CHA: blood labs, Sickle Cell, Anemia

27-31

Normal range for the MCH, or mean corpuscular hemoglobin

bilirubin

What is the iron from lysed red blood cells changed into?

120 days

What is the lifespan of a red blood cell?

pain

What is the major symptom that occurs with a sickling crisis?

fatigue

What is the most common manifestation of anemia regardless of cause?

d

What is the pathologic mechanism of hemolytic anemia? a. Decreased intake of iron. b. Decreased bone marrow production of red blood cells. c. Increased (excessive) demand for oxygen. d. Increased rate of red blood cell destruction.

infection, bleeding, and anemia

What major problems are patients with aplastic anemia at risk for?

kidneys

What organ responds to a lower than normal oxygen concentration in the blood by releasing the hormone erythropoietin? It does so at the same rate of RBC destruction or loss to maintain a normal number of circulating RBC's

globin

What portion of hemoglobin carries CO2?

Liver

What removes bilirubin from the blood?

c

A school-age child is admitted to the hospital with a sickle cell crisis. Which measure in his care should be given priority? a. Beginning of active range of motion exercises. b. Seeing that he ingests a protein-rich diet. c. Maintaining a fluid intravenous line. d. Encouraging him to take deep breaths hourly.

marcocytic

(megaloblastic anemias) the cell is larger than normal

a

A client with a history of sickle cell anemia begins to complain of pain. The nurse suspects that the client is going to into sickle cell crisis because of the pain, which signals: a. vasoocclusion by sickled cells. b. viscosity of the blood. c. spasms caused by thickened blood. d. cells in the marrow causing bone pain.

possible iron deficiency anemia, hemorrhage

A decrease in Iron levels can indicate......

d

A nursing diagnosis that is appropriate for patients with moderate to severe anemia of any etiology is a. impaired skin integrity r/t edema and pruritus. b. disturbed body image r/t changes in appearance and body function. c. imbalanced nutrition: less than body requirements related to lack of knowledge of adequate nutrition. d. activity intolerance r/t decreased hemoglobin and imbalance between oxygen supply and demand.

d

A nursing intervention that is indicated for the patient during a sickle cell crisis is a. frequent ambulation. b. application of antiembolism hose. c. restriction of sodium and oral fluids. d. administration of large doses of narcotic analgesics.

c

A patient's CBC indicates pancytopenia. The nurse suspects that the patient has an impairment of the a. liver. b. spleen. c. bone marrow. d. lymph system.

nursing dx for anemia

Activity intolerance, acute pain, risk for decreased cardiac output, self-care deficit

normocytic, normochromic

Acute blood loss, hemolysis, chronic renal disease, chronic disease, cancers, sideroblastic anemias, aplastic anemia

polycythemia

An abnormally high level of RBC's in the blood

eating excess, liver disorders, certain anemias

An increase in iron levels can indicate....

sickle cell anemia

An intrinsic form of hemolytic anemia is

Iron deficiency anemia

Anemia caused by inadequate dietary intake, malabsorption of iron. Labs: decreased H & H, MCV, MCHC, serum iron. Tx: increase iron intake

60-70%

normal percentage of Neutrophils

3-8%

normal percentage of monocytes

1-1.5%

normal reticulocyte count (% of RBC total)

Macrocytic, normochromic

B12 deficiency, folate deficiency, liver disease, post splenectomy:

spleen

red blood cell destruction, storage of bloood components, filtering

erythrocytes

Carry hemoglobin molecule. Have polypeptide chains, alpha and beta. Each chain carries iron atoms.

normocytic anemia

Caused by underproduction of RBC's due to (1) the anemia of chronic disease (2) marrow failure (3) renal failure. loss or destruction of RBC's due to (1) Hemolysis or (2) acute blood loss

bone marrow

responsible for blood formation; produces RBC's, WBC's, Platelets and involved in immune response

37-47%

Hct normal value for females

42-52%

Hct normal values for males

Iron

Hemoglobin molecules need what to transport O2?

oxygen disassociation

Hgb most important feature is that it combines loosely with O2 when there is a small drop in tissue oxygen levels; it increases the transfer of Oxygen from Hgb into the tissues. When there is normal or high oxygen O2 binds tightly to Hgb because there is no need to provide oxygen to tissue if not needed.

12-16

Hgb normal value for females

14-18

Hgb normal values for males

jaundice

If there is increased hemolysis or decreased liver function what symptoms will you see

microcytic, hypochromic

Iron deficiency, thalassemia, lead poisoning:

80-180

Iron levels for Males

60-150

Iron levels for females

Mean corpuscular hemoglobin:

MCH is the average amount of hemoglobin by weight in a single RBC.

Mean corpuscular hemoglobin concentration

MCHC measures the average amount of hemoglobin by percentage in a single RBC. When MCHC is decreased the cell has a hemoglobin deficiency most likely due to iron deficiency. Hypochromic means the cell is a lighter color

aspirin, corticosteroids, seizure medications, TB meds, sulfa

Medication red flags for anemia

4.2-6

Normal range for RBC's (million/mm3)

iron, protein, vitamin K, alcohol

Nutrition status can alter clotting, what nutrients should you assess?

Megaloblastic anemia

RBC's large and abnormal, easily destroyed, usually caused by B12 & folate deficiency

4.2-5.4

RBC's normal value for females

4.7-6.1

RBC's normal value for males

red blood cell distribution width

RDW or RCDW is a measure of the variation of RBC volume that is reported as part of a standard CBC. Usually RBCs are 6-8 um in diameter. These results are often used together with the MCV to determine causes of anemia.

failure to thrive, developmental delays, recurrent infection

symptoms of anemia in children

weight loss, memory loss, confusion, ataxia

symptoms of anemia in the elderly

microcytic

the cell is smaller than normal, as seen in iron deficiency anemia

B12 deficiency

Schilling test diagnosis this

10-150

Serum Ferritin levels in Females

12-300

Serum Ferritin levels in Males

lymphatic system

Supports the circulatory system by draining excess fluids and proteins from tissues back into the blood stream, prevents tissue swelling

pancytopenia

Term that describes a situation where bone marrow does not produce any blood components

d

The cause of aplastic anemia may: a. be related to drugs, chemicals, or radiation damage. b. be idiopathic. c. result from certain infections. d. be related to all of the above.

a

The client with anemia from sickle cell disease asks you what causes this disease. What is your best response? a. "A pair of genes that you inherited makes defective hemoglobin which causes your red blood cells to die off faster than normal." b. "Your body doesn't recognize your red blood cells as belonging to you and makes antibodies that destroy them." c. "A gene that you inherited doesn't allow you to make an important enzyme that is responsible for keeping enough iron in your red blood cells." d. "The actual cause of sickle cell disease is unknown, but it appears that exposure to some chemicals, like benzene and chemotherapy, poisons the bone marrow."

ESR

the rate at which red blood cells sediment in a period of one hour, this is increased by inflammation, pregnancy, rheumatoid arthritis, kidney CA. Decreased in polycythemia, sickle cell, spherocytosis, and CHF. This is slightly higher in females.

c

The nurse is discharging a client with aplastic anemia. Which of the following statements made by the client would demonstrate the need for additional teaching by the nurse? a."I'm a little nervous about the side effects of my medicines and will call if I have questions." b."I have a lot of sisters and brothers. I hope one of them will match for my bone marrow transplant." c."I'm going back to my job in the toddler room at a day care center tomorrow." d."Diabetes runs in my family so we will be checking my glucose levels while I am on the Prednisone."

hypoxia

The stimulus for production of more RBC's is....

reticulocyte count

This count is useful in determining bone marrow function. Increased levels mean RBC's are being produced and released by the bone marrow before they mature, and is normally only .5-2% of RBCs (can be normal)

a

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to: a. Notify a health care provider if the child develops an upper respiratory infection. b. Prevent the child from drinking an excess amount of fluids per day. c. Encourage the child to participate in school activities such as long-distance running. d. administer an iron supplement.

iron saturation

Transferrin saturation, abbreviated as TSAT and measured as a percentage, is a medical laboratory value. It is the ratio of serum iron and total iron-binding capacity.

T lymphocytes

WBC's responsible for cellular immunity

eosinophils

WBC's that are found in the mucosa of the intestines and lungs

basophils

WBC's that contain histamine and heparin

b lymphocytes

WBCs responsible for humoral immunity

iron deficiency, megaloblastic, chronic disease, aplastic

What anemias are related to ddecreased RBC production?

rest, oxygen, fluids, analgesics

What are four major components in the treatment for the patient with sickle cell anemia?

unknown, or radiation, chemicals, antibiotics, chemo

What causes aplastic anemia?

elevated bilirubin due to increase in breakdown of RBC's, poor liver function

What causes jaundice?

bile

What is bilirubin excreted as?

produces more immature RBC's called reticulocytes

What is the bone marrows response to a low level of RBC's?

c

When preparing the patient for a bone marrow biopsy, the nurse explains that a. the procedure will be done under general anesthesia because it is so painful. b. the patient will not have any pain after the area at the puncture site is anesthetized. c. the patient will experience a brief, very sharp pain during aspiration of the bone marrow. d. there will be no pain during the procedure but an ache will be present several days afterward.

kidneys

Where is erythropoietin produced?

pulse ox of 88%, near drowning in icy lake, pneumonia, being outside on a hot day- all could

Which of these could stimulate a sickling crisis?

b

Which problem is common to all types of anemia, regardless of cause? a. Increased risk for bleeding b. Fatigue/activity intolerance c. Impaired blood clotting d. Weight loss

b

Which situation listed below is most likely to stimulate a crisis in a person who has sickle cell trait? a. becoming pregnant b. shoveling snow when it is 0 degrees. c. having surgery under general anesthesia for colon cancer. d. having a cast placed on the wrist after sustaining a simple fracture.

stimulates production of RBC's

Why is Epogen used for patients with anemia?

low, high, high, low, normal

With Iron deficiency, the iron level is ___ but the TIBC is ____, thus transferrin saturation becomes very low. In Iron overload states, the iron level will be ___ and the TIBC will be ___ or ___, causing the transferrin saturation to increase

macrocytic

these anemias are Megaloblastic-as in B 12 or folic acid deficiency Non- megaloblastic with alcohterm-74 ol, hypothyroidism, and liver disease.

total iron binding capacity

used along with serum iron test to evaluate people suspected of having iron deficiency or iron overload. Together, these tests calculate the transferrin saturation.

erythropoiesis

begins in bone marrow of the vertebrae, sternum, ribs, pelvis, shoulder girdles, skull and is completed in the blood or spleen. Healthy bone marrow will make 2.5 billion RBCs, 2.5 billion platelets, and 1 billion WBC's per kg/day.

monocytes

biggest WBC's, have powerful bactericidal substances and proteolytic enzymes, mature into macrophages

: age and sex, changes in baseline, comparison to other labs, comparison to clinical picture and other dx tests

blood lab values must be interpreted based on...

low body/environmental temps, hypoxia, excessive exercise, dehydration, infections, pregnancy, ETOH.

causes of sickle cell crisis

spleen

damaged or old red blood cells are primarily destroyed by what organ?

liver

filters, produced procoagulants

4

how many O2 molecules can each Hgb molecule carry?

fibrinogen

inactive protein that is activated to form fibrin

globulins

main proteins of antibodies

albumin

maintains osmotic pressure of blood, prevents plasma from leaking into the tissue

MCV

measures the average volume or size of a single RBC and is useful for classifying anemias

5000-10000

normal WBC range (/mm3)

0.3-0.5%

normal percentage of Basophils

1-3%

normal percentage of Eosinophils

20-30%

normal percentage of Lymphocytes