labs
hgb/hct
hct is the percent of rbc in a sample; influenced by hydration status
hgb is weight of hemoglobin attached to circulating rbc; influenced by #cells in circulation, their size and shape
3 etiologies
production problem, excessive loss (hemorrhage), excessive destruction (hemolytic)
this production anemia is r/t complete bone marrow failure
etiology is exposure to radiation or toxins, viral infections, chemo
labs- pancytopenia (all counts are low)
this reaction can lead to elevated levels of unconjugated bilirubin and jaundice
hemolytic transfusion reactions
this is given in hemochromatosis pts
se include anaphylaxis, shock, and red urine
deferoxamine im, iv, and sq if phlebotomy is contraindicated
mcv
mean corpuscular volume; avg size of rbc in a sample
this production anemia is genetic and causes free excess iron
s/s are fatigue darkening of skin r/t iron deposits, and joint pain
tx is phlebotomy
hemochromatosis
this production anemia is a disease that shortens the life of a rbc and has a decreased response to erythropoietin and affects pts with aids, cancer, autoimmune disorders, and chronic renal failure
labs- low h/h and low reticulocyte count (not enough new rbc enter to replace old ones
anemia of chronic disease
these 2 drugs treat iron-deficient anemia
adverse effects: heartburn, constipation, and dark stools
take with food and OJ to reduce gi upset and increase absorption
important to increase fluid and fiber intake to prevent constipation
ferrous sulfate (oral for mild)
iron dextran (iv or im for severe- z track if im)
this drug is given to prevent sickle cell crisis and decreases the need for transfusions...increases fetal hgb and decreases likelihood of cells sickling
hydroxyurea
mch/mchc
mean cell hemoglobin (concentration); mchc is more accurate bc it correlates the concentration to the size of the rbc
measures avg amount of hemoglobin per rbc
this production anemia is most common, r/t insufficient intake and chronic slow blood loss
microcytic, hypochromic
labs indicate low h/h, low ferritin, low icv and mchc
red sore tongue, spoon shaped nails, brittle hair, pika
tx is iron replacement
iron deficiency anemia
these anemias is gi related and has a slow onset r/t slow loss and will lead to low h/h and increased reticulocyte count
why is im or intranasal the only route for cyanocobalamin (b12 deficient anemia)?
(given monthly)
you can't absorb it orally due to lack of intrinsic factor
HOWEVER- for nutritional deficits, oral and sublingual are the recommended routes
transfusions, anti T cell agents, filgastrim (colony-stimulating factor that stimulates wbc production), and cyclosporine (calcineurin inhibitor) all treat this condition, including bone marrow transplants but the success of this procedure drops significantly after 40
aplastic anemia/pancytopenia
rbc indices- cell size via mcv value
microcytic, normocytic, macrocytic
this production anemia is due to insufficient intake, intrinsic factor, deficiency, or autoimmune destruction of parietal cells
megaloblastic (macrocytic/normochromic)
low h/h, increased mch, low b12
tx is vitamin replacement and may experience parathesia, ataxia, sore and glossy tongue
b12 deficiency (pernicious anemia)
this anemia is genetic, and if only one gene is inherited, symptoms will be milder since less hemoglobin is affecting the rbc
if two genes are inherited, more than 80% of rbc are prone to sickling due to lack of oxygen in circulation
hemolytic; sickle cell trait vs disease
this drug is used to treat folate deficiency anemia indicated in alcoholic vitamin deficiencies and to prevent neural tube defects
rbc indices- hemoglobin content via mchc
hypochromic (very little or poor hgb)
normocytic (normal hgb)
this production anemia is dangerous for infants whose moms are deficient and goes unnoticed due to slow-onset...can lead to spina bifida
etiology is loss of this supplement to cooking, deficiencies, malabsorption
megaloblastic anemia (macrocytic/normochromic)
low h/h and high hcv tx is replacement therapy
folic acid deficiency anemia
this anemia is genetic and is caused by mutations in hemoglobin alpha or beta chains...the anemia associated is due to early destruction of abnormal rbc
thalassemia- hemolytic anemia
adverse effects are htn in IV use; sq is recommended and more common especially in dialysis pts
epoetin alpha, darbopoetin