II.

Anemia
Anemia indicators  B9 & B12
o Microcytic
 Iron deficiency anemia
o Normocytic
 Aplastic anemia
 Chronic disease
 Increased RBC production
 Blood loss
DECREASED RBC PRODUCTION
> MACROCYTIC MEGALOBLASTIC ANEMIA
I. Folic acid deficiency anemia
Causes
 Reduced intake (most common)
o Food preference
o Heating
 Increased demand (most common)
o Pregnancy
o Lactation
o Rapid growth spurts
o Iron deficiency anemia
o Hemolytic anemia – RBC destroyed faster than they are made
o Cancer
 Impaired absorption
o Alcohol intake
o Drugs
 Sulfa
 Phenytoin
o Oral contraceptive pills
Signs and Symptoms
 Smooth, sore, red tongue
 Mild diarrhea
 Pale – mucous membranes
 Confused
(Anemia, WHO)  Paresthesia in the extremities
Basic principles  Difficulty maintaining balance
 More proliferative – grow or multiple rapidly producing new tissues  Loss of position sense – proprioception
 Nuclear maturation – meiotic arrest at prophase I  meiosis  metaphase II Lab findings
 Cytoplasmic maturation – process that prepares the egg for activation and  Decreased
pre-implantation development o Serum B9 level
Types of anemia o RBC count
 Decreased RBC production o HCT
o Macrocytic o HgB
o Megaloboblastic  Increased
o MCV macrocytic
II. Anemia
o Hyperchromia – excessive pigmentation  Subacute combined degeneration of spinal cord
o Hyper-segmented neutrophils – presence of neutrophils whose o Paresthesia
nuclei has six or more lobes o Ataxia – loss of full control of bodily movements
o Bone marrow – megaloblastic – bone marrow that produces large o Spasticity – muscles are continuously contracted
abnormal immature RBC o Dementia
 Pancytopenia – deficiency of three cellular components of blood Labs findings
Treatment  Decreased
 1mg of folic acid o Serum B12 level
 IM – malabsorption o HCT
 1 hour before or 2 hours after meals o RBC
o Nausea  Increased
o Loss of appetite o MCV
o Bloating o Hyperchromia
o Mood changes o Hypersegmented neutrophils
o Bitter o HgB
 Don’t give in large doses o Megaloblastic
II. Vitamin B12 deficiency  Pancytopenia
Causes  Schillings test
 Reduced intake o Measures absorption of radioactive vit B12 before and after
o Vegan diet parenteral administration of IF
o Breastfeed baby w/ vegan mother  Fasting
 Increased demand (uncommon)  Radioactive vit B12 by mouth
 Impaired absorption (most common)  Nonradioactive vit B12 IM
o Gastrectomy – surgical removal of the stomach  Saturate tissue binding sites and to permit excretion of vit
o Intake of corrosives B12 in the urine
o Elderly – achlorhydria – absence of HCL in the gastric secretions  24-48 hour urine
o PT w/ PEG or gastrostomy tube  Bacterial overgrowth
o Pancreatitis  Pancreatitis
o Tape worm infestation  TB
o Bacterial overgrowth  Lymphoma
o Defective ilium  Crohn’s disease
 Pernicious anemia (most common)  IBS
o Vitamin B12 combines w/ IF so it can be absorbed in the ileum into Treatment
the bloodstream  Increased B12 rich foods – animal products
 Large erythrocytes and hypochlorhydria  Oral B12 supplement – 1mg daily
 Lack of IF caused by gastric mucosal atrophy o Methotrexate – synthetic compound that interferes w/ cell growth
 Total gastrectomy and it is used to treat leukemia
o Autoimmune destruction of gastric fundus mucosa o Fluorouracil – chemotherapy drug
 Hashimoto thyroiditis  IM vit B12 supplement
 Autoimmune Addison’s disease o 1mg weekly for 8 weeks
 Vitiligo o 1mg monthly for life
o 40-60 years old > MICROCYTIC ANEMIA
o Blue eyed persons I. Iron deficiency anemia
Signs and Symptoms Cause
II. Anemia
 Inadequate absorption or excessive loss of iron o TIBC
o Blood loss o Transferrin receptor
 Heavy menstruation o Biliverdin – bilirubin
 Colon cancer o Platelets
 Peptic ulcer disease  Anisocytosis/Poikilocytosis
o Increased metabolic demands Treatment
 Growth spurts  Increase intake of iron rich foods
 Pregnancy o Heme
 Lactating  Pork
o GI malabsorption  Red meat
 Cow’s milk  Poultry
 Gastric bypass – stomach is divided into a small upper o Non heme
pouch and a larger lower pouch and the small intestine is  Green leafy vegetables
connected to both  Ferrous sulfate 325MG TID
o Dietary inadequacy o GI upset, constipation, and black tool
 Poor diet o 2 months
 Strict vegan o 3-6 months
Signs and Symptoms  Ferrous gluconate
 Exertional dyspnea  Ferrous fumarate
 Weight loss  6-12 months
 Alopecia  Parenteral iron
 Tachycardia o Risk of anaphylaxis
 Vertigo – loss of balance  Iron replacement
 Amenorrhea o Best taken on empty stomach
 Tachypnea o Absorption can be enhanced w/ vit C & amino acids
 Tinnitus o Decreased absorption w/ tea, cereals, wheats, food/drinks
 Functional murmur containing phosphates
 PICA o Decreased absorption due to AB & other meds
 Koilonchyia – spoon nails o Constipation
 Atrophic glossitis – bald, smooth tongue o Dark stool
 Cheilosis/Angular stomatitis – painful inflammation and cracking of the o Loss of appetite
corners of the mouth o Nausea
Lab findings > NORMOCYTIC ANEMIA
 Decreased I. Chronic disease
o Hemosedrin Cause
o Serum ferritin  Thyroid disease
o Serum iron  Collagen vascular disease – connective tissue
o Transferrin saturation  Inflammation bowel disease – colitis and Crohn’s
o HCT  Malignancy
o RBC  Chronic infections – OM, TB, HIV
o MCV (microcytic)  Renal disease
o HgB Labs findings
 Increased  Decreased
o Transferrin o Serum Fe
II. Anemia
o Transferrin o Frequent and prolonged, recurrent infections
o Ferritin  Thrombopenia
Treatment o Petechiae
 EPO o Ecchymosis
 Transfusion o Nose & gum bleeding
 Chelation – remove heavy metals from the body o Prolonged bleeding
 No iron supplement Labs results
Nursing diagnosis  Decreased
 Activity intolerance related to imbalance between O2 supply and demand o RBC
 Ineffective tissue perfusion o WBC
 Decreased cardiac output o Platelet
 Disturbed sensory perception  Normal
 Impaired oral mucous membrane o MCV
 Imbalance nutrition: less than body requirement o MCH
 Constipation  Bone marrow aspirate
 Deficient knowledge  Hypoplastic – underdevelopment of a tissue/organ
 Low self esteem  Aplastic - Failure of an organ or tissue to develop or
 Fatigue function normally
 Risk for infection  Reticulocytopenia – aplastic crisis marrow failure
 Risk for injury o Low of reticulocytes
Nursing diagnosis  Yellow bone marrow – storage of fats
 Administer  Myeloid stem cell surrounded by immune cells – lymphocytes
o O2 Treatment
o Blood products  Allogenic bone marrow aspirate
o EPO o Young adults
o Stem cells
 Reduce activities & stimuli that cause tachycardia
 >50 – ATG + cyclosporine
 Allow for rest
o Prevent the rejection of grafts and transplantation
 Elevate patient’s head on pillows during SOB
 Allogenic – other
 Provide extra blankets
 Autogolous – own
 Health teaching
 Cyclosporine – myelosuppresant
 Administer oxygen as prescribed
 Blood transfusion
II. Aplastic anemia
 Neutropenic reginmen
Cause
 Removal of thymus
Signs and Symptoms
Nursing interventions
 Anemia
 Neutropenic regime
o Fatigue
o Well cooked meat, no fresh fruits, veggies, no fresh flowers
o DOB
o Limit visitors
o Tachypneic
o Wear mask
o Tachycardiac
o Avoid crowded areas
o Dizziness
o No bather of pets
o Pale skin
o Pasteurized milk
o Thin hair
 Thrombocytopenia
 Leukopenia
o Do not
II. Anemia
 Take OTC drugs Signs & symptoms
 Heavy lift  Anemia
 Walk in bare feet  Splenomegaly
 Razor blade  Mild jaundice
 Blow nose forcefully  Pigment stones
 Tight fitting clothing Lab results
 Tampons  Osmotic fragility test – RBC are more likely to breakdown
o Prevent constipation o Decreased
o Avoid aspirin  RBC
o Soft bristle brush  HB
 HCT
 MCV
o Increased
 MCHC
 Reticulocytes
 RDW
o Normal MCH
o Presence of spherocytes or globular RBC
Treatment
 Splenectomy
 Exchange transfusion
Complications
 Aplastic crisis  parvo virus  blood transfusion
 Hemolytic crisis  spleen  exchange blood transfusion
(Inheritance pattern)  Cholelithiasis  bilirubin stone  cholecystectomy
Intravascular hemolysis Extravascular hemolysis II. G6PD
 Anemia  Anemia Definition
 Slight macryocytosis  Increased reticulocyte count  Sex linked recessive disorder
 Increased reticulocyte count  Hypercellular bone barrow  Common enzyme deficiency in humans
 Hemoglobinemia  Slight macrocytosis  Intravascular  extravascular
 Decreased or absence of  Increased unconjugated Signs & Symptoms
haptoglobin bilirubin  Anemia
 Hypercellular bone marrow  Mild to moderate jaundice –  Jaundice
 Hemoglobinuria lemon yellow color skin  Dark colored urine
 Increased LDH  Kernicterus – bilirubin induced brain dysfunction
 Increased urobilinogen in urine Lab results
 Dark colored stool  Decreased
o Haptoglobin
INCREASED RBC DESTRUCTION
 Increased
I. Hereditary spherocytosis
o Reticulocytes
Definition
o LDH
 Autosomal dominant disease of the erythrocytes
o Bilirubin
 Membrane protein formation
 Heinz bodies and bite cells
 Extravascular  intravascular hemolysis
 Hemoglobinemia
II. Anemia
 Hemoglobinuria
 Acute tubular necrosis
Treatment
 Prevent oxidative stress/damage
 Infections
 Medications – Avoid
o Chloramphenicol
o Flutamide
o Naldixic acid
o Nitrofurantoin
o Primaquine
o Sulfa drugs
o Ciprofloxacin
o Aspirin
o Paracetamol
 Food - Avoid
o Fava beans & legumes
o Menthol
o Artificial blue food coloring
o Gluten free products
o Ampalaya
o Chinese herbs
o Black/green tea
o Soys
 Antioxidants
o Berries
o Walnut
o Sunflower seeds
o Ginger
o Grapes
o Orange
o Pineapple
o Prunes
o Spinach
o Tomatoes
o Garlic
 Mothballs/Naphthalene
Nursing interventions
 Newborn screening
 Health teaching
 Avoid exposure to oxidative stress
 Child understand condition
 S/SX of acute hemolysis