Anemia Flashcards
(44 cards)
1
Q
Anemia: A deficiency in the …
A
- Number of erythrocytes (red blood cells [RBCs])
- Quantity of hemoglobin
- Volume of packed RBCs (hematocrit)
2
Q
Anemia: Gerontological Considerations
A
- Common in older adults
- Chronic disease
- Nutritional deficiencies
- Signs and symptoms may go unrecognized or mistaken for normal aging changes
3
Q
Anemia: Causes
A
Blood loss
Impaired production of erythrocytes
Increased destruction of erythrocytes
4
Q
Anemia: Groups
A
Morphological: • Cellular characteristics • Descriptive, objective laboratory information Etiological: • Underlying cause
5
Q
Anemia: Clinical manifestations
A
- Caused by the body’s response to tissue hypoxia
* Hemoglobin (Hb) levels are used to determine the severity of anemia
6
Q
Anemia: Clinical manifestations, Mild + Moderate
A
Mild = Hb 100-140 g/L • May exist without symptoms • Possible symptoms • Palpitations, dyspnea, diaphoresis Moderate = Hb 60-100 g/L • ↑ Cardiopulmonary symptoms • Experienced at rest or during activity
7
Q
Anemia: Clinical Manifestations, Severe (Body Systems)
A
Severe = Hb
8
Q
Anemia: Integumentary Manifestations
A
- Pallor
- ↓ hemoglobin
- ↓ blood flow to the skin
- Jaundice
- ↑ concentration of serum bilirubin
- Pruritus
- ↑ serum and skin bile salt concentrations
9
Q
Anemia: Cardiopulmonary Manifestations
A
- Additional attempts by the heart and lungs to provide adequate O2 to the tissues
- Cardiac output maintained by ↑ the heart rate and stroke volume
10
Q
Iron-Deficiency Anemia
A
- One of the most common chronic hematological disorders
- Iron is present in all RBCs as heme in hemoglobin and in a stored form
- Heme accounts for two thirds of the body’s iron
11
Q
Iron- Deficiency Anemia: Etiology
A
- Inadequate dietary intake
- 5-10% of ingested iron is absorbed
- Malabsorption
- Blood loss
- Hemolysis
12
Q
Iron-Deficiency: Clinical Manifestations
A
- General manifestations of anemia
- Pallor is the most common finding
- Glossitis is the second most common
- Inflammation of the tongue
13
Q
Iron-Deficiency Anemia: Diagnostics
A
- Laboratory findings
- Hb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets
- Stool test for occult blood
- Endoscopy
- Colonoscopy
14
Q
Megaloblastic Anemias
A
- Group of disorders caused by impaired DNA synthesis
- Characterized by the presence of large RBCs (megaloblasts)
- Majority result from deficiency in • Cobalamin (vitamin B12)
- Folic acid
15
Q
Megaloblastic Anemias: Classification
A
- Cobalamin (vitamin B12) deficiency
- Folic acid deficiency
- Drug-induced suppression of DNA synthesis
- Inborn errors
- Erythroleukemia
16
Q
Cobalamin Deficiency
A
• Intrinsic factor (IF)
• Protein secreted by the parietal cells of the
gastric mucosa
• IF is required for cobalamin absorption in the small intestine
17
Q
Cobalamin Deficiency: Causes
A
- Pernicious anemia
- Insidious onset
- Nutritional deficiencies
- Hereditary enzymatic defects
18
Q
Cobalamin Deficiency: Etiology
A
• Absence of IF • Acid environment required for IF secretion • GI surgery • Long-term users of H2-histamine receptor blockers
19
Q
Cobalamin Deficiency: Clinical Manifestations
A
- General symptoms of anemia
- Sore tongue
- Anorexia
- Nausea
- Vomiting
- Abdominal pain
20
Q
Cobalamin Deficiency: Neuromuscular Manifestations
A
- Weakness
- Paresthesias of the feet and hands
- ↓ Vibratory and position senses
- Ataxia
- Muscle weakness
- Impaired thought process
21
Q
Cobalamin Deficiency: Diagnostics
A
- RBCs appear large
- Abnormal shapes
- Structure contributes to erythrocyte destruction
- ↓ Serum cobalamin levels
- Normal serum folate levels and ↓ cobalamin levels suggest megaloblastic anemia due to cobalamin deficiency
- Schilling test
22
Q
Folic Acid Deficiency
A
- Also a cause of megaloblastic anemia
- Folic acid is required for DNA synthesis
- RBC formation and maturation
23
Q
Folic Acid Deficiency: Common Causes
A
- Poor nutrition
- Malabsorption syndromes
- Drugs
- Alcohol abuse and anorexia
- Lost during hemodialysis
24
Q
Folic Acid Deficiency: Clinical Manifestations
A
- Clinical manifestations are similar to those of cobalamin deficiency
- Insidious onset
- Absence of neurological problems
- Treated by replacement therapy
- Encourage client to eat foods with large amounts of folic acid
25
Anemia of Chronic Disease
* Underproduction of RBCs
| * Mild shortening of RBC survival
26
Anemia of Chronic Disease: Causes
* End-stage renal disease
* Primary factor, ↓ erythropoietin
* Chronic liver disease
* Chronic inflammation
* Malignant tumours
* Chronic endocrine diseases
27
Anemia of Chronic Disease: Findings
Anemia of chronic disease findings:
• ↑ Serum ferritin
• ↑ Iron stores
• Normal folate and cobalamin levels
28
Anemia of Chronic Disease: Treatment
* Treating underlying cause is best
* Rarely blood transfusions
* Erythropoietin therapy
29
Aplastic Anemia
* Pancytopenia
* ↓ of all blood cell types
* RBCs
* White blood cells (WBCs)
* Platelets
* Hypocellular bone marrow
30
Aplastic Anemia: Etiology
* Low incidence
* Affecting 4 of every 1 million persons
* Manageable with erythropoietin or blood transfusion
* Can be a critical condition
* Hemorrhage
* Sepsis
31
Aplastic Anemia: Clinical Manifestations
* Gradual development
* Symptoms caused by suppression of any or all bone marrow elements
* General manifestations of anemia
* Fatigue, dyspnea
32
Aplastic Anemia: Diagnostics
* Confirmed by laboratory studies
| * Normocytic, normochromic anemia
33
Acute Blood Loss
Result of sudden hemorrhage
• Trauma
• Complications of surgery
• Disruption vascular integrity
34
Acute Blood Loss: Concerns
* Hypovolemic shock
* ↑ Plasma volume
* ↓ O2 due to ↓ RBCs available
35
Acute Blood Loss: Clinical Manifestations
* Cause
* Body’s attempt to maintain an adequate blood volume and O2
* Pain
* Internal hemorrhage
* Retroperitoneal bleeding
* Shock is the major complication
36
Acute Blood Loss: Diagnostic Tests
• Laboratory data do not adequately assess RBC problems for 2-3 days
37
Chronic Blood Loss: Decreased Iron
↓ Iron stores
• Bleeding ulcer
• Hemorrhoids
• Menstrual and post-menopausal blood loss
38
Hemolytic Anemia
* Destruction or hemolysis of RBCs at a rate that exceeds production
* Third major cause of anemia
* Intrinsic hemolytic anemia
* Abnormal hemoglobin
* Enzyme deficiencies
* RBC membrane abnormalities
39
Hemolytic Anemia
• Jaundice
• Destroyed RBCs cause ↑ bilirubin
• Enlarged spleen and liver
• Hyperactive with macrophage phagocytosis
of the defective RBCs
• Accumulation of hemoglobin molecules can obstruct renal tubules
• Tubular necrosis
40
Sickle Cell Disease (SCD)
* Group of inherited, autosomal recessive disorders
* Presence of an abnormal form of hemoglobin in the erythrocyte
* Hemoglobin S (HbS), abnormal
41
Sickle Cell Disease (SCD)
* HbS causes the RBC to stiffen and elongate
* Sickle shape in response to ↓ O2 levels
* Substitution of valine for glutamic acid on the β-globin chain of hemoglobin
* Genetic disorder
* Incurable disease, often fatal
42
SCD: Clinical Manifestations
* Typical client is asymptomatic, except during sickling episodes
* Symptoms can be
* Pain and swelling
* Pallor of mucous membranes
* Fatigue
43
SCD: Complications
* Gradual involvement of all body systems
* Usually fatal by middle age from renal and pulmonary failure
* Prone to infection
* Pneumonia, most common infection
44
SCD: Diagnostics
* Peripheral blood smear
* Sickling test
* Electrophoresis of hemoglobin
* DNA testing
* Skeletal x-rays
* Magnetic resonance imaging (MRI)
