Blood Disorders Anemia

Blood Disorders Anemia – a condition of lower than normal RBC count and hemoglobin levels Classification: 1. Hypoproliferative 2. Hemolytic 3. Loss of RBC Diagnostic Methods: 1. CBC 2. Serum Vit B12 and folate acid level 3. Bone marrow aspiration Manifestations: 1. dyspnea, chest pain, muscle pain or cramping and tachycardia 2. weakness, fatigue, general malaise 3. jaundice 4. smooth, red tongue 5. beefy, red tongue 6. angular cheilosis 7. brittle nails and pica in patients with IDA Medical Managements: 1. The goal is to correct or control the cause of anemia and replace loss or destroyed RBC’s by transfusing packed RBC’s Nursing Management 1. Manage fatigue 2. maintaining adequate nutrition 3. maintaining adequate perfusion Types: Aplastic Anemia - a rare disease caused by a decrease in or damage to marrow stem cells in the bone marrow reducing hematopoiesis - can be congenital or acquired (from medications, chemicals) Manifestations:

1. Gradual onset marked by complications: infection, fatigue, pallor and dyspnea 2. Purpura 3. Retinal hemorrhage are common 4. Repeated sore throat Iron Deficiency Anemia - a condition in which the total body iron content is decreased and iron stores are depleted. Manifestations: 1. Fatigue, irritability, numbness, tingling of extremities 2. In more severe cases (a) smooth, red, tongue (b) pica and angular cheilosis 3. Serum iron concentration low Nursing Managements: 1. Administer IM or IV iron in cases when oral iron is not absorbed or poorly tolerated 2. Take iron an hour before meals 3. Health teaching on iron preparation (STAFB) Megaloblastic Anemia (Vit. B12 and Folic Acid Deficiency) - both vitamins are essential for DNA synthesis - RBC’s produced are abnormally large because of hyperplasia of the bone marrow and the erythroid and myeloid cells are large. - Vit B12 deficiency can occur from inadequate intake in strict vegetarians, faulty absorption in the GIT, absence of intrinsic factor. - Folic acid deficiency occurs when intake of folate is deficient or the requirement is increased. People at risk include those who rarely eat uncooked vegetables and fruits and alcoholic individual. Manifestations: 1. Gradual development of signs of anemia 2. Possible development of smooth, red tongue and mild diarrhea 3. Confusion, difficulty keeping balance 4. Vitiligo and premature graying hair 5. Without treatment, patients die usually as a result of congestive heart failure from anemia. DX Methods: 1. Schilling Test – to assess capacity to absorb

2. CBC Hemoglobin as low as 4-5 g/dL – NV Male 14-16.5 Femaile 12-15 WBC 2k-3k/mm3 NV 4.4 – 11.3 x 103/uL Platelet less than 50,000/mm3 – NV 150-400 x 109 Medical Managements: For Vit B12 Deficiency 1. Oral supplementation with vitamins or fortified soy milk 2. IM vitamin B12 for defective absorption 3. Prevention of recurrence with lifetime vitamin B12 therapy For Folic Acid Deficiency 1. Intake of nutritional diet and 1mg folic acid daily 2. IM folic for malabsorption syndrome 3. Folic replacement can be stop when hemoglobin levels returns to normal Sickle Cell Anemia - severe hemolytic anemia resulting from the inheritance of the sickle hemoglobin gene (Hbs) which causes defective hemoglobin molecule. - Inherited - Sickle RBC’s have shortened life span, resulting in anemia - Most common in Africans Defective hemoglobin molecule Assume sickle shape when exposed to low O2 tension Lodged in small vessels Obstructs blood flow to body tissues Ischemia Sickling Crisis Manifestations: 1. Anemia 2. Jaundice 3. Bone marrow expands in childhood causing enlargement of bones of the face and skull 4. Tachycardia, cardiac murmur and often caridomegaly in chronic anemia 5. Heart failure in adult 6. Severe pain in various parts of the body 7. Acute chest syndrome Leukemia - unregulated proliferation or accumulation of WBC in the bone marrow, replacing normal marrow elements.

Classifications: 1. Lympocytic 2. Myeloctyic Acute Lymphocytic Leukemia - uncontrolled proliferation of immature cells - common in young children (boys) peak 4 years old - uncommon after age 15 - 80% children survive at least 5 years. Manifestations: - leukopenia, anemia, thrombocytopenia - pain due to enlarged liver or spleen and bone - headache, vomiting due to leukemic cell infiltration into other organs - leukocyte either low or high but always has immature cells. Chronic Lymphocytic Leukemia - common cancer of older adulthood - derived from B lymphocytes escape apoptosis excess accumulation more than immature cells - diagnosed through P.E. - many are asymptomatic - B symptoms : fever, night sweats, weight loss, infection is common - anergy - lymphadenopathy - spleenomegaly - erythrocytes platelet may be normal or decreased - lymphocytes is always present - anemia and thrombocytopenia in late stage Management of ALL 1. Chemo – major treatment - with vinca alkaloids and glucocorticoids - combination of vincristine, prednisone, dannorubucin, and aspiraginase, are used initially (they can be used as maintenance for up to 3 years.) - irradiation of the cerebro spinal region and intrathecal injection of chemo agents

prevents CNC recurrence. Management of CLL 1. No treatment in early stage 2. for severe symptoms, chemo with steroids and chlorambucil (leukeran) 3. Other chemo agents are vincristine, boxorubicin, cyclophospamide 4. IV immunoglobulin may prevent bacterial infection General Nursing Managements: 1. Prevent bleeding a. assess thrombocytopenia, anemia b. avoid trauma and injection c. small gauge needle should be used d. apply gentle pressure at the injection site e. report melena, petechia, epistaxis f. use acetaminophen instead of ASA g. manage with bed rest 2. Prevent infection 3. Manage mucositis a. oral care b. avoid commercially prepared mouth washes c. provision of comfort and relief of pain d. adequate hydration e. fluid and electrolyte balance. Myeloid Leukemia - results from defect in the hematopoietic stem cell that differentiates into all myeloid cells : monocytes, gametocytes, basphils, neutrophils, eosonophils) - all age groups affected - death usually occur secondary to infection or hemorrhage. Manifestations 1. Evolve from insufficient production of normal blood cells a. fever and infection results from neutropenia b. weakness and fatigue due to anemia c. bleeding tendencies as a result of thrombocytopenia - most common site of bleeding occurs at the GI, pulmonary, and intracranial d. proliferation of leukemic cells within the organs leads to variety of additional symptoms:

- pain form enlarge liver or spleen - hyperplasia of the gums - lymphadenopathy - headache or vomiting secondary to meningeal leukemia - bone pain - decreased erythrocyte and platelet - leukocyte – low, normal or high Diagnostic Tests: 1. bone marrow specimen (excess of immature blasts cells) 2. CBC Medical Managements: 1. Chemo – supportive care 2. Administration of blood products and treatment of infection 3. bone marrow transplantation – done when a tissue match with of a close relative can be obtained. Chronic Lymphocytic Leukemia - arises from mutation in the myeloid stem cells more normal cells present than in acute form. A cytogenic abnormality termed Philadelphia chromosome is found in 90% to 95% of patients. - uncommon before 20 yrs old - incidence rises with median age (40-50) 3 stages 1. Chronic 2. Transformation 3. Accelerated or Blastic Crisis Manifestations 1. Marrow expands into cavities of the long bones 2. Cells are formed in the liver and spleen 3. infection and bleeding rare until disease becomes acute.