Anemia

Medical-Surgical Nursing                    
 Adult Nursing
 HEMATOLOGICAL DISORDER

Submitted by
Haider H.
BSN, MSN

Blood:
The heart pumps 5-6 liters of blood per minute through the circulatory system.
Blood is an aqueous mixture consisting of plasma and cells.

plasma :

A straw-colored liquid consisting of approximately 90% water and 10% proteins.
The proteins are albumin, globulins, and fibrinogen.

Red Blood Cells:

Also called erythrocites, these are the most numerous blood cells in the body.
RBCs in conjunction with the respiratory and circulatory systems oxygenate body tissues.
Hematocrit  is the percentage of blood cells in a volume of blood.

White Blood Cells:

Also called leukocytes, these fight infection and assist with immunity.
An increased number of WBCs (leukocytosis) may signify the presence of an infection, inflammation, tissue necrosis, or leukemia.
A decreased number (leukopenia) may indicated bone marrow failure, a massive infection, dietary deficiency, drug toxicity, or autoimmune disease.

Platelets:

Platelets (thrombocytes) are nonnucleated, granular, ovoid, or spindle-shaped cell fragments that are active in the clotting mechanism of the body.

Red Blood Cell Disorders:

Anemia:

Anemia is a common blood disorder in which the client has a decreased number of RBCs and a low hemoglobin level.
Causes are a decreased production of RBCs, an increased destruction of RBCs, or loss of blood.
Types include: Iron-deficiency, hypoplastic (aplastic), pernicious, acquired hemolytic anemia, and sickle-cell.

1- Iron Deficiency Anemia:
Most common type. Body does not have enough iron to synthesize functional Hgb.
Symptoms are fatigue, loss of appetite, decreased ability to concentrate, and pallor.

2- Hypoplastic (Aplastic) Anemia:
The bone marrow decreases or stops functioning in a client with aplastic anemia.
Develops without a known cause and thought to be genetic.
Secondary aplastic anemia caused by exposure to viruses, chemicals, radiation, or medications.
Clients are extremely ill.

3- Pernicious Anemia:
An autoimmune disease in which the parietal cells of the gastric mucosa are destroyed and the gastric mucosa atrophies, so that Vitamin B12 cannot be absorbed.
Symptoms include extreme weakness, sore tongue, numbness and tingling of extremities, edema of the legs, etc..

4- Acquired Hemolytic Anemia:
In hemolytic anemias, hemolysis,  or destruction of RBCs.
Causes include autoimmune reaction, radiation, blood transfusion, chemicals, arsenic, or medications.
Symptoms include mild fatigue and pallor or, more severely jaundice, palpitations, dyspnea, and back and joint pain.

5- Sickle Cell Anemia:

Also known as Inherited Hemolytic Anemia, this genetic disorder has abnormal hemoglobin S rather than hemoglobin A.
Condition occurs most frequently in African Americans.
Symptoms are enlarged heart, fatigue, jaundice, chronic leg ulcers, dyspnea, and arrhythmias.
Sickle cell crisis, which occurs periodically, involves severe pain and fever.

Polycythemia:

A disease in which there is an increased production of red blood cells.
Occurs most frequently in the middle-aged and in Jewish men.

General clinical manifestation:

1- Dyspnea, chest pain, muscle pain or cramping
2- Tachycardia, weakness, fatigue, general malaise
3- pallor of skin and mucous membranes (sclera ,oral mucosa).
4- Jaundice  (megaloblastic ,hemolytic anemia )
6- Smooth, red tongue (iron deficiency anemia )
7- Beefy ,red, sore tongue (megaloblastic anemia )
8- Ulceration in the corner of the mouth .

Diagnostic studies :
General hematological studies,Hb, RBCs,hematocrit.
Serum iron level.
Serum vitamin B12 and folate level.
Bone marrow aspiration and biobsy.

Nursing management :
Maintain pt, diet (vitamin B12,iron,folate)
Avoid activity that causes increase heart rate and cardiac output
Monitoring vital signs
Administer oxygen and medication or transfusion as prescribed.
Psychological support to reduce anxiety