What are some risk factors for Anemia?
Culture - African American or Mediteranean descent have ^ prevalance of Sickle Cell Anemia
What are the causes of Anemia?
Dec production of RBC's
Inc destruction of RBC's
Loss of blood
Bone Marrow Diseases
GI Bleeds are most common blood losses
What are normal HGB/HCT levels?
Hgb 12-15 g/dl in women
Hgb 13.5-17 g/dl in men
Hct 40-54% in men
Hct 46% in women
THEY CONFIRM ANEMIA
What are some assessments for Anemia?
(Those may occur with strenuous activity)
Anema may be asymptomatic related to chronic disease
Delayed cap refil
Murmurs (If severe)
FATIGUE (Common, 1st symptom)
What is Iron Deficiency Anemia?
Chronic form lack of iron in the blood
Women need 15mg daily
Men need 10mg daily
Most iron is supplied by diet which contains meat
Anemia is found in 30% of world population
What can cause malabsorption of iron?
Due to chronic diarrhea, celiac disease, gastrectomy and removal of the upper part of bowel
Some antacids that contain magnesium may not allow iron to be absorbed. Give those meds about 30 min after a meal
(Due to inadequate diet)
What are some assessments for the malabsorption of iron?
Pallor in face, palm of the hands, nail beds, mucous membranes of mouth and conjunctiva
Numbness and tingling of fingers
Smooth, bright red tongue
What is Pernicious Anemia?
Absence of intrinsic factor leads to malabsorption of Vit B12
Usually heredity is the culprit but GERD may be responsible also
What is some pharmacology for Pernicious Anemia?
Inj of 1000mcg Cobalmin every day for 2 weeks
Then 1000 mcg Cobalmin weekly until HCt returns to normal
Monthly injections are needed for lifetime
Iron may also be needed
What causes Folic Acid Deficiency Anemia?
Diet lacking green leafy vegetables, liver, citrus fruits, nuts, grains & yeast
Alcoholics at risk along with those haveing hemodialysis treatments
What are some medications and items that can cause Folic Acid Deficiency anemia?
long-term use of anticonvulsants
Use of antimetabolites in those with cancer & leukemia
Certain BC pills
What pharmacology is needed for folic acid deficiency anemia?
Folic Acid 0.1mg-5mg daily until anemia is corrected
Sickle-Cell Disease is inherited, is the most common type of anemia worldwide and has the highest rate in West Africa, What are some assessments and what does it do?
Turns healthy red blood cells into a sickle shape, they are less flexible, fragile and can cause occlusions.
Can cause tissue infarcts
Blood to become more viscious
Acute chest syndrome (Cause of death)
Low oxygen levels
Iron is used for Sickle-Cell Anemia, what is the daily dose required?
If cause not from blood loss then usual dosage if 180-200mg daily on an empty stomach
Given in divided doses
What are some side effects of iron?
Constipation or Diarrhea
Black tarry stools
What do you want to teach about iron?
Diet high in fiber
Absorption Inc when taken with Vitamin C
Tea dec absorption
The Blood types are A, B, AB, and O. What is the universal donor type and the universal recipient type?
Antigens in the blood at + or -
Universal Donor Type: O-
Anyone can receive O-
Universal Recipient: AB+
What are some reasons for blood transfusions?
Trauma (Hemorrhage, Blood Loss)
Surgery (Due to blood loss)
What do you want to do to cover your assets (Interventions) for a blood transfusion?
LOTTA LOTTA LOTS
Confirm compatibility (Must have 2 nurses to check pt is correct, blood is compatible, and dr order)
- Go to lab and Check blood bag label and requisition slip to each other (Type and cross is correct) Then initial, name, date and time on bag
-Go through process again at bedside
Check R number on band, against order, req slip and blood
Make sure it's not cloudy, no bubbles, no discoloration and the integrity of the bag
You have 30 min to initiate blood from time it is taken from the bank!!!
Assess VS again right before starting, As soon as blood hits the vein, then 15 min.
Monitor for the first 15-30 minutes
(That's when severe reactions occur; S&S of reaction: flank pain, SOB, anxiety, itching)
Start at a slow rate, at 15 min mark we can bump up the rate if no reaction has occured
Hemolytic Transfusion Reaction Pg. 901
If life threatening STOP transfusion IMMEDIATELY and flush line
Do not shake the bag
Do not alow blood to hang for more than 4 hours
Access vein with large bore needle (20g is smallest)
Blood tubing (bc filter is present) - Prime with NS
Have informed consent
Check vital signs before transfusion (make sure stable and set a baseline)
Get proper equipment
Assess Lung sounds for crackles due to fluid volume overload (HOB up, O2, fan)
What is Agranulocytosis?
Failure of the bone marrow to make WBCs
Caused by autoimmune, chemo and some meds
Destruction or inadequate production of neutrophils.
Are powerful when fighting an injury
Eat (phagocytosis) harmful bacteria
neutrophil count needs to be higher than 500/mm3
@ Risk for Infection - Neutropenia Precautions
What are the signs and symptoms of agranulocytosis?
(Flu Like Symptoms)
What is considered acute blood loss and what are the signs and symptoms?
A rapid loss of 500-1000 ml due to accident, hemorrhage or surgery
Cool & moist, Inc heart rate, Low BP
Later Signs: Dec H&H
What are some interventions for acute blood loss?
STOP the bleeding!! Apply pressure PRN
LR (Fluid Volume Expander)
Evaluate loss stopped or shock prevented
(S&S of shock: Pallor, diaphoretic, Inc HR, Dec Bp)
Intervent for shock: Flat with legs elevated or trendelenburg
What is aplastic anemia?
CAN BE LIFE THREATENING OR CRITICAL
It's a reduction in RBC, WBC and platelet
D/T Bone marrow depression
50-66% of cases are idiopathic
Can be sudden or gradual onset
Assess for CBC, neutropenic precautions, assess RBC's and bleeding time
Bone marrow aspiration biopsy is a diagnostic done for aplastic anemia, what is it and what are some teachings?
Removal and exam of tissue from the body to detect diseases/malignancies
Most common sites are the Illiac crest or sternum
Removing the cause
Prevention of Infections
Bone marrow transplants
Need for O2 & rest
What are some interventions for aplastic anemia?
What is Erythrocytosis (Polycythemia vera)?
An abnormally Dec HCT & HGB
> 55% HCT and HGB up to 18-25
Increased RBC, WBC, platelets
S&S related to GOUT
Blood is hyperviscious
Can have blood clots or bleeding tendencies (All of the platelets are attracted to clot so bleeding tendencies)
Can be fatal in 2 years if left untreated
What is the primary and secondary cause of erythrocytosis (polycythemia vera)?
Neoplastic disease (Bone marrow cells will be atypical)
Compensatory reaction usually to prolonged hypoxia. Depends on erythropoietin stimulation
What are some assessments for pylycythemia vera?
Assess for bleeding tendencies, thrombosis, readily clots, sluggish blood flow due to viscosity
Superficial vein distention
Amost always hypertensive
Dark red or flushed face
Purple mucous membranes
Tissue and organs congested with blood
What are some interventions for polycythemia vera?
Pheresis - Withdrawal whole blood and take out RBC's and put back in all the other stuff
Therapeutic phlebotomies (not suitable for donorship)
Dec Iron intake
Avoid tight fitting clothes
Ultimately need cytotoxic drugs/myelosuppressive agents and radiation treatment
What is the pathophysiology for Anemia?
Transport of O2 is decreased
Cardiac output is increased
How do you diagnose pernicious anemia?
Measures the Vit B12 in the urine after given radioactive B12
What is a test for Sickle Cell Anemia?
Detects Cell Destruction
Want 0.5-5.0% of total blood
What is an autologous transfusion?
Your own blood
Taken and infused at later time
Thrombocytopenia, What is it?
The platelets are not being produced or there is an increase breakdown in bloodstream or spleen and liver
# of platelets are lower
Can be due to chemo, radiation or viral infection
If less than 20,000 = LIFE THREATENING
What are you going to assessfor thrombocytopenia?
Hx of recent infections
What are you going to do (Interventions) thrombocytopenia?
Aim at minimizing the injury
Dcument the prescense/severity of bleeding, petechiae, purpura, ecchymosis, hematuria, epistaxix