Iron Deficiency Anemia

Anemia

• Blood lacks adequate healthy red blood cells (RBC) and hemoglobin.

Iron Deficiency Anemia

• Caused by a lack of iron
• Leads to microcytic and hypochromic RBCs.
• Most common type of anemia.
• Affects premature infants and small for gestational age (SGA) babies, adolescent girls, alcoholics, and the elderly (due to chewing difficulties).
• Decrease in iron supply and low hemoglobin (Hgb) levels.
• Symptoms: Fatigue, weakness, pallor, slight jaundice (bilirubin), shortness of breath (SOB), dysrhythmias, chest pain, tachycardia, compensatory mechanism, and cool extremities.
• Diagnostic tests: Complete blood count (CBC), stool occult test, serum ferritin, total iron binding capacity (TIBC) testing
• Decreased RBC, low Hgb & Hematocrit (HCT), low serum iron, high total iron binding capacity.
• Priority Nursing Diagnosis: Activity intolerance
• Management: Administer blood products and hematopoietic medications.
• Encourage a diet rich in iron, folate, and B12.
• Control the source of bleeding.
• Encourage rest
• Dietary iron intake supplements.
• Include foods such as egg yolk, green leafy vegetables, organ meats, dried fruits, fortified cereals, beef, shellfish (oysters), dried fruit (apricot), raisins, red meat, dried beans, spinach, unsweetened chocolate, and quinoa.
• Medication: Ferrous gluconate, ferrous fumarate, and ferrous sulfate on an empty stomach, with food
• Administer in butt cheeks and causes skin staining.
• Folic acid with vitamin C and hydrochloric acid.
• Diet: high protein
• Use a straw, can stain teeth and may cause gastric irritation.
• If anemia is severe, administer via Z-track or IM.
• Iron must be taken between meals for better absorption.
• Avoid taking with milk.
• Symptoms: Fatigue, pallor, SOB.
• Low Hgb (<11 g/dl), low HCT (<42).
• Glossitis and angular cheilitis, pica, brittle nails, and hair thinning.

Pernicious Anemia

• Lack of vitamin B12.
• Macrocytic/megaloblastic anemia.
• Related to a faulty intrinsic factor from the stomach, resulting in poor B12 absorption. and enlarged premature RBCs
• Symptoms: Fatigue, pallor, weight loss, severe neuropathy, paresthesia, ataxia (loss of muscle control), memory loss, cognitive impairment, and glossitis (smooth, red tongue).
• Diagnostic test: CBC and Positive anti-intrinsic factor antibodies, Schilling test
• Treatment: Lifelong injections of cyanocobalamin (Rubramin PC) or hydroxocobalamin crystalline (Hydroxi Cysti 12).
• Include foods such as white button mushrooms, squash, and pumpkin seeds.
• Dietary consumption with clams, tuna, king crab, beef, fortified cereals, and fortified soymilk.

Folic Acid Deficiency Anemia

• Deficiency of folic acid/vitamin B9.
• Macrocytic, normochromic RBCs.
• Causes: chronic malnutrition, alcoholism, pregnancy, malignancy, chronic HD, and prolonged TPN.
• Diagnostic test: Folic acid levels <4 mcg.
• Folic acid supplementation at 1 mg/day.
• Need a dietary supplement
• Symptoms: Dyspepsia, hindi natutunawan, cracked lips, beefy red tongue, pallor, fatigue, tinnitus, weakness, tachycardia, and SOB.
• Include foods such as green leafy vegetables (lightly cooked), meat liver, fish legumes, peanuts, orange juice, and avocado

Aplastic Anemia

• Hereditary, congenital, or idiopathic.
• Autosomal recessive.
• Often of unknown cause.
• Pancytopenia, prolonged clotting time, low Hgb, and bone marrow aspiration showing red bone marrow turning into fatty bone marrow.
• Treatment: Bed rest, prevent infection, reverse isolation precaution, and avoid contact sports.
• Use immunosuppressive medications as antilymphocyte globulin antithymocyte, corticosteroids or cyclosporine
• Transfusions of blood after an injury.  

Sickle Cell Anemia

• Genetic blood disorder.
• Autosomal recessive and characterized by Hgb S.
• Newborn screening, CBC, a peripheral blood smear.
• Managed with 02, H2O, blood transfusion, and analgesics.
• Hydroxyurea at 15 mg/kg/day every 12 weeks.
• Caused by a mutation of the beta-globin chain.
• Primarily affects those of African, Mediterranean, Middle Eastern, and Indian descent.
• Symptoms: Rigid and clumped cells. 
• Complications: Fever, dehydration, and emotional/physical stress. Hemoglobinopathies with insufficient oxygen causes cells to assume a sickle shape.
• This leads to cell obstructing capillary blood flow and exaberations
• Monitor for complications and health awareness
• Vaccinations and a splenectomy may also be considered
• Comfortable positioning, caloric intake of 4 cal and protein , folic acid supplementation.
• Symptoms include abdominal pain, splenic sequestration (pooling and clumping in the spleen), profound anemia, hypovolemia, shock, and hyperhemolytic crisis (increased RBC destruction).
• Can also lead to anemia, jaundice, reticulocytosis, aplastic crisis (decreased production, increased destruction), viral infection, decreased folic acid, profound anemia, pallor, acute chest syndrome, stroke, pulmonary hypertension, organ damage, chronic pain, and increased risk for infections.
• Prolonged abnormal bleeding and frequent epistaxis.

Hemophilia

• Bleeding disorder due to deficiency in clotting factors.
• Hemophilia A is a deficiency in Factor VIII and is classic hemophilia
• X chromosome carriers are females and males have the disease
• Monitor for headaches and changes in vital signs.
• Desmopressin (DDAVP) may be used for mild hemophilia A  

Hemophilia A and B

• Bleeding disorders as a result of deficiencies in specific coagulation factors.
• Deficiency in Factor VIII is hemophilia A (Christmas disease).
• X-linked recessive inheritance.
• Characterized by hemarthrosis (bleeding in the joints, muscles, or soft tissues) and easy bruising.
• Can also present with blood in urine/stool and intracranial bleeding.
• Treatment
• Replacement therapy for life.
• Relieve pain and use regular prophylactic infusions to prevent bleeding.
• The use of medications that increase bleeding risk (aspirin, NSAIDs) should be avoided.
• Physical therapy for joint pain.
• Symptoms range from mild to severe depending on factor activity.  

Agranulocytosis

• Severe condition due to extremely low granulocyte count, which compromises body's ability to fight off infections.
• Can be life-threatening if untreated.
• Reverse isolation.
• Monitoring of white blood cell count, avoiding triggers and ensuring nutritional support
• Prompt diagnosis and treatment for infections
• Strict hygiene
• Medications as prescribed, and provide oral care.

Idiopathic/Immune Thrombocytopenic Purpura

• Chemo, antibiotics (sulfonamides), antithyroid drugs
• Autoimmune diseases such as lupus, rheumatoid arthritis
• Bone marrow disorders such as AA, leukemia
• Infections viral or bacterial
• Genetic predisposition, with rare cases
• Sudden onset of fever, sore throat or weakness or fatigue
• Bleeding gums are apparent with infections
• Can lead to low platelet count, petechiae, bruising and purpura are apparent
• More acute in children than adults
• Mouth ulcers and black blisters
• Heavy periods and fatigue

Leukemia

• Cancer that affects the blood and bone marrow.
• Characterized by abnormal proliferation of WBCs.
• Speed of progression and the type of WBC affected.
• Factors: Exposure to certain toxic substances.
• Monitor diet and side effects
• Ensure nutritional support
• Monitor for bleeding
• Ensure patient is aware of the risks
• Administer prescriptions
• Symptoms: Fever, Pallor, Fatigue, Anorexia, Hemorrhage
• Diagnostics: CBC
• Infiltration of the bone marrow, marrow biopsy, and imaging studies.  

Beta Thalassemia

• Blood disorders characterized by abnormal hemoglobin production, leading to anemia.
• Caused by genetic mutation of the HBB gene, inherited in an autosomal recessive manner.
• Can be minor, intermedia or major
• Fatigue, weakness, jaundice, dark urine, and hepatosplenomegaly.
• Frontal bossing, maxillary prominence, wide-set eyes, and a flattened nose
• Symptoms of traits include mild microcytic anemia while they’re asymptomatic