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*N126-U4-Anemias-1*
Dobrisky-Anemias, pernicious anemias
| Question | Answer |
|---|---|
| The erythrocyte or red blood cell (RBC) is the | transport mechanism for hemoglobin which carries oxygen from the heart and lungs to the tissues, exchanges it for carbon dioxide (CO2), and then returns to the heart and lungs |
| The average life of an RBC is | 120 days |
| RBCs are produced in the | bone marrow where some are replaced every day |
| The bone marrow responds to an increased need for RBCs by | increasing their production |
| Immature RBCs (reticulocytes) are produced in | high numbers when there is a great demand for more RBCs |
| Anemia is a common hematopoietic disorder defined as | a decreased number of RBCs, mature RBCs and/or a decreased amount of Hb. |
| The general effects of anemia result from | a deficiency in the oxygen-carrying mechanism |
| Resulting signs and symptoms of anemia may include | Increased HR & RR, Decreased O2 & BP |
| SOB, dyspnea, dizziness and fatigue are all early or late signs of anemia | Early |
| Describe the change in HR during exertion for the patient with anemia | Tachy |
| In addition to being tachycardic, what other cardiac symptoms might an anemic patient have | Palpitations |
| Describe the appetite of an anemic patient | Anorexia |
| Describe the general appearance of a patient with anemia | Pale, depressed |
| What therapy should always be consistent when ambulating anemic patients | Oxygen |
| For normal erythrocyte production, the bone marrow requires | iron, vitamin B12, folic acid, pyridoxine (vitamin B6) and other factors |
| If any of these factors are deficient during erythropoiesis | decreased RBC production and anemia result |
| Laboratory tests which correlate with various types of anemias are | HB, HCT, RBCs, MCV, MCH, MCHC, Reticulocytes, RDW, Serum FE, TIBC, Transferrin, Bilirubin, Sed rate, Platelets, b12, and folate |
| *HB is | Iron-containing pigment of RBCs |
| HB Norms | Male - 14-18 g/dL; Female - 12-16 g/dL |
| *HCT is | Fraction of blood occupied by erythrocytes |
| HCT Norms | M - 40%-54%; F - 37%-47% |
| *RBCs are | Hemoglobin carrying red blood cells |
| RBC norms | M - 4.5-6.2 million/uL; F 4-5.5 million/uL |
| MCV is | classifies RBCs as normocytic (normal sized) |
| MCV stands for | Mean corpuscular volume |
| MCV norms | 82-98 fL |
| MCH stands for | Mean corpuscular hemoglobin |
| MCH fluctuates directly with | MCV – larger RBCs can accommodate more Hb |
| MCH norms | 26-34 p |
| MCHC stands for | Mean corpuscular hemoglobin concentration |
| MCHC measures adequacy of | Hb in the RBC |
| MCHC norms | 31% - 38% |
| Reticulocytes are | Immature RBCs |
| Reticulocyte norms | 25,000-75,000 uL or 0.5%-2.0% of RBCs |
| Reticulocyte levels will be changed how in anemia | increasedRDW stands for |
| RDW is an index of the variation in | cell volume within the red cell population. |
| The RDW may be the first test result to | increase with changes in red cell population sizes |
| *Serum Fe is | Serum iron |
| Serum Fe norms | M - 80-200 ug/dL; F - 60-130 ug/dL, Children - 55-185 ug/dL; Elderly - 60-80 ug/dL |
| *TIBC stands for the | Total iron binding capacity |
| TIBC measures the amount of | iron-transporting protein (transferring) available in the blood to bind with and carry iron throughout the body |
| TIBC norms are | 250-410 ug/dL |
| Transferrin is the | Largest of proteins that bind to iron |
| Transferrin norms are | 215 – 380 mg/dL |
| Bilirubin is Chief bile pigment derived from the breakdown of | RBCs by the reticuloendothelial cells of the liver and spleen |
| Bilirubin norms | 0.3-1.4 mg/dL |
| Sed rate (ESR) is a measure of the speed | That RBCs in anticoagulated whole blood settle to the bottom of a test tube |
| ESR norms | M - 0-9 mm/hr; F - 0-20 mm/hr; Children - 0-15 mm/hr |
| *Platelets are responsible for | Accelerating coagulation |
| Platelet norms | 150,000 - 400,000/uL |
| Serum Vitamin B12 norms | 330-900 pg/mL |
| Serum Folate norms | 3-25 ng/mL |
| RDW norms are | 11.5-14.5% |
| what is the first lab to show s/s of anemia? | RDW |
| Vitamin B12 (Cobalamin) Deficiency is also known as | pernicious anemia |
| Due to vitamin B12 (cobalamin) deficiency what changes occur in regards to RBCs | the bone marrow produces an abnormally increased amount. |
| Describe the size and shape of immature RBCs in a pt with Vit B12 deficiency | large and abnormally shaped |
| Many immature RBCs die within the bone marrow because | they are so fragile. |
| The number of mature red blood cells which leave the bone marrow are then | Decreased |
| efine Pancytopenia | deficiency of all cellular elements of the blood |
| What condition develops as a result of the changes in RBCs in a pt with Vit B12 deficiency | Pancytopenia |
| Name the cellular elements that are decreased in pancytopenia | RBCs, Hb, WBCs and platelets |
| The RBCs are described as what during pancytopenia | RBCs are large and polymorphonuclear (hypersegmented) |
| What are some causes of Vit B12 deficiency | Absence of intrinsic factor, faulty absorption from the GI tract, or inadequate dietary intake. |
| What type of surgery may lead to the absence of intrinsic factor and ultimately to a vitamin b12 deficiency | gastric bypass surgery |
| What might cause the absence of intrinsic factor (IF) | either from gastric mucosal atrophy or autoimmune destruction of the parietal cells |
| The elderly patient (usually over 60) may experience what change in intrinsic factor | fail to secrete intrinsic factor |
| Intrinsic factor usually binds with | dietary B12 Intrinsic factor binds with vit b12 and travels to be absorbed in the |
| What type of stomach environment is needed for secretion of IF | An acid |
| Long time users of what type of drug may cause a decrease of IF | H2-histamine receptor blockers |
| Faulty absorption from the GI tract may occur secondary to what conditions | small bowel resection involving the ileum, malabsorption syndromes, intestinal inflammation and intestinal infection. |
| what type of urine testing is done to determine vit b12 deficiency? | 24 hr urine, if b12 excretion is low there is a problem |
| if a person has a deviciency of vitamin b12, what would you expect their urine to show? | low levels of excreted b12 |
| what type of diet is associated with an inadequate intake of vitamin b12? | vegetarian, no meat |
| If a person has no parietal cell function what is the route of choice for vitamin b12 replacement therapy? | IM injections |
| pernicious anemia has one symptom that sets it apart from other disorders but is the same as folic acid deficiency anemia, what is it? | smooth, beefy red tongue |
| Neuro s/s such as confusion, loss of balance and numbness and tingling of the extremeties are found in what type of anemia? | pernicious |
| what changes in weight are common in pernicious anemia? | loss |
| in cases of severe anemia, increased workload on the heart may cause | chf |
| would the patient with pernicious anemia be mildy constipated or have mild diarrhea? | mild diarrhea |
| the symptoms of pernicious anemia are described as | progressive |
| CBC testing will show increased levels in what two areas? | MCV & MCHC |
| Serum b12 levels will be high or low in pernicious anemia? | low |
| pernicious anemia is diagnosed by a negative or positive result from a schilling test? | positive |
| what type of diet should the patient getting ready to undergo a schilling test follow? | fasting for 12 hours |
| what is considered a low urine level of vitamin b12? | <3% |
| what type of drink is the patient given after fasting 12 hrs for a schilling test? | a drink with a small dose of radioactive b12 |
| a gastric analysis involves an injection of what to stimulate gastric acid secretion? | histamine |
| how is the gastric juice obtained? | via NG tube over several hours |
| depressed parietal cell function can be determined by the absence of what? | HCl acid in a pH never less than 3.5 |
| what is achlorydria? | absence of free HCl acid in a pH never less than 3.5 |
| HCl is needed in order for us to absorb what? | vit b12 |
| what are the seven diagnostic tests for pernicious anemia? | CBC, schilling test, gastric analysis, gastroscopy, serum b12 level below 100mg, trial administration of vitamin b12 and serum folate levels of decreased or normal values |
| what findings via gastroscopy will identify pernicious anemia? | pale and grey gastric mucosa |
| what should also be evaluated for during a gastroscopy? | gastric carcinoma |
| if serum vitamin b12 levels are at 75 what does that indicate? | pernicious anemia |
| when pernicious anemia is present what level of serum vitamin b12 would you expect to see? | under 100 mg |
| a serum vitamin b12 level of 180 would rule out what? | pernicious anemia |
| name three priority nursing diagnoses for a pt with pernicious anemia | activity intolerance, altered nutrition, ineffective mgmt of therapeutic regimen |
| what would activity intolerance in a patient with pernicious anemia be related to? | fatigue and imbalance between oxygen supply/demand |
| altered nutrition in a patient with pernicious anemia would be less or more than body requirements? | less |
| ineffective mgmt of therapeutic regimen could be related to what? | lack of knowledge about nutrition and medication |
| vitamin b12 is also known as | cobalamin |
| an absence of intrinsic factor could mean a lifetime of what? | meds |
| what types of food should be included in the diet of a pt with pernicious anemia? | liver, meat, milk, eggs, cheese |
| vitamin b12 replacement therapy is dosed how? | 1000 mg IM daily x 2 weeks, then weekly until hct is normal, then monthly for life |
| what lab value determines that IM injections of B12 can be changed from weekly to monthly? | Hct |
| what change in Hct would you expect to see in a newly diagnosed pt with pernicious anemia? | low |
| what changes in Hct should occur after weekly IM injections of B12? | increase to a normal level |
| what nursing diagnoses would take presidence in a pt with neurological involvement? | risk for injury r/t fatigue and decreased sensation to heat and pain |
| patient outcomes should include | pt verbalizes diet modifications, is free from injury and infection, verbalizes preventative measures |
Created by:
Lori Dobrisky
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