physiology of anemia, Slides of Medical Biochemistry

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Interferences

with

Diffusion

Anemia

Leukemia

Hemophilia

venkatesh

Bsc Nursing

Interferences with Diffusion

 (^) Describe clinical manifestations, causes, therapeutic interventions, & nursing management of patients with the following Hematologic Problems:  (^) Anemias –  (^) Decreased Erthrocyte Production  (^) Iron Deficiency Anemia; Thalassemia;  (^) Megaloblastic Anemias: Cobalamin deficiency, Folic Acid Deficiency; Aplastic Anemia  (^) Anemia Caused by Blood Loss  (^) Anemia Caused by Erythrocyte Destruction  (^) Sickle Cell Disease  (^) Acquired Hemolytic Anemia  (^) Hemochromatosis  (^) Polycythemia  (^) Problems of Hemostasis:  (^) Thrombocytopenia  (^) Hemophilia and Von Willebrand’s Disease  (^) Leukemias –  (^) Acute myelogenous leukemia  (^) Acute lymphocytic leukemia  (^) Chronic myelogenous leukemia  (^) Chronic lymphocytic leukemia  (^) Lymphomas  (^) Hodgkin’s Disease / non-Hodgkin’s lymphomas  (^) Multiple Myeloma

Nutrients Needed for Erythrocytes

Interferences with Diffusion Hematologic System Review 

Complete Blood Count Studies

 (^) Hgb  (^) Hct  (^) Total RBC Count  (^) Red Cell Indices  (^) MCV – mean corpuscular volume (size of RBC)  (^) MCH – mean corpuscular hemoglobin (weight of Hb/RBC)  (^) MCHC – mean corpuscular hemoglobin concentration (saturation of RBC with Hb)  (^) WBC  (^) WBC Differential  (^) Platelet Count

 Erythrocyte Sedimentation Rate (ESR or Sed Rate)

Blood Components

What are the functions of blood components?

Drugs Affecting Hematologic

Function

Interferences with Diffusion

Anemias Caused by Decreased Erythrocyte Production

Anemia

 Deficiency in the number of erythrocytes (RBCs)



The quantity of hemoglobin

 Volume of packed RBCs (hematocrit)



Clinical Manifestations: caused by the body’s response

to hypoxia

 (^) Mild (Hb 10 -14) no symptoms or minor changes  (^) Moderate – (Hg 6 – 10) CV Changes: palpitations, dyspnea, diaphoresis  (^) Severe – (Hg<6) multiple body system CV, Cerebral, Major Organs

Interferences with Diffusion

Anemias Caused by Decreased Erythrocyte Production

Iron-Deficiency Anemia

 (^) Common hematologic disorder  (^) Etiology: Inadequate dietary intake, malabsorption, blood loss, or hemolysis  (^) Clinical Manifestations:  (^) Pallor  (^) Glossitis – inflammation of the tongue  (^) Cheilitis – inflammation of the lips  (^) Headache, paresthesia, burning sensation of the tongue  (^) Diagnostic Studies: Lab Studies Endoscopy to identify GI bleed  (^) Treatment: Drug Therapy – oral Iron replacement  (^) Iron absorbed best in duodenum  (^) Ferrous sulfate – take about one hour prior to meal  (^) Gastric side effects: nausea / constipation  (^) Nursing Management – Diet & Medication Instruction

Interferences with Diffusion

Anemias Caused by Decreased Erythrocyte Production

Thalassemia

 (^) Autosomal recessive genetic disorder of inadequate production of normal hemoglobin  (^) Hemolysis occurs  (^) Abnormal Hb synthesis  (^) Ethnic groups of Mediterranean Sea & near equatorial regions of Asia and Africa  (^) Clinical Manifestation : mild – moderate anemia with hypochromia (pale cells) or microcytosis (small cells)  (^) Minor: one thalassemic gene – mild  (^) Major: two thalassemic genes – severe – physical & mental growth retarded - cardiac failure is fatal  Medical Management :  (^) Medication: Chelation Therapy IV deferoxamine (Desferal) – iron binding agent to reduce iron overload  (^) Transfusions to maintain Hg >10g/dl  (^) Nursing Management : Supportive

Interferences with Diffusion

Anemias Caused by Decreased Erythrocyte Production

Megaloblastic Anemias

Folic Acid Deficiency – Folic Acid is required for DNA

synthesis leading to RBC formation & maturation

 (^) Causes: Poor nutrition green leafy vegetables, citrus fruits, & beans, nuts, grains; malabsorption syndromes; drugs that impede absorption (Dilantin); Alcohol abuse; anorexia; hemodialysis patients  Clinical ManifestationsClinical Manifestations: similar to cobalamin deficiency – dyspepsia, smooth, beefy red tongue; absence of neurologic problems  (^) Diagnostic Testing: < Folate Level (norm: 3-25mg/ml)  (^) Medical Management: Replacement Therapy Folic Acid 1mg/ day  (^) Nursing Management: Medication & dietary compliance

Interferences with Diffusion

Anemias Caused by Decreased Erythrocyte Production

Anemia of Chronic Disease  Associated with underproduction of RBCs and decreased RBC survival  Causes: Renal failure; advanced liver cirrhosis; chronic inflammation; malignancy; immunosuppression  Medical Management: 

Correct underlying disorder

 Erythropoietin Therapy – Epogen, Procrit

 Nursing Management: Care of the debilitated patient – dietary & medication compliance

Interferences with Diffusion

Anemia Caused by Blood Loss



Acute Blood Loss

 (^) Hemorrhage  (^) Decreased oxygen-carrying capacity 

Chronic Blood Loss

 (^) Body maintains its blood volume by slowly increasing plasma volume < RBCs 

Clinical Manifestations:

 (^) Range from fatigue with melena to orthostatic BP changes to shock 

Medical Management:

 (^) Treat underlying cause –  (^) Blood replacement – packed RBCs  (^) Supplemental Iron

Lab Study Findings in Anemias