Hematology Part 2 PDF

Hematology Part 2 Dorothy Maka, DNP, APN, FNP-BC DePaul University NSG 422  Section 1.0 Alterations in Erythrocytes Overview Anemia Red Blood Cells Measures for Anemia Anemia  How do we define anemia?  Reduction...

Hematology Part 2 Dorothy Maka, DNP, APN, FNP-BC DePaul University NSG 422  Section 1.0 Alterations in Erythrocytes Overview Anemia Red Blood Cells Measures for Anemia Anemia  How do we define anemia?  Reduction in the total number of erythrocytes (RBCs) in the circulating blood OR in the quality or quantity of hemoglobin Many various causes of anemia Anemia  Classification by size and hemoglobin  Size – Special ending “-cytic”  Macrocytic, microcytic, normocytic  Hemoglobin content – special ending “-chromic”  Normochromic and hypochromic Image Credit: The McGill Physiology Virtual Lab Anemia Reduced Oxygen carrying capacity ↓ Hypoxia  Classic Anemia Symptoms:  Fatigue  Weakness  Dyspnea  Pallor  May lead to compensatory tachycardia Red Blood Cell Measures for AnemiaTest Measures Values Amount of Hemoglobin (HB) 12–17.4 g/dL Hemoglobin in blood Proportion of RBCs to Hematocrit (HCT) 36–52% total blood cells Mean corpuscular Average mass of 27–34 pg hemoglobin (MCH) hemoglobin per RBC Concentration of Mean corpuscular hemoglobin in select hemoglobin concentration 32–36 g/dL volume of packed (MCHC) RBCs Mean corpuscular volume Average RBC size 80–100 fL (MCV) 4.2–6.1 million Red blood cell count (RBC) Number of RBCs cells/mcL Red blood cell distribution Range of RBC sizes 11.5–14.5 width (RDW)  Section 2.0 Macrocytic Anemias Vit B12 Deficiency Pernicious Anemia Folic Acid Deficiency Macrocytic Anemias  Size of the RBCs - Large / Macrocytic  Result of defective DNA synthesis while RNA processes occur normal rates  Due to deficiency's in Vit b12 or folate  Subtypes  Vitamin B 12 Deficiency  Folate Deficiency  Macrocytic Anemia – Vit B 12 Deficiency Anemia  Vitamin B 12 Deficiency Causes  Gastric Abnormalities  Pernicious Anemia = Autoantibodies to intrinsic factor or gastric parietal cells  Gastrectomy/Bariatric surgery  Diet  Strict Vegans and Vegetarians at risk  Sources of Vit B12: Meats, eggs, dairy, fish  Small Bowel Disease (Absorption) Means & Fairfield, 2020; Porth, 2015, Sorenson, 2019) Macrocytic Anemia – Vit B 12 Deficiency Anemia Think…red BEEFY tongue = Vit B12  Clinical Manifestations Deficiency …B’s  Initial ss/sx may be vague  Weakness, fatigue  Sore tongue that appears beefy red in appearance  Neuro symptoms  Difficulty walking, paresthesia of feet and fingers  Nerve demyelination Macrocytic Anemia – Vit B 12 Deficiency Anemia  Evaluation  Complete blood count (CBC) – Increased MCV (large rbc!), decreased HCT  Serum Vit b 12 – decreased  May assess antibodies  Treatment  Parenteral or high oral doses of vitamin b 12  Treatment is dependent on etiology, why? Macrocytic Anemia - Folate Deficiency Anemia  Importance of folate  Causes:  Absorptive etiologies (chronic malnourishment)  Dietary Deficiency  Sources of folate: meats, enriched breads/cereals, fortified grain products, leafy green vegetables, citrus fruits Macrocytic Anemia - Folate Deficiency Anemia  Clinical manifestations:  May present general anemia manifestations  Specific folate deficiency manifestations may include  Cheilosis  Stomatitis or oral mucosal ulcerations  Evaluation:  Increased MCV  Decreased folate  Treatment:  Oral folate supplementation  Increase folate rich foods (meats, enriched breads/cereals, fortified grain products, leafy green vegetables, citrus fruits )  Section 3.0 Microcytic –Hypochromic Anemias Iron Deficiency  Microcytic Hypochromic Anemia- Iron Deficiency Anemia ⬤ Iron-deficiency anemia Most common type of anemia worldwide Causes ∙ Inadequate dietary intake ∙ Blood Loss ∙ Chronic blood loss [GI bleed] ∙ Ulcers, ∙ Use of medications that cause gastrointestinal bleeding (aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]) ∙ Menorrhagia (excessive bleeding during menstruation) Microcytic Hypochromic Anemia- Iron Deficiency Anemia Clinical Manifestations -> Become symptomatic when hemoglobin drops to 7-8 g/dl  Early symptoms:  Fatigue, weakness, shortness of breath, pallor  Progressive symptoms  Brittle, thin, coarsely ridged, and spoon-shaped nails (koilonychia)  Cheilosis, stomatitis, painful ulcerations in mouth Microcytic Hypochromic Anemia- Iron Deficiency Anemia  Evaluation:  CBC: decreased MCV, decreased MCH/MCHC, decreased HCT  Serum ferritin  Treatment:  Identify and eliminate sources of blood loss  Iron replacement therapy:  Oral : Ferrous sulfate  Parenteral: Iron dextran  Duration of therapy: Usually 6 to 12 months after the bleeding has stopped but may continue for as long as  Section 4.0 Normocytic – Normochromic Anemia Aplastic Anemia Post Hemorrhagic Anemia Hemolytic Anemia Anemia of Chronic Disease Normocytic Normochromic Anemia – Aplastic Anemia  Produces Pancytopenia -> reduction in all three types of blood cells (red blood cells, white blood cells, platelets)  Leading to:  Causes:  Autoimmune disorders, some chemical exposures (cancer chemotherapy)  Clinical Manifestations:  Anemia- Fatigue, pallor, dyspnea  Neutropenia- Fever  Thrombocytopenia- Petechiae , ss/sx of bleeding  Treatment depending on etiology Normocytic Normochromic Anemia – Aplastic Anemia  Acute blood loss from the vascular space  Clinical manifestations  Depends on the severity of the blood loss  Treatment  Intravenous administration of saline, dextran, albumin, or plasma  Large volume losses: Fresh whole blood Normocytic Normochromic Anemia – Hemolytic Anemia: Transfusion Related Hemolysis Normocytic Normochromic Anemia – Hemolytic Anemia: Sickle Cell  Many different forms of hemolytic anemia  Sickle Cell Anemia Image Cred  Autosomal Recessive Disorders Mayo Clinic  Genetic mutation results in structural changes in the hemoglobin 2020 (Hemoglobin S)  Forms:  Sickle Cell Trait  Sickle Cell Disease  Consequences of Disease Process:  Chronic Hemolytic Anemia  Blood Vessel Occlusion  -> Vaso-occlusion -> Tissue Ischemia and Infarction  Normocytic Normochromic Anemia – Hemolytic Anemia: Sickle Cell Image Credit: Porth, Image Credit: 2015 AboutKidsHealth, Normocytic Normochromic Anemia – Hemolytic Anemia: Sickle Cell  Clinical Manifestations  Jaundice (icterus)  Vaso-occlusive pain crisis  Tissue infarct complications  Treatment  Medications: (Hydroxyurea, pain treatment)  Blood transfusions  Hydration  Oxygen Photo Credit: Nursing Education Consults , Normocytic Normochromic Anemia – Anemia of Chronic Disease  Mild-to-moderate anemia from decreased erythropoiesis  Result from conditions of  Chronic Inflammation OR  Chronic systemic disease (ex. Chronic Kidney Disease [CKD]) Normocytic Normochromic Anemia – Anemia of Chronic Disease  Diseases with chronic inflammation leading to anemia  Results from: Decreased erythrocytes life span Suppressed production of erythropoietin Ineffective bone marrow response Altered iron metabolism in macrophages Normocytic Normochromic Anemia – Anemia  of Disease Chronic Systemic Chronic Disease CKD -> leading to anemia of chronic disease  How ?  Kidney damage -> affects erythropoietin production Application Exercise 1. Why should Joan’s nurse  Mrs. Joan Cass, age 56, came to her practitioner ask her about neuro nurse practitioner with fatigue, pallor, symptoms like paresthesia? dyspnea on exertion, and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and reticulocyte 2. Why did her nurse practitioner count are low, that her MCV is high, and that her MCH and MCHC are normal. prescribe vitamin B12 by intramuscular Her diagnosis is pernicious anemia. injection rather than orally? Section 5.0 Polycythemia Polycythemia  Polycythemia  Overproduction of red blood cells  Relative polycythemia  Hemoconcentration of blood due to dehydration  Primary polycythemia (Polycythemia vera)  Blood cancer -> bone marrow produces too many RBCs  Manifestations:  Splenomegaly – abdominal pain  Hypercoagulable state  Treatment: phlebotomy, medications Questions??