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RBC Disorders

 Decreased




Production of RBC

Iron Deficiency Anemia
Vitamin B12 Deficiency Anemia
Folic Acid Deficiency Anemia
Aplastic Anemia

Fe Deficiency Anemia
 Common

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

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

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 .

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

Diagnostics  HCT < 47 ml/dl M  HCT < 42 ml/dl F  Fe binding capacity   Serum ferritin level   Bone marrow may also be indicated .

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

egg yolks. kidney beans. spinach. whole-wheat products. organ meats. carrots & raisins .Treatment  Diet high in Fe rich foods – Red meats.

2 g tid with meals Ferrous Gluconate (Fergon) 0. nausea.Treatment  Hematinic – – – agents Ferrous Sulfate (Feosol) 0. inflammatory bowel disease – Liquid preparation taken mixed with H2O or juice & sipped thought straw .3 g bid Oral irritating to GI mucosa. contraindicated in PUD. GI upset. blackish green stool. etc.

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 .

dairy products. epigastric pain.Treatment  Side effects: Nausea. constipation. cimetidine. hemolytic anemia. Vit E. black & red tarry stools. ulcerative colitis/regional enteritis.  Contraindicated with hypersensitivity. caffeine. peptic ulcer disease. cholestramine. eggs . cirrhosis   absorption with antiacids.

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

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 .

alcoholics & elderly  Increase incidence in drug use and pregnancy . malabsorption syndromes. and pregnancy  Most prevalent in infants. adolescents. pregnant & lactating females.Folic Acid Deficiency  Vitamin B complex  Seen in alcoholism.

wheat germ . collards. broccoli.Food Sources  Found in asparagus spears. peanut butter. beef liver. mushrooms. red beans. oatmeal.

Clinical Manifestations  Develop slowly over a period of months  Symptoms related to tissue hypoxia  Glossitis  Jaundice  Splenomegaly .

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

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

Aplastic Anemia.  BM supression. cont. detruction or aplasia resulting in failure of BM to produce adequate # stem cells .

Clinical manifestations         Fatigue Dyspnes Multipel infections  temperature Headache Waskness Anorexia Gingivitis          Epistaxia Purpra Petechiae Ecchymosis Pallor Palpitations Tachycardia Tachypnes Melena .

Diagnostic Tests  Prepheral blood smear – pancytopenia  Hemtoaplogy  granulocutes. RBC  Stool for occult blood – positive  Uring chemistry – hematuria  Bone Marrow biopsey – Fatty narrwo with  of stem cells . thrombocytes.

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 .

general immunosuppression agents – Prednisone % cylophosphamide  Splenectomy.Treatment  For severe. considered in clients with enlarged spleen – Either destroying normal RBC’s or suppressing their development  BMT replaces defective stem cells – Cure for some patients .

& severe congestion of all organs & tissues .  total blood volume.RBC Disorders  Hyperplasia of bone marrow results in  production  Overproduction results in  blood viscosity.

Polycythemia  Myeloproliferative disorder that results in the increaed productions of – – – – Erthrocytes Hemoglobin Myelcytes Thrombocytes .

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 .

Clinical Manifestations        Ruddy complexion Dusky mucosa Vertigo Headaches Dyspnea & orthopnea Tachycardia Ecchymosis        Heaptomaeglay & spelnomegaly  gastric secretions Weakness & fatigue Pururitus Epistaxis GI bleeding Angina .

WBCs. SGPT. LDH  Hematology  RBCs.Diagnostic Tests  Blood Chemistries  UA. SGOT. alkaline phosphatase. unconjugated bilirubin. Hct. vitamine B12. platelets.  Fe in marrow  Urine chemistry – hematuria . Hgb.  Bone Marrow biopsy  # of immature cells forms.

low Fe  Antacids  Histamine antagonists  Antigout  Radioactive phosphorus (P32)  Phlebotomy  Myelosuppressants .Management  Soft diet.