Anemia Anemias Caused by Decreased Erythrocyte Production

- Reduction below normal in the number of RBCs, quantity of Hgb, and the - Common hematologic disorder
volume of packed RBC caused by rapid blood loss, impaired production of Etiology Inadequate dietary intake,
RBC, or increase destruction of RBC malabsorption, blood loss, or hemolysis
(rupture or destruction of RBC)
Classification of Anemia • Blood loss (2mL of whole blood
Normocytic Anemias Normal RBC size & blood loss, bone marrow contain 1 mg of iron)
shape suppression • 50-75 ml of blood from UGIT
Microcytic Anemias Small RBCs with Iron-deficiency, occult GI (melena)
decreased levels of Hgb bleeding • Normal menstrual blood loss is 45 ml
Macrocytic Anemias Large RBC vit B12 & folic acid (loss 22 mg of iron)
deficiency Clinical Manifestations: • Pallor
Hemolytic Anemias Destruction of RBC sickle cell anemia • Glossitis – inflammation of the tongue
• Cheilitis – inflammation of the lips
Nutrients Needed for Erythrocyte • Headache, paresthesia, burning
Nutrient Role Food Sources sensation of the tongue
Cobalamin (Vitamin B12) RBC maturation Red meats Diagnostic Studies Lab Studies
Folic acid RBC maturation Green leafy vegetables, Endoscopy to identify GI bleed
liver, meat, fish, legumes, Treatment Drug Therapy – oral Iron replacement
whole grains • Iron absorbed best in duodenum
Iron Hemoglobin synthesis Liver and muscle meats, • Ferrous sulfate – take about one hour
eggs, dried fruits, prior to meal
legumes, dark green leafy - Gastric side effects: nausea /
vegetables, whole grain constipation
and enriched bread and Nursing Management Diet & Medication Instruction
cereals, potatoes
Vitamin B6 Hemoglobin synthesis Meats, wheat germ, Thalassemia
legumes, potatoes, - Autosomal recessive genetic disorder of inadequate production of normal
cornmeal, bananas hemoglobin
Amino acid Synthesis of Eggs, meat, milk, and • Hemolysis occurs
nucleoproteins milk products. Poultry, • Abnormal Hb synthesis
fish, legumes, and nuts • Ethnic groups of Mediterranean Sea & near equatorial regions of Asia and
Vitamin C Conversion of folic acid Citrus fruits, leafy green Africa
to its active form, aids in vegetables, strawberries, Clinical Manifestation mild – moderate anemia with
iron absorption cantaloupe hypochromia (pale cells) or
microcytosis (small cells)
Functions of Blood • Minor: one thalassemic gene – mild
- Transportation, protection, and regulation
 • Major: two thalassemic genes – severe
– physical & mental growth retarded -
cardiac failure is fatal
Medical Management • Medication: Chelation Therapy IV
deferoxamine (Desferal) – iron binding
agent to reduce iron overload
• Transfusions to maintain Hg >10g/dl
Nursing Management Supportive
Megaloblastic Anemias
- Caused by impaired DNA synthesis & characterized by the presence of large
RBCs
A. Cobalamin Deficiency (Vitamin B12)
- Intrinsic factor is secreted by the parietal cells of the gastric mucosa; cannot
be absorbed if intrinsic factor is not present
Causes Pernicious anemia (type of vitamin B12
anemia), nutritional deficiency; heredity
enzyme defect
Clinical Manifestations GI—sore tongue, anorexia, N&V,
abdominal pain; muscle weakness,
paresthesia (burning or prickling
sensation) of feet and hands; confusion
Diagnostic Testing Serum cobalamin levels; gastroscopy;
Schilling Test – assesses parietal cell
function
Medical Management Parenteral administration of cobalamin –
daily for 2 weeks, then weekly until
>HCT, then monthly for life; intranasal
form
Nursing Management Health Promotion; protection from
sensory injury— burns, trauma; pt
compliance with replacement therapy
B. Folic Acid Deficiency
- Folic Acid is required for DNA synthesis leading to RBC formation &
maturation
Causes Poor nutrition green leafy vegetables,
citrus fruits, & beans, nuts, grains;
malabsorption syndromes; drugs that
impede absorption (Dilantin); Alcohol
abuse; anorexia; hemodialysis patients
Clinical Manifestations Similar to cobalamin deficiency –
dyspepsia (pain or an uncomfortable
feeling in the upper middle part of your
stomach area), smooth, beefy red
tongue; absence of neurologic problems
Diagnostic Testing < Folate Level (norm: 3-25mg/ml)
Medical Management Replacement Therapy Folic Acid
1mg/day
Nursing Management Medication & dietary compliance
Anemia of Chronic Disease
- Associated with underproduction of RBCs and decreased RBC survival
Causes Renal failure; advanced liver cirrhosis;
chronic inflammation; malignancy;
immunosuppression
Medical Management • Correct underlying disorder
• Erythropoietin Therapy – Epogen,
Procrit
Nursing Management Care of the debilitated (very weak and
infirm state) patient – dietary &
medication compliance
Aplastic Anemia
- condition that occurs when your body stops producing enough new blood cells
Pancytopenia
- decrease of all blood cell types --- RBCs, WBCs, platelets & hypocellular
bone marrow
Causes • Congenital
• Acquired – exposure to radiation &
chemicals, post viral & bacterial
infections • Idiopathic – 70%
Medical Management • Immunosuppressive therapy
• Bone Marrow Transplantation
Anemia Caused by Blood Loss • Hemolyzed in the spleen
A. Acute blood loss - Hemorrhage (acute loss of blood from a damaged blood • Initially reversible – then becomes irreversible due to chronic sickling
vessel)
• Decreased oxygen-carrying capacity Sickle Cell Crisis
B. Chronic Blood Loss - Body maintains its blood volume by slowly increasing - Severe, painful, acute exacerbation of RBC sickling causing a Vaso occlusive
plasma volume < RBCs crisis
Clinical Manifestations Range from fatigue with melena to • Impaired blood flow, vasospasm, severe capillary hypoxia
orthostatic BP changes to shock • RBC Cell membrane permeability changes – plasma loss, & thrombi; tissue
Medical Management •Treat underlying cause ischemia & infarction
• Blood replacement – packed RBCs - Sudden & persists for days
• Supplemental Iron Clinical Manifestation Pain – tissue ischemia
• Aching joints—hands & feet
Hemolytic Anemias (Destruction of RBC) • Organs that have a high need for
Sickle cell anemia oxygen are most affected: Heart, lungs,
- an inherited disorder of hemoglobin synthesis resulting in hypoxia and eyes, kidneys, brain
obstruction of blood vessels • Spleen scarring & small – auto
- Anemia Caused by Increased Erythrocyte Destruction splenectomy
Sickle cell disease • Bones – osteoporosis
- Group of inherited autosomal recessive disorders characterized by the • Chronic leg ulcers
presence of abnormal Hgb in the erythrocyte • Prone to infection – pneumococcal
Outcome/result • Causes the erythrocyte to stiffen & pneumonia
elongate Medical Management Hospitalization--Oxygen, rest, fluids &
• Sickle shape in response to lack of electrolytes, treat infection, transfusion
oxygen therapy, Chelation therapy, pain
Occurrence: 50,000 Americans management
• 1 in 350-500 African Americans; • Bone Marrow Transplant & Gene
Mediterranean, So Am; East Indian, therapy technology
Arabian ancestry
Types: • Sickle Cell Anemia: most severe – Sickle Cell Disease Manifestations
inherited homozygous for hemoglobin S Brain Thrombosis or hemorrhage causing
(HbSS) from both parents paralysis, sensory deficits, or death
• Sickle Cell Trait: mild - inherited from Lung Acute chest syndrome, pulmonary
one parent + one normal hypertension, pneumonia
Sickling Episodes Kidney Hematuria (the presence of blood cells
- Hypoxemia – triggered by stress, surgery, blood loss, viral or bacterial in the urine), renal failure
infection (most common), dehydration, acidosis Bones and joints Hand-foot syndrome, osteonecrosis
- Low oxygen tension in the blood (painful bone condition that can affect
- Sickled cells cannot easily pass-through capillaries mobility)
 Liver-gallbladder Hepatomegaly, gallstones
Eye Hemorrhage, retinal detachment,
blindness, retinopathy
Heart Congestive heart failure
Spleen Splenic atrophy (auto splenectomy)
Penis Priapism (persistent, usually painful,
erection that lasts for more than four
hours and occurs without sexual
stimulation)
Skin Stasis, ulcers of hands, ankles, and feet
Acquired Hemolytic Anemia
- Disorder that occurs in individuals who previously had a normal red blood cell
system.
Extrinsic causes of hemolysis • Physical – trauma – renal dialysis; CP
bypass
• Autoimmune Reactions – medications;
systemic lupus erythematosus;
leukemia; lymphoma
• Infectious agents and toxins –
parasites; antigen-antibody reactions;
splenomegaly
Medical Management • Corticosteroids; Blood product
administration; splenectomy
Polycythemia
- Production o& presence of increased number of RBCs
• Increased blood viscosity – hyper viscosity
• Increased circulating volume – hypervolemia (medical condition when you
have too much fluid in your body, also described as having excess water
retention or fluid overload)
Types A. Primary – polycythemia vera /
chromosomal mutation –
insidious --> 50 years of age
B. Secondary – chronic hypoxia
stimulates erythropoietin
production in the kidney >
erythrocyte production
• High altitude, COPD, CV
disease
Diagnosis Elevated RBC, WBC, Platelets; bone
marrow aspiration – hypercellularity of
RBCs; splenomegaly
Medical Management • Phlebotomy to maintain HCT 45-48%
• 300-500 ml removed every other day
until <HCT
• Hydration
• Myelosuppressive therapy: busulfan
(Myleran); hydroxyurea (Hydrea) =
inhibits bone marrow production
• Gout – Allopurinol
• Antiplatelet medication: Persantine,
Plavix, ASA – prevent thrombotic
complications
Thrombocytopenia
- Reduction of platelets below 150,000/ul
Types of Thrombocytopenia:
ITP: Immune Thrombocytopenic • autoimmune
Purpura • platelets are coated with antibodies;
destroyed in spleen
• Women 20-40 years
• Normal survival 8-10 days; ITP: 1-3
days
TTP: Thrombotic Thrombocytopenic • Uncommon syndrome; adults 20-50
Purpura years • Characterized by hemolytic
anemia, thrombocytopenia, neurologic
abnormalities, fever, renal abnormalities
HITT: Heparin-Induced • Immune-mediated response to Heparin
Thrombocytopenia & Thrombosis • Triggers platelet aggregation
Syndrome • Decreased platelets & increased
thrombosis
Clinical Manifestations • Bleeding
 • Mucosal — epistaxis, gingival, large gently—one side at a time; signs &
bullous hemorrhages on buccal mucosa symptoms of bleeding; lab values;
• Skin -- superficial ecchymoses; health promotion—rest, oxygenation,
petechiae — flat pin-pointed red brown nutrition; pain management
microhemorrhages; purpura —
numerous petechiae resulting reddish
skin bruising
• Prolonged bleeding – after injections
& venipuncture
• Internal bleeding – hemorrhage – any
major organ -- orthostatic hypotension --
Cerebral hemorrhage fatal
Medical Management • ITP: Corticosteroid;
immunosuppressive therapy;
splenectomy; platelet transfusion • TTP:
Corticosteroids; plasma exchange;
plasmapheresis; splenectomy
• HITT: Discontinue Heparin –
Protamine Sulfate
Nursing Management
A. Assess Assess oral cavity, skin, nasal cavity,
urine, stool – occult and overt bleeding;
Lab values—CBC, platelet count; vital
signs; signs & symptoms for each blood
dyscrasia

B. Action : Ice, packing, direct pressure to control

bleeding; administer medications; No
ASA or platelet-acting meds; oral
hygiene, skin care, IV carefully—blood
product transfusion care; Avoid IM/SQ
meds; pad rails & firm surfaces; pain
management as needed; post
splenectomy care.

C. Patient Education : Interpret lab values; Rationale for no

sharps – electric razor; disease process;
medications; avoid Valsalva; blow nose