Anemia

Normal reticulocyte count

.5 - 2.5%

What is anemia?

A hemoglobin (Hb) of less than 120 g/L in women and less than 140 g/L in men

What would put someone at risk for deficiency of B12?

Anything that attacks levels intrinsic factor (gastritis, gastric bypass, autoimmune disease that attacks intrinsic factor)

Normocytic anemias

Bleeding (acute/chronic) Impaired production (CKD, Aplastic anemia/pancytopenia) Hemolytic anemia Hemodilution in later stages of pregnancy

What does the red pulp of spleen do?

Filters blood Stores erythrocytes, platelets, and leukocytes (phagocytes) Phagocytes help with heme reabsorption

why is the spleen important?

Filters out old RBCs and introducing them to macrophages that help digest RBCs so we can reuse raw materials also important immune system organ highly vascular

What is folic acid's relationship to RBCs?

Folic acid is needed to produce heme for hemoglobin. It is a necessary coenzyme.

Sign/symptoms of iron deficiency

Glossitis - "irritated tongue Pica Evaluate dentition (can this pt eat meat) Koilonychia (brittle or spoon shaped nails as a result of iron deficiency)

What is crucial for B12 absorption?

Intrinsic factor

Complications fo treatment

Iron causes constipation and/or GI upset and black stools Hypersensitivity to IV iron is not uncommon, PO route is preferred

What does the liver do with RBCs?

It digests biproducts of RBC breakdown It interacts with iron to make it usable It breaks down bilirubin

Mean corpuscular hemoglobin concentration (MCHC)

Low = hypochromic (lack of hemoglobin - usually anemia) High = hyperchromic

Some causes GI bleeds

PUD Gastritis Diverticulitis Maybe hemorrhoids Esophageal varisces Ulcerative collitis Crohn's disease

What does the white pulp of the spleen do?

Stores lymphocytes

Why do cells need B12?

To effectively perform mitosis

most common source of normocytic anemias?

bleeding disorders (GI bleeds)

Meds that can cause normocytic anemia

blood thinners NSAIDs (can cause gastritis and inhibit platelet function)

What are risks of hypovolemia

decreased perfusion --> hypoxia

Why are plasma proteins important?

for drug dosing sometimes b/c protein binding

What usually leads to microcytic anemia?

iron deficiency

A client has a low hemoglobin level that is attributed to a nutritional deficiency. Which foods should the nurse teach the clinent ot increase in the diet? SATA 1. liver 2. apples 3. carrots 4. cheese 5. spinach

liver and spinach are high in iron. The client needs iron for RBC production and hemoglobin - a low hemoglobin level --> client is anemic. Applies are high in fiber, carrots in vitamin A. Cheese is high in calcium. All three of these are low in iron.

Low Mean Corpuscular Volume

microcytic anemia

Anemic reticulocyte count

should see high reticulocyte count to show that body is compensating by making more RBCs

What is crucial for iron abosprtion?

Acidity of the stomach

What can iron deficiency result from?

- Dietary insufficiency (alcohol) - chronic blood loss depleting iron stores - poor GI absorption or malabsorption - increase in utilization: infancy, adolescence, pregnancy

Treatment for iron deficiency

- Increase dietary intake - iron supplement - ferrous sulfate - find source of bleeding - discontinue H2 clockers/PPI

Microcytic anemias

- Iron deficiency - Anemia of chronic disease (may be normocytic or microcytic) - Thalassemia

Hypochromic anemia

- Iron deficiency - anemia of chronic illness - thalassemia

What should we assess for anemia (specifically normocytic)?

- look for s/sx of bleeding - esp GI bleeds - meds that may predispose to bleeding - if acute bleed, assess for hypovolemia - Hx of CKD?

What is mean corpuscular hemoglobin (MCH)?

Average amount of hemoglobin per each RBC

What is Mean copuscular volume (MCV)>

Average volume of a red blood cell

Why are RBCs especially prone to malfunction if there are low B12 and folate levels?

B/c they are high turnover cells

Macrocytic anemias

B12 and folate deficiencies

What usually leads to macrocytic anemia?

B12 or folate deficiency

Testing for normocytic anemia

BMP to check creatinine CBC to check H&H Fecal Occult Blood Study EGD Reticulocyte count (should be elevated)

Aplastic anemias

CKD Failure of bone marrow Autoimmune disease

What type of anemia would you see jaundice skin/scleral icteris?

Hemolytic anemia Rapid breakdown of RBCs overwhelms liver's ability to excrete bilirubin

What would put someone at risk for iron deficiency?

If on H2 block receptors or PPI --> decreases acidity of stomach --> at risk for impaired iron absorption even if eating enough (GERD)

When performing a focused assessment on a client with a possible diagnosis of iron deficiency anemia, which locations would the nurse examine? SATA 1. Sclera 2. Nail beds 3. conjunctivae 4. palms of hands 5. bony prominences

Nail beds, conjunctivae, and palms of hands. Nail beds lose their pink coloration b/c of reduced hemoglobin. A reduced amount of hemoglobin deceases pink color of conjunctivae. Palms of hands will become pale b/c of the decreased hemoglobin.

Where are RBCs digested?

Spleen Hemoglobin is released

When caring for a client with iron-deficiency anemica,, which abnormal laboratory value will the nurse expect? 1. Macrocytic RBCs 2. Thrombocytopenia 3. Decreased folate levels 4. Increased total iron-binding capacity (TIBC)

TIBC may be elevated from 350 to 500 mcg/dL (expected range is 250-460) b.c more iron is being used to attempt to make more RBCs and less iron is bound to proteins that transport iron in the circulation. Iron deficiency causes microcytic RBCs. Platelet count is not decreased with iron-deficiency anemia. Folate deficiency would cause folate deficiency anemia, a macrocytic anemia