blood comp pptf

7/31/2019 Blood Comp Pptf

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Khyber Medical University

Subject: Adult Health Nursing

Topic: Blood Composition And Different Types Of

Anemias

Prepared by: Awal Sher Khan

Irum Afsar Ali

M. Aurang Zeb


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Objectives

At the end of this presentation the students will be

able to:

Define blood and its composition.

Define anemia and identify different types ofanemia.

Enlist causes, signs, symptoms and complications of

different types of anemia.

Discuss medical diagnosis and treatments for

different types of anemia.

Make nursing diagnosis and nursing interventions for

anemia.


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Blood Blood is a specialized bodily fluid in humans and

other animals that delivers necessary substances

such as nutrients and oxygen to the cells and

transports metabolic waste products away fromthose same cells.


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Composition of Blood

Consists of blood cells (45%) suspended & carried in

plasma (55%).

Total blood volume is about 5-6L.

Plasma is straw-colored liquid consisting of H20 (90%) &

dissolved solutes

Includes ions, metabolites, hormones, antibodies and

plasma proteins.

13-7


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Formed Elements

Formed elements are erythrocytes (RBCs) &leukocytes (WBCs) and platelets(thrombocytes).

Red Blood Cells (Erythrocytes)

o RBCs are flattened biconcave discs. It

accounts for 4-6 million per mm3 of the ofthe total blood cells. Lifespan is 120 days.

Shape provides increased surface areafor diffusion.

Lack nuclei & mitochondria.

Each RBC contains 280 millionhemoglobins.

Transport oxygen as well as smallamount of carbon dioxide.


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Leukocytes (WBCs)

WBCs account for 4000-11000 of the total bloodcells.

WBCs have nucleus, mitochondria, & amoeboid

ability. Can squeeze through capillary walls (diapedesis).

WBCs form a protective, movable army that helps

defend the body against damage by pathogens and

tumor cells.

Lifespan is 3-7 days.

13-10


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Types of leukocytes There are two main types of leukocytes:

Granulocytes

Agranulocytes


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Granulocytes

These are granules containing WBCs. They havelobed nuclei , which typically consist of several

rounded nuclear areas connected by thin strands of

nucleus.

Granular leukocytes help detoxify foreign substances& release heparin and histamine.

Include eosinophils (1-4%), basophils (0-1%), &

neutrophils (40-70%).


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Platelets (thrombocytes)

Are smallest of formed elements, lacknucleus

Are fragments of megakaryocytes;amoeboid

Constitute most of mass of blood clots Release serotonin to vasoconstrict &

reduce blood flow to clot area

Secrete growth factors to maintain

integrity of blood vessel wall

Survive for 5-9 days.


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Anemia

Definition:A reduction in the quantity in the oxygen

carrying pigment hemoglobin in the blood

characterized by excessive tiredness, fatigue, pallor

and poor resistance to infection is called anemia.


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Types Of Anemia Iron deficiency Anemia

Pernicious Anemia

Hemolytic Anemia

Aplastic Anemia

Folic acid deficiency Anemia

Sickle cell Anemia.


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Iron Deficiency Anemia When our body does not have enough iron, it will

make fewer red blood cells or red blood cells that are

too small. This is called iron deficiency anemia.

Iron deficiency anemia is the most common formof anemia.


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Etiology

Blood loss due to:o Heavy, long, or frequent menstrual periods

o Cancer in the esophagus, stomach, or colon

o Esophageal varices

o The use of aspirin, ibuprofen, or arthritis medicinesfor a long time

o Peptic ulcer disease

Malabsorption of iron in the intestines due to:o Celiac disease

o Crohn's disease

Poor diet such as strict vegetarian.


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Signs and symptoms Feeling grumpy

Feeling weak or tired more often than usual, or withexercise

Headaches

Problems in concentrating or thinking Brittle nails

Pallor

Shortness of breath.

Sore tongue.

Dizziness.

Coldness in extremities.


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Diagnosis

Physical Exam.

Complete Blood Count.

Reticulocyte count.

Serum iron.


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Treatment

Dietary Changes and Iron Supplements

Vitamin C supplements.

Treatment To Stop Bleeding

Blood Transfusion for Severe Iron-Deficiency Anemia.


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Complications

Severe iron deficiency anemia can cause low oxygen

levels in vital organs such as the heart, kidneys and

can lead to a heart attack and kidney failure.


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Pernicious Anemia

Pernicious anemia is a type of vitamin B12 anemia.

The body needs vitamin B12 to make red blood cells.

this vitamin is got from eating foods such as meat,

poultry, shellfish, eggs, and dairy products. A special protein, called intrinsic factor, helps our

intestines to absorb vitamin B12.

This protein is released by cells in the stomach.When the stomach does not make enough intrinsic

factor, the intestine cannot properly absorb vitamin

B12.


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Signs and Symptomso Fatigue

o Loss of appetite

o Pale skin

o Problems concentrating

o Shortness of breath, mostly during exercise

o Swollen, red tongue or bleeding gums

o Diarrhea or constipation


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Diagnosis

Physical exam.

Bone marrow examination.

CBC

Hgb level

Reticulocyte count

Schilling test

LDH (lactate dehydrogenase test)

Vitamin B12 level


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Complications

Gastric polyps.

Gastric cancer and gastric carcinoid tumors.

Brain and nervous system problems may continue or

be permanent if treatment is delayed.


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Hemolytic anemia Hemolytic anemia is a condition in which there are

not enough red blood cells in the blood, due to the

premature (Before 120 days) destruction of red

blood cells.


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Etiology

Hereditary.

Immune disorders

Infections

Reactions to medicines or blood transfusions

Hypersplenism


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Signs and Symptoms Chills

Dark urine

Enlarged spleen

Fatigue

Fever

Pale skin color (pallor)

Rapid heart rate

Shortness of breath

Yellow skin color (jaundice)


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Diagnosis

Reticulocyte count.

Free hemoglobin in the serum or urine.

Red blood cell count (RBC).

Hemoglobin level , and hematocrit (HCT).

Serum LDH(105-333 IU/L).


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Treatment

Blood Transfusions

Corticosteroid medicines, such as prednisone, can

stop immune system from, or limit its ability to,

make antibodies (proteins) against red blood cells. Plasmapheresis.

Surgery: Some people who have hemolytic anemia

may need surgery to remove their spleens.

Blood and Marrow Stem Cell Transplant.


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Complications

Severe hemolytic anemia can cause cardiovascular

collapse (failure of the heart and blood pressure,

leading to death).

Severe anemia can worsen heart disease, lungdisease, or cerebrovascular disease.


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Folic acid deficiency anemia Folic acid deficiency anemia happens when your

body does not get enough folic acid. Folic acid is one

of the B vitamins, and it helps your body make new

cells, including new red blood cells


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Etiology

Poor folic acid diet.

Being pregnant or have some medical problems,

such as sickle cell disease.

Malabsorption of folic acid in the gut.

Certain medicines, such as some used

for cancer, rheumatoid arthritis, and seizures.


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Signs and Symptoms Feel weak and tired.

Feel lightheaded.

Be forgetful.

Feel grouchy.

Lose of appetite and weight lose.

Problems in concentrating.


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Diagnosis

Physical examination.

Complete blood count.

Hgb level.

Folic acid level.

Vitamin B12 level.


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Treatment

To treat the anemia, take folic acid pills each day to

bring folic acid level back up.

After folic acid level is normal, eat foods rich in folic

acid so we don't get anemia again. These foodsinclude fortified breads and cereals, citrus fruits, and

dark green, leafy vegetables.


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Aplastic Anemia Aplastic anemia is a blood disorder in which the

body's bone marrow doesn't make enough new

blood cells. Bone marrow is a sponge-like tissue

inside the bones. It makes stem cells that developinto red blood cells, white blood cells, and platelets.


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Etiology

Many diseases, conditions, and factors can cause

aplastic anemia, including:

Toxins, such as pesticides, arsenic, and benzene.

Radiation and chemotherapy (treatments for cancer). Medicines, such as chloramphenicol.

Infectious diseases, such as hepatitis and HIV.

Autoimmune disorders, such as lupus andrheumatoid arthritis.

Hereditary.


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Signs and Symptoms Fatigue (tiredness)

Shortness of breath

Swelling or pain in the abdomen or swelling in the

legs caused by blood clots Blood in the urine

Headaches

Jaundice (a yellowish color of the skin or whites ofthe eyes)

Irregular heartbeat

Heart murmur


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Diagnosis Physical Exam

Complete Blood Count

Reticulocyte Count

Bone Marrow Tests

Biopsy of bone marrow


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Treatment

Blood Transfusions

Blood and Marrow Stem Cell Transplants

Medicines to:

o Stimulate bone marrow (erythropoietin)

o Suppress your immune system (antithymocyte

globulin (ATG), cyclosporine, and

methylprednisolone)o Prevent and treat infections (antibiotic and antiviral

medicines)


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Sickle Cell Anemia Sickle cell anemia is a serious disorder in which the

body makes sickle-shaped red blood cells. Sickle-

shaped means that the red blood cells are shaped

like a crescent.

Sickle cells contain abnormal hemoglobin called

sickle hemoglobin. Sickle hemoglobin causes the

cells to develop a sickle, or crescent, shape.

This occur because amino acids glutamine is in thebeta chain of hgb is replaced by amino acid valine.


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Etiology

Sickle cell anemia is an inherited disease. People whohave the disease inherit two genes for sickle

hemoglobinone from each parent.


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Signs and Symptoms Shortness of breath

Dizziness

Headaches

Coldness in the hands and feet Paler than normal skin or mucous membranes

Jaundice (a yellowish color of the skin or whites ofthe eyes)

Fatigue

Pain throughout the body.


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Diagnosis

Complete blood count (CBC)

Hemoglobin electrophoresis

Sickle cell test

Other tests may include:

o Blood oxygen

o CT scan or MRI

o Peripheral smearo Serum creatinine

o Serum hemoglobin.


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Treatment The goal of treatment is to manage and control

symptoms, and to limit the number of crises.

Folic acid supplements should be taken. Folic acid is

needed to make red blood cells. Treatment for a sickle cell anemia includes:

Blood transfusions (may also be given regularly to

prevent stroke)

Pain medicines

Plenty of fluids


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Cont. Other treatments for sickle cell anemia may include:

Hydroxyurea (Hydrea), a medicine that may help

reduce the number of pain episodes (including chest

pain and difficulty breathing) in some people Antibiotics to prevent bacterial infections, which are

common in children with sickle cell disease


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Complications

Blindness/vision impairment

Brain and nervous system symptoms and stroke

Death

Disease of many body systems (kidney, liver, lung)

Erectile dysfunction (as a result of priapism)

Gallstones

Hemolytic crisis

Infection, including pneumonia, cholecystitis, bone

infection (osteomyelitis), and urinary tract infection

Loss of function in the spleen

Tissue death in the kidney


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Nursing diagnosis Activity intolerance related to weakness, fatigue, and

shortness of breath.

Imbalanced nutrition less than body requirementsrelated to anorexia.

Risk for impaired skin integrity related todecreased mobility, bed rest and tissue hypoxia.

High risk of infection related to an inadequatesecondary defenses or a decrease in granulocytes

(inflammatory response depressed)). Constipation or diarrhea related to decreased dietary

inputs secondary to changes in the digestive process.


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Nursing interventions

Monitor vital signs, color of skin, mucousmembranes.

Administer medication such as vitamins and mineral

supplements. Suggest the patient for balanced diet, avoiding hard

and spicy foods.

Provide oxygen as needed.

Assess the capability of the patient to

ingest nutrients or any other barriers such

as being lactose intolerant or has a pancreatic

disease.


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Cont.

Encourage intake of folic acid supplements. Assist the patient in the activities of daily living.

Note changes in balance/ gait disturbance, muscle

weakness to indicate neurological changesassociated with vitamin B12 deficiency, affecting

patient safety or risk of injury.

Elevate the head of the bed to enhances lung

expansion to maximize oxygenation for cellularuptake.

Explain necessity for bone marrow aspiration and

biopsy for definitive diagnosis.


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References

Lee MT, Piomelli S, Granger S, et al. Strokeprevention trial in sickle cell anemia (STOP):

extended follow-up and final results. Blood.

2006;108:847-852.

Brawley OW, Cornelius LJ, Edwards LR, Gamble VN,Green BL, Inturrisi C, et al. National Institutes of

Health consensus development conference

statement: hydroxyurea treatment for sickle cell

disease.Ann Intern Med. 2008;148:932-938.

Geller AK, O'Connor MK. The sickle cell crisis: a

dilemma in pain relief. Mayo Clin Proc. 2008;83:320-

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