anemia

• Presented by
• Manny Ramos RN, MSN

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Crossmatching game for RBC laboratory test values

• Reticulocytes
• Hematocrit
• MCV
• MCHC
• MCH
• Crossmatch items from this column that correspond
  correctly to the definitions in the other column

• Ave. volume of individual RBCs
• Number of immature RBCs/mm3 blood
• of circulating RBCs/mm3 blood
• calculated ave. weight of Hg/RBC
• Ave. concentration or of Hg/RBC
• Packed vol. of RBCs in 100ml blood

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Pathophysiology

• Decreased RBC production
• Iron deficiency
• Folic acid deficiency
• Aplastic anemia
• Increased RBC loss or destruction
• sickle cell anemia
• blood loss
• infection

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Iron deficiency anemia

• Causes
• inadequate dietary iron intake
• Malabsorption gastrectomy, chronic diarrhea,
  celiac sprue
• increased iron needs pregnancy and lactation
• chronic occult blood loss bleeding ulcers, GI
  inflammation, hemorrhoids, cancer, chronic
  hemoglobinuria
• Menstrual blood loss

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Iron Deficiency anemia

• Diagnostics
• Iron levels
• Total iron-binding capacity (TIBC)
• Serum Ferritin
• Medications
• Iron supplements, oral or parenteral
• Vit. C

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Vit. B12 deficiency anemia

• Causes
• Pernicious anemia lack of intrinsic factor
• ileal resections, loss of pancreatic secretions,
  chronic gastritis
• Strict vegetarians

• Diagnostics
• Schilling test
• Medications
• Vit. B12 parenteral

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Folic acid deficiency anemia

• Inadequate intake
• Chronically malnourished
• Older adults
• Alcoholics
• Drug addicted persons
• Increased need
• Pregnant women neural tube defects in fetus
• Persons experiencing rapid growth
• Malabsorption disorders Celiac sprue
• Persons taking methotrexate and other
  chemotherapy

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Sickle cell anemia

• Pathophysiology
• Autosomal recessive genetic defect
• Hypoxemia abnormal HbS deoxygenated
• crescent or sickle shape RBC
• Sickled cells clump together
• weakened RBCs, hemolyzed
• shortened RBC life span

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Sickle cell anemia

• Sickle cell crises arise from
• Hypoxia
• Low environmental or body temperature
• Excessive exercise
• Anesthesia
• Dehydration
• Infection
• Acidosis

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Sickle cell crises

• Manifestations
• pallor, fatigue, jaundice, irritability
• Painful swelling hands and feet, large joints,
  priapism, abdominal pain, stroke
• Aplastic anemia
• Blood pools in liver and spleen
• Diagnostics Sickle cell test

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Interventions

• Hydration
• Oxygen
• Rest
• Pain management

• Treat precipitating factors
• Folic acid supplementation
• Blood transfusions
• Genetic counseling

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Thalassemia

• Inherited disorder of hemoglobin synthesis
• alpha or beta chains of hemoglobin are missing
  or defective
• Manifestations
• Minor asymptomatic mild anemia, splenomegaly,
  bronze skin, bone marrow hyperplasia
• Major severe anemia, heart failure, liver and
  spleen enlargement fractures of long bones,
  ribs, vertebrae
• Diagnostics Hemoglobin electrophoresis

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Acquired hemolytic anemia

• Causes
• Mechanical trauma to RBC prosthetic heart valves
• Autoimmune disorders
• Bacterial or protozoan infection
• Immune system-mediated responses
• drugs, toxins, chemical agents, venoms
• Manifestations
• Anemia
• splenomegaly, jaundice, pathologic fractures

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Glucose -6-Phosphate Dehydrogenase (G6PD) Anemia

• Hereditary defect in RBC metabolism
• Direct oxidation of hemoglobin damages RBC
• occurs when person exposed to stressors aspirin,
  sulfonamides, Vitamin K derivatives
• Manifestations pallor, jaundice, hemoglobinuria,
  elevated reticulocyte count
• Diagnostics quantitative assay of G6PD

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Aplastic anemia

• Bone marrow failure decreased RBC, WBC,
  platelets
• Marrow replaced with fat
• Causes idiopathic
• Viral infections
• stem cell damage from radiation
• Exposure to chemicals
• Certain antibiotics (chloramphenicol)
• Chemotherapeutic drugs

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Aplastic anemia

• Manifestations vary with onset and severity of
  pancytopenia
• Pallor, fatigue, headache, exertional dyspnea,
  tachycardia, heart failure
• Bleeding due to low platelet levels
• Fever, increased infection risk due to
  low WBC
• Diagnostics bone marrow exam

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Aplastic anemia

• Interventions
• Removal of causative agent
• Blood transfusions
• Bone marrow transplant

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Assignment

• Identify 3 priority nursing diagnoses for anemia
  and formulate nursing care plan for anemia