Download - Hematology III
RBC DisordersRBC Disorders
Decreased Production of RBC Decreased Production of RBC – Iron Deficiency AnemiaIron Deficiency Anemia– Vitamin B12 Deficiency AnemiaVitamin B12 Deficiency Anemia– Folic Acid Deficiency AnemiaFolic Acid Deficiency Anemia– Aplastic AnemiaAplastic Anemia
Fe Deficiency AnemiaFe Deficiency Anemia
Common world wideCommon world wide Affects 10-30% of population in USAffects 10-30% of population in US Common in premenapausal woman, Common in premenapausal woman,
infants, children, adolescents, & infants, children, adolescents, & elderlyelderly
Develops slowlyDevelops slowly
A&PA&P
Occurs when supply of Fe is too low Occurs when supply of Fe is too low for optimal RBC formationfor optimal RBC formation
Iron RDAIron RDA– 10mg/d M, 10mg/d M, – F 12-49 15 mgF 12-49 15 mg– Typical American diet provides 10 to 20 Typical American diet provides 10 to 20
mg/dmg/d– Many woman consume only 12.4mg/dMany woman consume only 12.4mg/d
Cause of DevelopmentCause of Development
Inadequate absorption or excess Fe lossInadequate absorption or excess Fe loss Inadequate dietary intake of foods high in Inadequate dietary intake of foods high in
FeFe Principal cause in adults acute or chronic Principal cause in adults acute or chronic
bleedingbleeding Secondary to traumaSecondary to trauma Excessive mensesExcessive menses GI bleedingGI bleeding Blood donationBlood donation
DiagnosticsDiagnostics
Hgb Panic value < 5g/dlHgb Panic value < 5g/dl Hgb level can drop to 3.6g/dlHgb level can drop to 3.6g/dl Total RBC count rarely below 3 Total RBC count rarely below 3
million/dlmillion/dl MCH < 27 pgMCH < 27 pg MCHC 20 to 30 g/dlMCHC 20 to 30 g/dl Serum Fe as low as 10mcg./dlSerum Fe as low as 10mcg./dl
DiagnosticsDiagnostics
HCT < 47 ml/dl MHCT < 47 ml/dl M HCT < 42 ml/dl FHCT < 42 ml/dl F Fe binding capacity Fe binding capacity Serum ferritin level Serum ferritin level Bone marrow may also be indicatedBone marrow may also be indicated
SymptomsSymptoms
Pallor, glossitisPallor, glossitis Dizziness, irritability, numbness & Dizziness, irritability, numbness &
tingling in limbs, fatigue, decreased tingling in limbs, fatigue, decreased concentrated & HAconcentrated & HA
Tachycardia & dyspnea on exertionTachycardia & dyspnea on exertion Sensitivity to cold, brittle hair & nailsSensitivity to cold, brittle hair & nails Atrophic glossitis, stomatitis, Atrophic glossitis, stomatitis,
dysphagiadysphagia
TreatmentTreatment
Diet high in Fe rich foodsDiet high in Fe rich foods– Red meats, organ meats, kidney beans, Red meats, organ meats, kidney beans,
whole-wheat products, spinach, egg whole-wheat products, spinach, egg yolks, carrots & raisinsyolks, carrots & raisins
TreatmentTreatment
Hematinic agentsHematinic agents– Ferrous Sulfate (Feosol) 0.2 g tid with Ferrous Sulfate (Feosol) 0.2 g tid with
mealsmeals– Ferrous Gluconate (Fergon) 0.3 g bidFerrous Gluconate (Fergon) 0.3 g bid– Oral irritating to GI mucosa, GI upset, Oral irritating to GI mucosa, GI upset,
nausea, etc. blackish green stool, nausea, etc. blackish green stool, contraindicated in PUD, inflammatory contraindicated in PUD, inflammatory bowel diseasebowel disease
– Liquid preparation taken mixed with H2O Liquid preparation taken mixed with H2O or juice & sipped thought straw or juice & sipped thought straw
TreatmentTreatment
Hematinic agentsHematinic agents– Iron-dextan (Imferon) 100 to 250 mg/dIron-dextan (Imferon) 100 to 250 mg/d– Ascorbic acid as indicatedAscorbic acid as indicated– Deep IM use Z-track to prevent Deep IM use Z-track to prevent
subcutaneous irritation & discoloration subcutaneous irritation & discoloration from leaking medfrom leaking med
– Can be given IV to pregnant or elderly Can be given IV to pregnant or elderly with severe Fe deficiency anemiawith severe Fe deficiency anemia
TreatmentTreatment
Side effects: Nausea, constipation, Side effects: Nausea, constipation, epigastric pain, black & red tarry epigastric pain, black & red tarry stools,stools,
Contraindicated with hypersensitivity, Contraindicated with hypersensitivity, ulcerative colitis/regional enteritis, ulcerative colitis/regional enteritis, peptic ulcer disease, hemolytic peptic ulcer disease, hemolytic anemia, cirrhosisanemia, cirrhosis
absorption with antiacids, absorption with antiacids, cimetidine, cholestramine, Vit E, dairy cimetidine, cholestramine, Vit E, dairy products, caffeine, eggs products, caffeine, eggs
TreatmentTreatment
False positive occult bloodFalse positive occult blood Toxicity: nausea, vomiting, diarrhea, Toxicity: nausea, vomiting, diarrhea,
hematemesis, pallor, cyanosis, hematemesis, pallor, cyanosis, shock, comashock, coma
Over dose: Diarrhea, fever severe Over dose: Diarrhea, fever severe stomach pain, nausea, vomitingstomach pain, nausea, vomiting
Fe binding Agent DeferoxamineFe binding Agent Deferoxamine
Nursing CareNursing Care
Oral hygiene & dental careOral hygiene & dental care Preventing irritations & infections in oral Preventing irritations & infections in oral
cavitycavity Nail & hair & hygieneNail & hair & hygiene Assist with maintenance proper diet Assist with maintenance proper diet Fe supplementFe supplement Aware of changes in stoolAware of changes in stool Safety to prevent fallsSafety to prevent falls
Folic Acid DeficiencyFolic Acid Deficiency
Vitamin B complexVitamin B complex Seen in alcoholism, malabsorption Seen in alcoholism, malabsorption
syndromes, and pregnancysyndromes, and pregnancy Most prevalent in infants, Most prevalent in infants,
adolescents, pregnant & lactating adolescents, pregnant & lactating females, alcoholics & elderlyfemales, alcoholics & elderly
Increase incidence in drug use and Increase incidence in drug use and pregnancypregnancy
Food SourcesFood Sources
Found in asparagus spears, beef Found in asparagus spears, beef liver, broccoli, collards, mushrooms, liver, broccoli, collards, mushrooms, oatmeal, peanut butter, red beans, oatmeal, peanut butter, red beans, wheat germwheat germ
Clinical ManifestationsClinical Manifestations
Develop slowly over a period of Develop slowly over a period of monthsmonths
Symptoms related to tissue hypoxiaSymptoms related to tissue hypoxia GlossitisGlossitis JaundiceJaundice Splenomegaly Splenomegaly
TreatmentTreatment
Administer folic acid every day until Administer folic acid every day until deficiency is correcteddeficiency is corrected
High dises to patients with High dises to patients with malabsorption problemsmalabsorption problems
Folvite ; adults 250 to 1,000 mcg/d Folvite ; adults 250 to 1,000 mcg/d until hematological responses until hematological responses increasesincreases
Maintainance 400 mcg/day X 2Maintainance 400 mcg/day X 2
Aplastic AnemiaAplastic Anemia
Inherited, but can be acquired from Inherited, but can be acquired from chemical exposure or radiationchemical exposure or radiation
Failure of bone marrow to produce Failure of bone marrow to produce adequate amounts of RBCs, adequate amounts of RBCs, leukocytes, & plateletsleukocytes, & platelets
PancytopeniaPancytopenia Usually seen in young individual, Usually seen in young individual,
median age 25 yearsmedian age 25 years
Aplastic Anemia, cont.Aplastic Anemia, cont.
BM supression, detruction or aplasia BM supression, detruction or aplasia resulting in failure of BM to produce resulting in failure of BM to produce adequate # stem cellsadequate # stem cells
Clinical manifestationsClinical manifestations
FatigueFatigue DyspnesDyspnes Multipel infectionsMultipel infections temperaturetemperature HeadacheHeadache WasknessWaskness AnorexiaAnorexia GingivitisGingivitis
Epistaxia Epistaxia PurpraPurpra PetechiaePetechiae EcchymosisEcchymosis PallorPallor PalpitationsPalpitations TachycardiaTachycardia TachypnesTachypnes MelenaMelena
Diagnostic TestsDiagnostic Tests
Prepheral blood smearPrepheral blood smear– pancytopeniapancytopenia
HemtoaplogyHemtoaplogy granulocutes, thrombocytes, RBCgranulocutes, thrombocytes, RBC
Stool for occult bloodStool for occult blood– positivepositive
Uring chemistryUring chemistry– hematuriahematuria
Bone Marrow biopseyBone Marrow biopsey– Fatty narrwo with Fatty narrwo with of stem cells of stem cells
Treatment of Aplastic Treatment of Aplastic AnemiaAnemia
Blood transfusion for disabled or Blood transfusion for disabled or bleeding thrombocytopeniableeding thrombocytopenia
Immunosuppressants for individual Immunosuppressants for individual with disease causes similar to with disease causes similar to autoimmune problemsautoimmune problems
Antilymphocyte globim (ALG)Antilymphocyte globim (ALG) Antihymocyte globin (ATG)Antihymocyte globin (ATG) Cyclosporine (Sandimmune0Cyclosporine (Sandimmune0
TreatmentTreatment
For severe, general For severe, general immunosuppression agentsimmunosuppression agents– Prednisone % cylophosphamidePrednisone % cylophosphamide
Splenectomy; considered in clients Splenectomy; considered in clients with enlarged spleenwith enlarged spleen– Either destroying normal RBC’s or Either destroying normal RBC’s or
suppressing their developmentsuppressing their development BMT replaces defective stem cellsBMT replaces defective stem cells
– Cure for some patientsCure for some patients
RBC DisordersRBC Disorders
Hyperplasia of bone marrow results Hyperplasia of bone marrow results in in production production
Overproduction results in Overproduction results in blood blood viscosity, viscosity, total blood volume, & total blood volume, & severe congestion of all organs & severe congestion of all organs & tissuestissues
PolycythemiaPolycythemia
Myeloproliferative disorder that Myeloproliferative disorder that results in the increaed productions ofresults in the increaed productions of– ErthrocytesErthrocytes– HemoglobinHemoglobin– MyelcytesMyelcytes– ThrombocytesThrombocytes
Polycythemia VeraPolycythemia Vera
Hyperplasia of the bone marrow Hyperplasia of the bone marrow results in increased productionresults in increased production
Overproduction results inincreased Overproduction results inincreased blood viscosity, increased total blood blood viscosity, increased total blood volume, & severe congestion of all volume, & severe congestion of all organs & tissuesorgans & tissues
Clinical ManifestationsClinical Manifestations
Ruddy complexionRuddy complexion Dusky mucosaDusky mucosa VertigoVertigo HeadachesHeadaches Dyspnea & Dyspnea &
orthopneaorthopnea TachycardiaTachycardia EcchymosisEcchymosis
Heaptomaeglay & Heaptomaeglay & spelnomegalyspelnomegaly
gastric secretionsgastric secretions Weakness & Weakness &
fatiguefatigue PururitusPururitus EpistaxisEpistaxis GI bleedingGI bleeding AnginaAngina
Diagnostic TestsDiagnostic Tests
Blood ChemistriesBlood Chemistries UA, unconjugated bilirubin, vitamine B12, UA, unconjugated bilirubin, vitamine B12,
alkaline phosphatase, SGOT, SGPT, LDHalkaline phosphatase, SGOT, SGPT, LDH HematologyHematology
RBCs, WBCs, platelets, Hct, Hgb, RBCs, WBCs, platelets, Hct, Hgb, Bone Marrow biopsyBone Marrow biopsy
# of immature cells forms, # of immature cells forms, Fe in marrow Fe in marrow Urine chemistryUrine chemistry
– hematuriahematuria
ManagementManagement
Soft diet, low FeSoft diet, low Fe AntacidsAntacids Histamine antagonistsHistamine antagonists AntigoutAntigout Radioactive phosphorus (P32)Radioactive phosphorus (P32) PhlebotomyPhlebotomy MyelosuppressantsMyelosuppressants