Understanding Anemia: Types, Symptoms and Treatment

Anemia: Etiology

• Anemia can stem from blood loss, failure in blood cell production, or excessive destruction of red blood cells.
• Anemia occurs when there is insufficient total body iron, diminishing erythropoiesis.
• The lack of iron inhibits the formation of hemoglobin (Hb).

Anemia: Signs and Symptoms

• Mild anemia presents with 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 presents with Hb levels less than 8 g/dL and can manifest in general symptoms, eye-related issues, skin problems, cardiovascular issues, respiratory difficulties, gastrointestinal problems, musculoskeletal issues, and neurological symptoms.

Anemia: Treatment

• Treatments involve iron supplements, vitamins, diet adjustments, blood transfusions, and Vitamin B12.

Aplastic Anemia

• Aplastic Anemia may arise after a viral infection, from a drug reaction, or be inherited.
• Bone marrow depression characterizes aplastic anemia, likely due to an immune-mediated disease.
• Treatment focuses on eliminating any identifiable underlying cause.
• Decreased levels of red cells, white cells, and platelets are observed.
• Packed red cells and platelets are administered as part of the treatment.
• Antibiotics are administered for identified infections.

Sickle Cell Disease

• Sickle cell disease occurs due to a genetic disorder leading to the production of hemoglobin S.
• Hypoxia triggers hemoglobin S to take on a sickle shape, which blocks vessels and forms thrombi.
• Signs and symptoms include pallor, lethargy, pain, and painful swelling of the hands and feet (related to bone infarction).

Sickle Cell Disease: Treatment

• Prevention of sickle cell crisis and management of symptoms are key.
• Folic acid should be taken regularly, alongside a diet rich in protein.
• Infection has to be prevented.
• Adequate fluid intake is essential for managing sickle cell disease.
• Alcohol and recreational drugs should be avoided.
• Hydroxyurea (Hydrea) can decrease the frequency of sickling episodes.

Sickle Cell Nusing Management

• Avoid high altitudes, vigorous exercise and iced liquids.
• Ensure adequate fluid intake.
• Stop smoking.
• Treat infections promptly.
• Ensure adequate rest.
• Provide adequate pain relief.
• Monitor intake and output.
• Use oxygen therapy.

Polycythemia Vera

• Polycythemia Vera is a neoplastic disorder that results in the overproduction of red blood cells.
• With increased cell numbers, the blood becomes thick, blood vessels become distended, and blood flow becomes sluggish.
• Treatment involves phlebotomy, antineoplastic agents, radiation therapy, increased fluid intake, and aspirin.

Leukemia

• Leukemia is cancer, but its exact cause remains unknown.
• Pathophysiologically, immature cells hinder the production of healthy cells.
• Symptoms include fever, headaches, bone pain, pallor, weakness, fatigue, malaise, frequent infections, swollen lymph nodes, enlarged spleen, bone pain, weight loss, and easy bleeding or thrombosis.

Leukemia: Treatment

• Aims at slowing down the growth of malignant blood cells, maintaining normal levels of red cells, hemoglobin, and platelets.
• Treatment may focus on managing symptoms, meeting patient needs, and exploring possible "curative" therapies like HCT.

Leukemia: Nursing Management

• Watch for potential infection.
• Watch for Abnormal bleeding.
• Watch for Anemia.
• Address Nutritional Alterations, such as severe anorexia and weight loss.
• Manage Increased Uric Acid Levels.
• Address Psychosocial well being.

Thrombocytopenia

• Causes include bone marrow depression from chemotherapy, radiation, autoimmune diseases, bacterial and viral infections, DIC, and over-function of the spleen.
• Nursing care involves prevention of bleeding, close observation for signs of spontaneous bleeding, quick intervention, essential invasive procedures only, and avoiding activities that induce bleeding.
• Prevent bleeding for patients with low platelet counts by maintaining pressure for 10 minutes after venipuncture, injections, or discontinuing IVs to prevent oozing.

Multiple Myeloma

• Abnormal plasma cells multiply uncontrollably in the bone marrow.
• These abnormal cells produce excessive amounts of abnormal immune globulin and cytokines.
• Symptoms appear gradually, primarily affecting the skeletal system and causing backache, bone pain, pathologic fractures, and severe pain.

Multiple Myeloma: Nursing Management

• Multiple Myeloma treatment involves chemotherapy, radiation, hematopoietic cell transplantation (HCT), pain control, and measures to prevent pathologic fractures.
• Provide supportive care and encourage adequate hydration (3 to 5 L daily) to minimize hypercalcemia-related problems.
• Assess and manage pain, using acetaminophen, nonsteroidal anti-inflammatory drugs, or narcotic analgesics.
• Take great for patients since they have a risk of fractures.

Hemophilia

• Hemophilia is an inherited X-linked disorder with a deficiency in specific clotting factors.
• Decreased activity of one of the 11 clotting factors normally present in blood and essential for clot formation.
• Signs and symptoms include bleeding and hemarthrosis (bleeding in joints).
• Diagnosis relies on history, physical examination, CBC, coagulation profile, and tests for clotting factors.
• Treatment includes recombinant forms of factor VIII and IX, desmopressin acetate (DDAVP), tranexamic acid (Cyklokapron), aminocaproic acid (Amicar), and analgesic drugs/corticosteroids.

Hemophilia: Nursing Mangement

• Administer the necessary clotting factors.
• Elevate the injured body part.
• Apply cold packs.
• Control pain.
• Observe for further bleeding.
• Provide psychological support for the patient and family.
• Encourage genetic counseling for family members, if this has not already been done.

Disseminated Intravascular Coagulation (DIC)

• DIC is a complicated disorder that typically occurs with tissue destruction.
• Tissue damage releases tissue thromboplastin, causing excessive clotting in the microcirculation.
• Treatment involves correcting the underlying problem, such as trauma or infection.

Disseminated Intravascular Coagulation (DIC): Nursing Management

• Be alert and assess for predisposing conditions.
• Watch for external bleeding.
• Monitor sensorium and perform vitals for indications of internal bleeding.

Transfusions

• Transfusions involve administering a blood component.
• Consent has to be given before administration.
• Blood products need to be checked by two nurses before administration.

LPN/LVN Transfusions

• Some states allow LPN's to administer transfusions.
• Practice needs to be within legal practice in your state.

Transfusion Reaction

• Tachycardia.
• Tachypnea.
• Hypotension.
• Hemoglobinuria.
• Shock.
• Chills.
• Fever.
• Shortness of breath.
• Itching/Rash.
• Apprehension.
• Headaches.
• Pain in chest or low back.

Acute Transfusion Reations

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

Management of Hematologic Disorders

• Include Oxygen therapy, Iron therapy, and Vitamin B12 therapy.
• Splenectomy due to Severe trauma, Splenomegaly, Splenomegaly from blood disorders.