LAB VALUES:
- RBC: 4-6 Million
- WBC: 5-10,000
- PLT: 150-400,000
- Hgb: 12-18
- HCT: 37-52%
- PT: 11-12.5 seconds
- aPTT: 30-40 seconds
- INR: 0.8-1.1
Hemolytic anemia:
- S/S: jaundice
Anemia:
- More common in older people
- ANEMIA IS NOT NORMAL!!!
- Deficiency in the number of erythrocytes (RBC)
- Problems with the quantity/quality of Hgb
- Issues with volume of the packed RBCs
Causes of Anemia:
- Deficiency in nutrients
o Iron
o Vitamin B12
o Folic acid
- Decreased EPO (erythropoietin) which means decrease in RBC
- Decreased in iron availability
- Blood loss
o Chronic (ex: ulcers, liver disease)
o Acute (ex: trauma, bleeding, aneurysm)
- Increase in RBC destruction
o Sickle cell anemia!!!
o Medications
o Incompatible blood
o Trauma
Assessment: what will the person look like?
- Skin: pale, cold skin
- Cardiac: increased HR, angina, HF, murmurs
- Pulmonary: increased RR, dyspnea at rest!!
- Neuro: vertigo, irritability, depression, impaired thought process
- GI: anorexia, difficulty swallowing
Diagnostics:
- CBC
o Hgb
o HTC
o Total RBC
o RBC morphology
- ESR
- PT, INR, PTT
- CT
- MRI
- Folic acid, vitamin B12, iron
IRON DEFICIENCY ANEMIA:
- MOST COMMON NUTRITIONAL DISORDER!!
- People most susceptible:
o Women in reproductive years (esp. when on periods)
o Very young
o Poor diet
- Causes:
o by low iron levels
o poor intake
o pregnancy
o loss of iron (from periods, GI bleed, ulcers, hemorrhoids)
o malabsorption
- Malabsorption (iron absorption occurs in duodenum) so surgeries or diseases that alter,
or remove the absorption area can cause anemia
- Signs & Symptoms:
o MAY BE VAGUE IN THE BEGINNING!!
o Lethargic
o SOB
o PICA (random ass cravings for weird shit loll)
o Cheilitis (INFLAMMATION OF LIPS)
o Glossitis (INFLAMMATION OF TONGUE)
o Change in RBC
o Nails change
o Neuro changes (confused and moody, so me all the time lol)
- Diagnostics:
o CBC
o Iron levels
o Blood smear
o Stool
o Endoscopy
- Interventions:
o MONITOR FOR BLEEDING!!
o Iron supplements
 Take on empty stomach to INCREASE absorption
 Take with orange juice to INCREASE absorption
 DO NOT take with antacid/milk/Ca+, OR wait at least 2 hours in between
 Black tarry stools may occur, this is NORMAL
 Constipation may occur so make sure you stay hydrated and increase
fiber
o Medications
o Good iron diet!!
 Egg yolks
 Apricots
 Tofu
 Legume, leafy greens
 Oysters, tuna, sardines (ew lol)
 Potatoes
 Red meat
 Raisins, nuts
 Iron fortified cereal
PERNICIOUS ANEMIA:
- Form of a vitamin B12 deficiency
- Affects nervous system, heart, and GI
- Vegans are at risk bc of their diet
- Caused by absence of intrinsic factor
o Intrinsic factor is a protein secreted by parietal cells of gastric mucosa
o It is REQUIRED for cobalamin absorption
o If intrinsic factor is NOT secreted, cobalamin will NOT be absorbed
- Insidious onset (comes on slowly, may not have obvious symptoms at first)
- Begins in middle age or older
- Predominant in Scandinavians and African American’s
- Signs & Symptoms:
o Pale
o Fatigue
o SOB
o Red, smooth, BEEFY tongue
o Numbness/tingling in hands and feet
o Intestinal issues
 Diarrhea
 Constipation
 Bloating
 Indigestion
o Confusion, depression
o Loss of appetite, weight loss!!
- Interventions:
- Replace vitamin B12
o Cobalamin
o Weekly IM injections which move to MONTHLY
- Educate patients on safety due to paresthesia
- Increase iron intake, vitamin C, and folic acid
- Educate on oral hygiene!!
Sickle Cell Anemia:
- INCURABLE!!!
-
Genetic blood disorder (recessive gene)
o PARENTS MUST BE CARRIERS OF SICKLE CELL TRAIT!!
- More common in African American’s, Asian’s, middle eastern, and Eastern
Mediterranean’s
- ABNORMAL Hgb in RBC
- Triggered by low oxygen in the blood
- INFECTION most COMMON precipitating factor
- RBC’s change shape and become:
o Stiff
o Weak
Diagnostics:
- Newborn testing
Signs & Symptoms:
- Dactylitis in INFANTS (swelling of fingers or toes, looks sausage-shaped lol)
- Pain in the joints, back, and spleen
- Tired
- Increased HR
- SOB
- Pale, fatigue
- Gallstones
- STROKE
- Eye problems
- Leg ulcers in OLDER CHILDREN
- VERY PAINFUL!!!
Complications:
- INFECTION (major cause of morbidity and mortality)
- Can lead to shutdown of RBC production
- Autosplenectomy is a result of scarring
o Severe infections can cause aplastic crisis
o Pneumococcal pneumonia is MOST common
Sickle Cell Anemia CRISIS:
- VERY PAINFUL
- Severe capillary hypoxia which can lead to tissue necrosis
- Life threatening shock could occur due to severe O2 depletion
- Vaso-occlusive
o RBCs are sticking to vessels
- Hyper-hemolytic
o Increase death of RBCs
- Aplastic
o No production of RBCs
- Splenic
o Spleen sequestration
o Swelling/infection
Interventions:
- Provide HYDRATION
- Oxygen
- PAIN CONTROL!! (Opioids around the clock)
- Bed rest
- Monitor RR
- Assess for pneumonia
- WATCH FOR IRON TOXICITY!!!
- Give antibiotics if they have an infection
Prevention:
- Avoid high altitudes
- Avoid stress!!
- No smoking
- Do NOT overdue exercise
- Stay HYDRATED!!
- Vaccines
Medications:
- Hydroxyurea
o Creates fetal Hgb
o Helps with the sickling of cells
o Side effects: decreased WBC
- Stem cell transplant
Things to AVOID:
- S: significant blood loss
- I: illness, infections
- C: climbing/flying to high altitudes
- K: keeping continuous stress (mental or physical)
- L: low fluid intake (dehydration)
- E: extreme temperatures (hot, cold, exercise)
Thrombocytopenia:
- Low platelets (< 150,000)
- Increased risk for bleeding due to low platelets, prolonged bleeding from trauma or
random without an injury
- NO PLATLETS= NO CLOTTING FACTOR!!!
- Risk Factors:
o Heparin induced
o DIC
o ITP
o Drugs (chemo, aspirin)
o Cancer, infections
- Usually, an acquired disorder
- Heparin can induce thrombocytopenia
- Patient will have petechiae (round spots that appear on the skin that happen because of
bleeding, think of your grandparents: they probably have little round red blood spots on
their arms/hands/legs lol)
-
Patients will also have ecchymosis (bruising)
Teaching:
o Be aware of bleeding gums
o Use an electric razor
o Soft toothbrush
o Watch for nose bleeds (don’t blow nose too hard)
Neutropenia:
- Neutrophils < 1000
- Normal range is 2200-7700
- So, they are VERY LOW!!
- LOW WBC
- Patient is at an increased risk for infection!!
- STRICT PRECAUTIONS
- Risk factors:
o Chemo
o Immunosuppressant therapy
- Neutropenic fever:
o Little ability to have an immune response
o Quickly progresses to sepsis and death!!
o Low grade fever (> 100.4)
o Monitor and report ASAP!!
o Blood cultures and antibiotics within 1 hour of fever starting
o Neutropenic precautions
 Strict hygiene
 Single room, not sharing with someone else in hospital
 Avoid contact with crowds
 Daily skin and oral hygiene are essential
 Wear a mask
 No flowers
 NO FRESH FRUIT ALLOWED!!! All foods MUST BE COOKED!!! NOTHING
UNCOOKED!!!
Leukemia:
- A group of cancers affecting the blood and blood-forming tissues of:
o Bone marrow
o Lymph system
o Spleen
- No single cause
- Can be from environmental factors or genetics
BLOOD TRANSFUSIONS:
- 2 nurses MUST sign for the transfusion!!
- 18-20 gauge IV is used
- DO NOT INFUSE WITH ANYTHING ELSE!! Just the BLOOD
- Bag of 0.9% NS to prime and flush IV tubing
- Check orders for type and cross match
-
-
-
-
-
ID Patient, draw blood for T+C in red topped tube, place blood band and label
Check consent
Pick up blood from blood bank
o MUST be administered within 30 minutes of receiving blood!!
o This is to avoid infection
Take vital signs
Blood warmer IF large amounts
Explain the process + what to report
Rate of infusion
o Start slow
o 2 ml/min for first 15 minutes, then start increasing slowly
o Infuse for no more than 4 hours
Remain with the patient for 15 minutes after the infusion
o Monitor for adverse reactions
o Monitor vital signs q 15 mins, then q 30 mins, then q 1 hour after the transfusion
is complete
If the patient is having a reaction to the transfusion:
o STOP TRANSFUSION!! Call MD
o Elevate HOB (head of bed)
o Give oxygen and comfort measures
o Change IV tubing and continue with NS (normal saline)
o Give fluids, epinephrine
o Re-check crossmatch record
o Monitor fluids and electrolytes
o STAY WITH PATIENT!!
Types of reactions to transfusions:
o Febrile non-hemolytic reaction
 Most common reaction
 Reaction to DONOR’s WBC, plasma, proteins, or contamination (bacteria)
 Give acetaminophen before the transfusions
 s/s: 1 degree rise in temperature, chills, malaise
 no need to stop the infusion unless hemolytic reaction develops
o Sepsis
o Hemolytic reaction (WORST ONE!!)
 Pain at site of reaction
 LOWER BACK PAIN!!! Fever, chills, nausea/vomiting, tachycardia, LOW
blood pressure, dark urine, septic shock
 STOP THE TRANSFUSION ASAP!!
o TACO
 Transfusion associated circulatory overload
 Most common in elderly and chronic anemia patients
 s/s: dyspnea, edema
 give blood SLOWLY over 3-4 hours
 diuretics before or between units of blood
o TRALI
 Transfusion related acute lung injury
 Most common cause of death associated with transfusions
 Fluid in alveoli= RESPIRATORY DISTRESS!!
 Better prognosis than ARDS (acute respiratory distress syndrome)
 s/s: dyspnea, hypoxemia, bilateral chest infiltrates
 stop the infusion, airway control, supportive care
o Allergic reactions
 Antibodies in the patients’ blood
 Give them Benadryl before if they know they are prone to allergic
reactions for transfusions or during the infusion