Exam 19 - Disorders of Erythrocytes and Leukocytes

Disorders Associated with Erythrocytes and Leukocytes

• Anemia: Characterized by below-normal levels of red blood cells, hemoglobin, and hematocrit, leading to insufficient oxygen delivery to tissues and cells. Caused by factors like hemorrhage, increased destruction of red blood cells (hemolysis), impaired production of red blood cells, nutritional deficiencies (e.g., iron deficiency). Peripheral circulation compensates by shunting blood to vital organs, causing hypoxia elsewhere.

Pathophysiology of Anemia

• Loss of red blood cells: Due to hemorrhage.
• Increased destruction of red blood cells (hemolysis): Implies red blood cells are destroyed faster than the body can replace them.
• Impaired production of red blood cells (bone marrow depression or failure): Bone marrow is unable to create new red blood cells at a sufficient rate.
• Nutritional deficiencies: Such as long-term iron deficiency, leading to an inadequate supply of essential nutrients for red blood cell production.
• Loss of oxygen-carrying elements: In the blood, causing a supply/demand imbalance in vital organs.

Clinical Manifestations of Anemia

• Sudden loss of 1/3 of blood volume: Hypotension, respiratory distress, altered mental status.
• Acute loss (Hgb below 5g/mL): Severe hypotension, myocardial infarction, stroke, severe altered mental status, death are potential complications.
• Chronic mild anemia: May be asymptomatic, unless detected in lab. General malaise, heart palpitations, shortness of breath on exertion, dizziness/lightheadedness might be present.

Assessment of Anemia

• Subjective data: Weakness, dyspnea, fatigue, vertigo, headaches, and sometimes insomnia.
• Objective data: Observing signs and symptoms of shock, bleeding, pallor, and monitoring laboratory values.

Diagnostic Tests for Anemia

• Complete blood count (CBC): Decreased RBCs, hemoglobin, and hematocrit.
• Decreased serum iron, total binding capacity, and serum ferritin levels: Indicate a deficiency in iron, which is crucial for red blood cell production.
• Increased reticulocyte count: Due to immature RBCs. Suggests the bone marrow is working to compensate for the loss of red blood cells.
• Bone marrow biopsy: Revealing abnormalities.
• Peripheral blood smears: Identifying cell shape/color abnormalities.
• Decreased vitamin B12 level: Associated with some types of anemia.

Medical Management of Anemia

• Intervention depends on the cause: May require blood transfusions, iron replacement, or addressing underlying conditions like hemorrhage.

Nursing Interventions and Patient Teaching for Anemia

• A comprehensive approach tailored to the specific type and stage of anemia is required.

Jehovah's Witnesses

• Opposed to homologous blood transfusions: Due to religious beliefs.
• May agree to autologous transfusions: Using the patient's own blood previously collected.
• May use volume expanders: To preserve circulatory volume.

Hypovolemic Anemia (Blood Loss Anemia)

• Deficiencies in RBCs and other components: Due to low circulating blood volume from hemorrhage.
• Blood loss of 1000 mL or more: Considered severe; less than 500 mL may be tolerated.
• Causes: Surgery, GI bleeding, menstruation, trauma, burns.
• Leads to hypovolemic shock: Sudden reduction in total blood volume.