ANEMIA

Definition A decrease in the number of RBCs, the quantity of Hgb, and/or the volume of PRBCs (which is measured by Hct). It is not a disease, it is a symptom of a disease or condition Can lead to tissue hypoxia How do you know if someone has hypoxia?

Etiologies Inadequate production of RBCs Premature or excessive destruction of RBCs Acute or chronic blood loss Nutrition deficits Hereditary factors Chronic diseases

Types of Anemias Hypoproliferative—Inadequate production of RBCs Iron deficiency, aplastic anemia, B-12 deficiency, folic acid deficiency, renal dz, chronic inflammation, cancer, chemotherapy induced Hemolytic—Increased RBC destruction (usually hereditary) Thalassemia, G6PD Blood loss—Usually caused by trauma or an underlying condition or disease—can be slow or fast Acute: injury, PUD Chronic: metorrhagia, colon cancer, PUD

General Manifestations of Anemia Deficient oxygenation of tissues results in: Pallor Complaints of feeling cold Fatigue, shortness of breath Dizziness, headache, light-headedness, slowing of thought processes, irritability, restlessness, depression Increased cardiac workload manifested as tachycardia, palpitations, chest pain, and even CHF in those patients with weak myocardium.

Specific Manifestations and Complications Glossitis, chelitis, spoon-shaped nails, petechiae, chronic leg ulcers Tingling, numbness, confusion, ataxia Joint pain Mental retardation Hepatomegaly, splenomegaly Sudden hemorrhage, tachycardia, hypotension, murmurs, angina Injury from falls (bone deformities, fractures, fainting)

General Labs CBC (RBC and indices; H & H) Hgb electrophoresis (identifies abnormal forms of hemoglobin) Serum iron Serum ferritin Iron deficiency Iron-binding capacity Microscopic analysis—tells size/shape/color Schilling test or serum gastrin—B-12 deficiency Bone marrow examination

Microscopic Analysis Hemoglobin & Hematocrit Males—14-18 g/dL; 42-52% Females—12-16 g/dL; 37-47% NB—14-24; 44-64 2-6 mos 10-17; 35-50 RBC (values are approximate): males 4-6 females 4-5.5 Newborns 5-7 2-6 months 3.5-5.5

RBC Indices MCV—size MCH—average amount of Hgb in a cell Macrocytic (H): B12 or folic acid deficiency Microcytic (L): iron deficiency or Thalassemia MCH—average amount of Hgb in a cell Follows values for size MCHC—color (has to do with concentration) Hypochromic (L): iron deficiency or Thalassemia Normochromic (may read as H due to abnormal shape of cell): hemolytic anemia RDW—has to do with identifying a wide variation of sizes in the cells, indicating abnormal blood conditions

Treatments Depends on type of anemia identified Pharmacologic therapy—iron, folic acid, vitamin B-12 Improved nutrition—eggs, red meat, dark green leafies, dried fruit, fish, seafood, iron-fortified cereals and grains, bean family Blood transfusions Transplants

Nursing Assessment Ask about SOB, fatigue, weakness dizziness, syncope, palpitations, bleeding, menstrual hx, meds, chronic diseases, diet, ETOH and cigarettes Look at general appearance, skin color, VS, heart and lung sounds, pulses, cap refill, abdominal tenderness, pain, bleeding, bruising

Nursing Diagnoses Activity Intolerance Altered Oral Mucous Membranes Self-Care Deficit Decreased Cardiac Output Fatigue Deficient fluid volume Impaired gas exchange Risk for injury Impaired physical mobility Ineffective tissue perfusion Imbalanced nutrition

Nursing Management Direct general management toward addressing the cause of anemia and replacing blood loss as needed to sustain adequate oxygenation Promote optimal activity and protect from injury Reduce activities and stimuli that cause tachycardia and increase cardiac output Provide for nutritional needs Provide teaching

Client Education Organize activities with rest periods Identify situations that cause palpitations, dyspnea Explain the need to ensure adequate oxygenation Drink at least 2-3 liters of fluid a day Instruct the client to report signs of fluid retention, paresthesias, poor coordination, ataxia and confusion Discuss dietary requirements and meds Encourage a well balanced diet Advise the client to avoid alcoholic beverages and spicy foods Explain the need for ongoing lab tests and treatment

Specific Anemias Iron deficiency Vit B-12 deficiency Folic acid deficiency Hypoproliferative Anemia of chronic dz (renal, cancer, inflammation) Aplastic Thalassemia Hemolytic Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)

Fe Deficiency Most common Usually from inadequate diet or blood loss Smooth, sore tongue Brittle nails Angular cheilosis Pica Low ferritin, microcytic RBCs

Ferrous Sulfate Action: Replaces iron stores needed for RBC development, energy, and O2 transport Dosage: po 750-1500 mg/d; IV 125 mg in 100 mL over 1h; requires IV push test dose first. SE: Nausea, constipation, epigastric pain, black stools Nursing: If giving IV, give IVP test dose first to assess for reactions. If giving IM, give Z-track in large muscle. Education: (Related to po route only) Take tabs whole, between meals with juice. If upset occurs, take after meals. Do not take with antacids or milk. Drink liquid through straw. Store in tight, light resistant container. Stools will turn black. Do not substitute one type with another. Take 1h before lying down. Eat iron-rich foods.