Hematologic Disorders: Anemia Part 1 PDF

HEMATOLOGIC DISORDERS  ANEMIA - – condition wherein hemoglobin concentration is lower than normal ( hemoglobin, rbc count, hematocrit) https://medicine.tamu.edu/class- https://pedclerk.bsd.uchicago.edu/sites/pedcle...

HEMATOLOGIC DISORDERS  ANEMIA - – condition wherein hemoglobin concentration is lower than normal ( hemoglobin, rbc count, hematocrit) https://medicine.tamu.edu/class- https://pedclerk.bsd.uchicago.edu/sites/pedclerk.uchicago.edu/files/styles/wide/public files/histopathology/Histopathology%20Study%20Gui /uploads/images/Microcytic%20hypochromic%20red%20cells%20in%20iron%20deficien de/Hematopoetic-Lymphoid/Slide303Normal15.jpg cy%20anemia.%20Red%20cells%20are%20hypochromic_0.png?itok=ybD4WiW2 CLASSIFICATION OF ANEMIA Defective Production Increased Destruction (Nutritional; Blood Loss (Bleeding) (Hemolytic) Hypoproliferative) Iron Deficiency Trauma Inherited Hemolytic Vitamin B12 Deficiency Bleeding Problems Anemia Folate Deficiency (Epistaxis, Menorrhagia, Abnormal Decreased Bleeding Disorders) Hemoglobin Erythropoietin Blood Cell Membrane Production Abnormality Cancer / Inflammation Acquired Hemolytic Anemia Antibody-Related Not Antibody Related NURSING DIAGNOSIS Inadequate tissue Fatigue r/t decreased perfusion (Oxygen) r/t hemoglobin or decreased oxygen diminished oxygen carrying capacity of the carrying capacity of the blood blood Imbalanced Nutrition: Activity Intolerance r/t Less than body inadequate hemoglobin requirements r/t and hematocrit inadequate intake of essential nutrients Non-compliance with prescribed therapy  https://gizi.unida.gontor.ac.id/wp-content/uploads/2020/04/cegah- anemia-saat-puasa-simasinsurtech-624x260.jpg DEFECTIVE PRODUCTION Nutritional Anemias / Hypoproliferative Anemias Iron Deficiency Vitamin B12 Deficiency Folate Deficiency Decreased Erythropoietin Production Cancer / Inflammation IRON DEFICIENCY ANEMIA Insufficient Dietary Chronic Blood Loss Intake: Pica (craving for (bleeding) unusual substances like ice, clay or laundry starch) Impaired GI absorption Increased Iron (gastrectomy, prolonged requirements (periods of severe diarrhea, intestinal rapid body growth, hookworm infestation, pregnancy, menstruation) bowel diseases) Clinical Manifestations: fatigue, exertional dyspnea Classical Signs: Brittle, spoon- shaped nails with longitudinal ridges (koilonychia); Smooth sore tongue; angular cheilosis (ulceration in the corners of the mouth)  Complete Blood Count DIAGNOSIS Bone Marrow aspiration (definitive) Laboratory Findings: Low hemoglobin Microcytic, hypochromic RBCs Low Serum Iron Concentration High total iron binding capacity (high transferrin levels) low serum ferritin decreased reticulocyte count NURSING MANAGEMENT AND CONSIDERATIONS Administer prescribed iron medication: Iron Preparations: e.g. ferrous sulfate, ferrous gluconate Z-track technique for parenteral. Use straw for liquid oral meds Encourage client to take iron with Vit. C / empty stomach to enhance absorption Educate on foods high in iron (organ meats (beef/chicken liver), cooked white beans (e.g garbanzos), green leafy veggies, raisins, molasses Tannates in tea, carbonates (e.g. softdrinks) and calcium (milk) hinder iron absorption. Stools will be black. Side effect: Constipation. Counsel and instruct high risk clients about preventive education  MEGALOBLASTIC, MACROCYTIC ANEMIAS ▪ Deficiency in vitamin B12 and Folic acid lead to defective DNA synthesis (impaired nuclear development) and abnormal RBC maturation  macrocytic RBCs ▪ Etiology: chemotherapeutic agents, anticonvulsants (interferes with DNA metabolism)  insufficient dietary intake surgery gastrectomy ileal resection malabsorption CAUSES OF pernicious anemia (failure to secrete intrinsic factor) VITAMIN B12 DEFICIENCY CLINICAL MANIFESTATIONS Anemia Beefy Red Tongue Vitiligo Weakness, listlessness, fatigue Neurologic Abnormalities (peripheral neuropathy, loss of balance) Loss of proprioception Mental status changes Impaired memory (Dementia) Depression SIGNS AND SYMPTOMS OF VIT B12 DEFICIENCY https://lh3.googleusercontent.co m/proxy/jFcU3txRJa9DR8L6SQPr QB1u6KoV65Cw- S7JYnzadkQOt6qqdzWJocbEyWg 0yP3vGp4bwF8q7KnbFrpMRdmu nx8lUKkepsYtJLM6F03vjGmSVqx _mAR17pMFqy9HpoKIHxc  Diagnosis: Bone marrow analysis Hyperplasia Pancytopenia macrocytic RBCs (increased MCV) https://i0.wp.com/medicoapps.org/wp- poikilocytosis content/uploads/2019/02/megaloblastic-anemia.jpg?fit=600%2C315&ssl=1  Diagnostic test : Schilling’s Test 24 hour urine sample Management: Vit. B12 Replacement – https://image.slidesharecdn.com/vit-b12-schilling-130316051450- phpapp01/95/vit-b12schilling-4-638.jpg?cb=1363410950 Oral, IM, SQ, intranasal forms Improve thought process minimize effects of paresthesia https://encrypted-tbn0.gstatic.com/images?q=tbn%3AANd9GcSEwf4spw9-gO27sehrlsAKKMpEo_jRyVPO6A&usqp=CAU  Etiology: Dietary deficiency, FOLIC ACID DEFICIENCY chronic alcoholism, overcooking of vegetables, malabsorption syndromes Decreased Folic Acid during pregnancy may lead to Neural Tube Defects (Spina Bifida) Clinical manifestations: anemia macrocytic rbcs (megaloblastic changes in the bone marrow ) decreased serum folate levels https://1.bp.blogspot.com/-Ir1z2jedp9Y/WSxeUqLSnZI/AAAAAAAAGKc/JvblFHHb8QEtr5tmIWR9a_bCWnz47DCJwCLcB/s1600/Folic%2Bacid%2BDeficiency%2BAnemia.jpg MANAGEMENT: oral folic acid supplements; well balanced diet (organ meats, eggs, cabbage, broccoli, citrus fruits, brussel sprouts) 100-200 mg daily HYPROLIFERATIVE ANEMIAS  HYPROLIFERATIVE ANEMIAS Anemias in Renal Disease Anemia of Inflammation -Occurs as a result of kidney damage -Occurs as a result of inflammation, infection and (decreased erythropoietin production) malignancy -Anemia occurs when GFR is less than 30 -Also includes anemia of critical illness and anemia ml/min. associated with aging -Previously known as anemias of chronic disease -Findings: decreased RBC count; normocyctic, normochromic RBCs -Management: treatment of underlying condition  Anemia is related to: mild shortening of rbc lifespan failure of or decreased production of Erythropoietin (EPO) to stimulate RBC production immune activation bone marrow suppression as a side https://www.lalpathlabs.com/blog/wp- content/uploads/2020/02/shutterstock_1120340036-Converted.jpg.png effect of treatment  Clinical Manifestations: Fatigue, Weakness Dyspnea Anorexia Management: Erythropoietin (EPO) Therapy (e.g. Epogen, Procrit, Epoetin alfa) Blood Transfusion https://www.verywellhealth.com/thmb/obSRDJx1HmDYrUDT- G4JTp8U9GY=/3000x2000/filters:no_upscale():max_bytes(150000):strip_icc()/anemia-after-surgery-3156852-Final- 63c258f51d7846e1b24d870a3b8ea88c.png APLASTIC ANEMIA Infection Drugs (antineoplastics, Chloramphenicol, sulfonamides, Phenytoin, radiation chemotherapy) chemicals (benzene and benzene derivatives, pesticides) Depression/ Viruses (Hepatitis B & C, EBV, CMV) Cessation of Miliary TB activity of all blood Fanconi anemia (hereditary) forming elements Decreased RBCs – (Anemia) pallor, fatigue, palpitations, exertional dyspnea Markedly reduced Decreased WBCs – (Granulocytopenia) susceptibility to infection hematopoiesis Decreased Platelets – (Thrombocytopenia) hemorrhage/bleeding (bone marrow aplasia) MANAGEMENT Removal of the Causative Agent Blood Transfusion Bone Marrow Transfusion with HLA Compatible donor Monitor and manage infection and bleeding