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