Understanding Anemia: Etiology, Symptoms and Treatment

Anemia Etiology

• Anemia can result from either blood loss or failure in blood cell production
• Anemia can be associated with excessive destruction of red blood cells
• Insufficient total body iron leads to diminished erythropoiesis, the process of producing red blood cells
• Lack of iron impedes the formation of hemoglobin (Hb)

Anemia Signs and Symptoms

• Mild anemia includes Hb levels of 11 to 13 g/dL, headache, palpitations, and dyspnea on exertion
• Moderate anemia includes Hb levels of 8 to 10 g/dL, brittle nails, sore tongue, pallor, chronic fatigue, headache, and dizziness of faintness
• Severe anemia includes Hb levels less than 8 g/dL, general symptoms and issues with the eyes, skin, cardiovascular, respiratory, gastrointestinal, musculoskeletal, and neurologic systems

Anemia Treatment

• Treatment includes iron supplements, vitamins, and diet adjustments
• Blood transfusion and vitamin B12 may also be used in treatment

Aplastic Anemia

• Aplastic anemia can develop after a viral infection, as a reaction to a drug, or due to an inherited tendency
• It is characterized by bone marrow depression and likely an immune-mediated disease
• The levels of red blood cells, white blood cells, and platelets are decreased
• Treatment must eliminate any identifiable underlying cause by administering packed red cells and platelets
• Antibiotics are given for identified infections

Sickle Cell Disease

• Sickle cell anemia is a genetic disorder where the genetic disorder causes production of hemoglobin S
• Hypoxia causes hemoglobin S to assume a sickle shape which blocks vessels and forms thrombi

Sickle Cell Disease: Signs and Symptoms

• Symptoms include pallor, lethargy, and pain
• Painful swelling occurs in the hands and feet due to bone infarction

Sickle Cell Disease: Treatment

• Focused towards prevention of a sickle cell crisis and managing symptoms when a crisis occurs
• Consume folic acid regularly, and maintain a diet with sufficient protein intake
• Prevent infection, maintain adequate fluid intake, and avoid alcohol and recreational drugs
• Hydroxyurea may decrease frequency of sickling episodes

Sickle Cell Disease: Nursing Management

• Provide patient teaching to avoid high altitudes, vigorous exercise, and iced liquids
• Maintain adequate fluid intake, refrain from smoking, treat infections promptly, and get adequate rest
• Provide adequate pain relief and monitor intake and output

Polycythemia Vera

• A neoplastic disorder where the patient gets over production of red blood cells
• Blood becomes thick from the increased numbers of cells
• Blood vessels become distended, and blood flow becomes sluggish

Polycythemia Vera: Treatment

• Treatment includes phlebotomy, antineoplastic agents, and radiation therapy
• Increased fluid intake and aspirin

Leukemia

• A cancer, but its cause is unknown
• Immature cells prevent the production of healthy cells
• Signs and symptoms include fever, headaches, bone pain, pallor, weakness and fatigue
• Additional symptoms include: malaise, frequent infections, swollen lymph nodes, enlarged spleen, bone pain, weight loss, and easy bleeding or thrombosis

Leukemia: Treatment

• Treatment aims to slow down the growth of the malignant blood cells
• Maintain a normal level of red cells, hemoglobin, and platelets
• Manage the symptoms and meeting the special needs of each patient, and exploring possible "curative" therapies like HCT

Leukemia: Nursing Management

• Observe the patient for: potential for infection, abnormal bleeding, and anemia
• Monitor for nutritional alteration with severe anorexia and weight loss, increased levels of uric acid in the urine and blood (due to chemotherapy)
• Observe for psychosocial problems related to the effects of the disease and treatment

Audience Response Question

• If a nurse initiates neutropenic precautions on a patient who had chemotherapy, appropriate actions would include:
• Use clean technique for wound care and invasive procedures
• Use protective isolation as needed
• Maintain integrity of skin and mucosa
• Provide analgesics, as needed

Thrombocytopenia

• Bone marrow depression due to chemotherapy,radiation, autoimmune diseases, bacterial and viral infections, disseminated intravascular coagulation (DIC), and over function of the spleen
• Nursing care includes prevention of bleeding and close observation for spontaneous bleeding
• Invasive procedures should only be performed when essential and activities that induce bleeding should be avoided
• For patients with a low platelet count, maintain pressure over the site of venipuncture, injection, or discontinued IV catheter for 10 minutes to prevent continuous oozing

Multiple Myeloma

• Abnormal plasma cells multiply out of control in the bone marrow and produce excessive amounts of abnormal immune globulin/cytokines
• Its Onset id gradual, and symptoms appear when the skeletal system is heavily involved resulting in Backache, bone pain, pathologic fractures and severe pain

Multiple Myeloma: Treatment

• Treatments include Chemotherapy, Radiation and Hematopoietic cell transplantation (HCT)
• Pain control and measures to prevent pathologic fractures

Multiple Myeloma: Nursing Management

• Provide supportive care for the many complications of the disease and treatment
• Encourage adequate hydration with an intake of 3 to 5 L of fluid daily to minimize problems from hypercalcemia
• Assess and manage pain with acetaminophen and nonsteroidal antiinflammatory drugs and narcotic analgesics
• Carefully move the patient because of the potential for fractures

Hemophilia

• Hemophilia is an inherited X-linked disorder where there is a deficiency of specific clotting factors
• A decrease in the amount of activity of 1 of the 11 different clotting factors normally present in blood and essential to the formation of clots
• Signs and symptoms include bleeding and Hemarthrosis – bleeding on joints
• Diagnosis includes a patients history, physical examination, CBC, coagulation profile and tests for the various clotting factors in the blood
• Treatment includes recombinant forms of factor VIII and factor IX, Desmopressin acetate (DDAVP),Tranexamic acid (Cyklokapron) and aminocaproic acid (Amicar),Analgesic drugs and corticosteroids

Hemophilia Nursing Management

• Administer the necessary clotting factors
• Elevate the injured body part, apply cold packs, and control pain
• Observe for further bleeding, provide psychological support for the patient and family
• Encourage genetic counseling for family members, if this counseling has not occurred previously

Disseminated Intravascular Coagulation

• A complicated disorder that usually occurs with tissue destruction
• Damaged tissue liberates tissue thromboplastin, creating a state of excessive clotting in the microcirculation throughout the body
• Goal of treatment is to correct the underlying problem

Disseminated Intravascular Coagulation: Nursing Management

• Be alert to the possibility when a patient has predisposing conditions
• Early detection of external bleeding as well as Monitoring sensorium and vital signs for indications of internal bleeding

Transfusions

• A blood transfusion involves the administration of a blood component
• Consent for blood administration is required and blood products are always checked by two nurses before administration

Checking LPN/LVN Role

• Some states have expanded their LPN practice act to include the administration of blood products
• Check the nurse practice act to ensure that the procedure is within legal practice in a given state

Signs and Symptoms of Transfusion Reaction

• Symptoms include Chills, Fever, Shortness of breath and Itching or rash
• Additional symptoms are Apprehension, Sense of impending doom, Headache, and Pain in the low back or chest
• Tachycardia, Tachypnea, Hypotension, Hemoglobinuria and Shock

Acute Transfusion Reactions

• Acute hemolytic reaction
• Febrile, nonhemolytic reaction (most common)
• Mild allergic reaction
• Anaphylactic and severe allergic reaction
• Circulatory overload
• Sepsis

Management of Hematologic Disorders

• Oxygen therapy
• Iron therapy
• Vitamin B12 therapy
• Splenectomy which is common in cases of Severe trauma to and rupture of the spleen, as well as Splenomegaly caused by rapid destruction of blood cells, and Splenomegaly from blood disorders, such as leukemia