Ch 33 Nonmalignant hematologic disorders

The overall prevalence of anemia increases with age from __________________% aged 65-69 __________________% over aged 85

4-6% 65-69 13-14% over 85

A rare disease caused by a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, or replacement of the marrow within fat

Aplastic anemia

may be caused by certain medications, chemicals, or radiation damage. Agents that may produce marrow aplasia include benzene and benzene derivatives (e.g., airplane glue, paint remover, dry-cleaning solutions). Certain toxic materials, such as inorganic arsenic, glycol ethers, plutonium, and radon, have also been implicated as potential causes.

Aplastic anemia

A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following

Decreased level of erythropoietin Explanation: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

severe hemolyic anemia that results from inheritance of the sickle cell gene which causes the hemoglobin molecule to be defecive

Sickle cell anemia

S/S Petechiae, Purpura, Ecchymoses, Hemorrhage

Thrombocytopenia

A condition in which the hemoglobin concentration is lower than normal reflecting the presence of fewer than the normal number of erythrocytes

anemia

______________ and _________________ should not be taken with iron preperations because they greatly deminish the absorbtion of iron

antacids and dairy products

General complications of severe anemia include

heart failure, paresthesias, delerium

A controversial treatment for DIC that interupts the thrombosis process

heparin infusin

A _________________ assessment should be performed for patients with known megaloblastic anemia

neurologic

A healthy person can tolerate as much as ________% gradual reduction in hemoglobin without pronounced symptoms or incapacity

50%

anemias caused by deficiencies of vitamin B12 or folic acid, identical bone marrow and peripheral blood changes occur because both vitamins are essential for normal DNA synthesis. In either case, the erythrocytes that are produced are abnormally large and called megaloblastic red cells.

Megaloblastic Anemias

S/S Tissue hypoxia GI: sore tongue, anorexia, NV Neuromuscular: weakness, paresthesias (hand and feet), decreased position sense, ataxia, impaired thought process

Pernicious Anemia

fatigue, pallor, dyspnea. Purpura (bruising) may develop later and should trigger a CBC and hematologic evaluation if these were not performed initially. If the patient has had repeated throat infections, cervical lymphadenopathy may be seen. Other lymphadenopathies and splenomegaly sometimes occur. Retinal hemorrhages are common.

manifestations of aplastic anemia

chronic use of ___________ to reduce gastric acid production can inhibit B12 absorbtion as can the use of ___________ in managing diabetes.

proton pump inhibitors (PPI's), and metformin (glucophage)

assessment of patients who have or are at risk for megaloblastic anemia includes inspection of

skin, mucous membrane, tounge

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

B12 Correct Explanation: The hematologic effects of vitamin B12 deficiency are accompanied by effects on other organ systems, particularly the gastrointestinal tract and nervous system. Patients with pernicious anemia may become confused; more often, they have paresthesias in the extremities (particularly numbness and tingling in the feet and lower legs). They may have difficulty maintaining their balance because of damage to the spinal cord, and they also lose position sense (proprioception).

Which of the following is a symptom of Hemochromatosis

Bronzing of the skin Explanation: Patients with Hemochromatosis exhibit symptoms of weakness, lethargy, arthralgia, weight loss, and loss of libido early in the illness trajectory. The skin may appear hyperpigmented from melanin deposits or appear bronze in color.

A patient with disseminated intravascular coagulation (DIC) has a critically low fibrinogen level and is beginning to hemorrhage. To increase the amount of fibrinogen in the body, the nurse anticipates administering which one of the following blood products

Cryoprecipitate Explanation: Cryoprecipitate is given to replace fibrinogen and factors V and VII

Which of the following are immunosuppressants that prevent the patient's lymphocytes from destroying the stem cells in a patient diagnosed with aplastic anemia

Cyclosporine • Corticosteroids • ATG • Cyclophosphamide Explanation: Immunosuppressants, including cyclosporine, corticosteroids, ATG, and cyclophosphamide, prevent the patient's lymphocytes from destroying the stem cells. Filgrastim is a growth-colony stimulating factor that may be used to decease the duration and severity of neutropenia associated with aplastic anemia.