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RNSG 1341

Chapter 29 & 33 Hematologic Disorders

Albumin Important for osmotic pressure and edema prevention
Polycythemia High red blood cells
Leukocytosis Higher than normal WBCs (Greater than 10,000)
Leukopenia Lower than normal WBCs (Lower than 5,000)
RBC production Tissue hypoxia cause Kidneys to release erythropoietin (Epogen) which Stimulates bone marrow to Produce more RBCs
S&S of anemia Nail clubbing Syncope, dizziness Orthostatic hypotension
Types of anemia Blood loss Nutritional Hemolytic Aplastic (bone marrow suppression)
Blood loss anemia - Circulating blood volume decreases - Cardiac output falls - Heart/resp rate increase, peripheral veins constrict fluid shifts - Circulatory failure and shock
S&S of blood loss anemia - Rapid pulse/breathing - Pale, cool, clammy skin - Low BP - Decreased LOC - Oliguria (decreased urine output)
S&S of Iron deficiency anemia -Brittle, spoon-shaped nails - Cheilosis (Crack at corner of mouth) - Glossitis ( Smooth, irritated tongue) - Pica (craving non-food items i.e. clay or starch)
What increases the absorption of iron Orange juice
Sources of iron - Beef, chicken, pork, turkey - Egg yolks - Clams, oysters - Green leafy vegetables - Beans - Fortified cereal
Pernicious anemia failure to absorb vitamin B12 due to a lack of intrinsic factors, which are secreted by the gastric mucosa
S&S of B12 anemia - Pallor/jaundice - Weakness - Paresthesias (numbness/tingling) in extremities - Proprioception problems (sense of one's position in space)
S&S of pernicious anemia - Glossitis - Diarrhea - Plus B12 anemia S&S
B12 for pernicious anemia must be administered IM and must be given for life
Sources of B12 - Meats - Shrimp, oysters - Eggs - Milk - Cheese
S&S of Folic Acid Deficiency - Pallor - Weakness - Fatigue - Palpitations - Shortness of Breath (SOB)
CNS symptoms (numbness/tingling and altered proprioception) occur in which type of anemia? B12 anemia
Sources of folic acid - Green leafy vegetables - Fruits - Cereals - Meats - Kidney beans - Broccoli - Milk
Causes of folic acid deficiency - Inadequate intake (undernourishment) - Increased metabolic requirements - Malabsorption
How are B12 deficiency and folic acid deficiency anemia so differentiated? CNS affects occur in B12 deficiency anemia,
Hemolytic Anemia - Premature destruction (lysis) of RBCs - Increased reticulocytes (immature RBCs) in circulating blood
Intrinsic (within RBC) hemolytic anemia causes - Cell membrane/structure defect - Hemoglobin structure defect
Extrinsic (acquired) (outside RBC) hemolytic anemia causes - Mechanical trauma to the RBC - Autoimmune disorders - Bacteria and other infections - Drugs, toxins, chemical agents, venoms
S&S of Hemolytic Anemia - Generally mild or moderate - Jaundice - if breakdown of heme units exceed liver ability - Bone marrow expands/bones deform or fracture
Treatment for Hemolytic Anemia - Steroids - Suppresses immune system - Blood transfusions - Plasmapheresis (Separation of blood components to extract plasma) - Splenectomy
Aplastic Anemia - Bone marrow fails to produce blood cells - Number of stem cells in the marrow reduced - Leads to pancytopenia (deficiency of all cellular components of blood) - Cause of aplastic anemia is often unknown
S&S of Aplastic Anemia - Fatigue - Pallor - Tachycardia. - Infections - Progressive Weakness. - Exertional dyspnea - Excessive bleeding
Aplastic Onset is usually insidious (Occur in short period of time)
How is Aplastic Anemia diagnosed? Bone Marrow aspiration
Damaged bone marrow presents as Fat
Treatments of Alplastic Anemia (medications) - Immunosuppressants - Erythropoietin - Antibiotics
Treatments of Alplastic Anemia - Blood transfusion - Splenectomy (if spleen is destroying RBCs) - Stem cell transplantation
Serum ferritin tests detect Iron storage protein
Hemoglobin electrophoresis detects Hemolytic anemia
Schilling test detects Vitamin B12 absorption
Bone marrow examination detects Aplastic anemia
Polycythemia Excess of RBCs (hyper viscous with hematocrit > 55%
Three types of polycythemia - Primary - Secondary - Relative
Primary polycythemia
Secondary polycythemia Overproduction of RBCs due to increased erythropoietin levels
Relative polycythemia Caused by fluid deficit (not RBCs)
Created by: pdimple
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