Chapter 29 & 33 Hematologic Disorders
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| Albumin | Important for osmotic pressure and edema prevention
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| Polycythemia | High red blood cells
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| Leukocytosis | Higher than normal WBCs (Greater than 10,000)
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| Leukopenia | Lower than normal WBCs (Lower than 5,000)
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| RBC production | Tissue hypoxia cause
Kidneys to release erythropoietin (Epogen) which
Stimulates bone marrow to
Produce more RBCs
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| S&S of anemia | Nail clubbing
Syncope, dizziness
Orthostatic hypotension
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| Types of anemia | Blood loss
Nutritional
Hemolytic
Aplastic (bone marrow suppression)
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| Blood loss anemia | - Circulating blood volume decreases
- Cardiac output falls
- Heart/resp rate increase, peripheral veins constrict fluid shifts
- Circulatory failure and shock
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| S&S of blood loss anemia | - Rapid pulse/breathing
- Pale, cool, clammy skin
- Low BP
- Decreased LOC
- Oliguria (decreased urine output)
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| 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)
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| What increases the absorption of iron | Orange juice
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| Sources of iron | - Beef, chicken, pork, turkey
- Egg yolks
- Clams, oysters
- Green leafy vegetables
- Beans
- Fortified cereal
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| Pernicious anemia | failure to absorb vitamin B12 due to a lack of intrinsic factors, which are secreted by the gastric mucosa
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| S&S of B12 anemia | - Pallor/jaundice
- Weakness
- Paresthesias (numbness/tingling) in extremities
- Proprioception problems (sense of one's position in space)
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| S&S of pernicious anemia | - Glossitis
- Diarrhea
- Plus B12 anemia S&S
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| B12 for pernicious anemia must be administered | IM and must be given for life
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| Sources of B12 | - Meats
- Shrimp, oysters
- Eggs
- Milk
- Cheese
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| S&S of Folic Acid Deficiency | - Pallor
- Weakness
- Fatigue
- Palpitations
- Shortness of Breath (SOB)
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| CNS symptoms (numbness/tingling and altered proprioception) occur in which type of anemia? | B12 anemia
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| Sources of folic acid | - Green leafy vegetables
- Fruits
- Cereals
- Meats
- Kidney beans
- Broccoli
- Milk
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| Causes of folic acid deficiency | - Inadequate intake (undernourishment)
- Increased metabolic requirements
- Malabsorption
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| How are B12 deficiency and folic acid deficiency anemia so differentiated? | CNS affects occur in B12 deficiency anemia,
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| Hemolytic Anemia | - Premature destruction (lysis) of RBCs
- Increased reticulocytes (immature RBCs) in circulating blood
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| Intrinsic (within RBC) hemolytic anemia causes | - Cell membrane/structure defect
- Hemoglobin structure defect
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| Extrinsic (acquired) (outside RBC) hemolytic anemia causes | - Mechanical trauma to the RBC
- Autoimmune disorders
- Bacteria and other infections
- Drugs, toxins, chemical agents, venoms
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| 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
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| Treatment for Hemolytic Anemia | - Steroids - Suppresses immune system
- Blood transfusions
- Plasmapheresis (Separation of blood components to extract plasma)
- Splenectomy
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| 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
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| S&S of Aplastic Anemia | - Fatigue - Pallor
- Tachycardia. - Infections
- Progressive Weakness. - Exertional dyspnea
- Excessive bleeding
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| Aplastic | Onset is usually insidious (Occur in short period of time)
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| How is Aplastic Anemia diagnosed? | Bone Marrow aspiration
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| Damaged bone marrow presents as | Fat
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| Treatments of Alplastic Anemia (medications) | - Immunosuppressants
- Erythropoietin
- Antibiotics
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| Treatments of Alplastic Anemia | - Blood transfusion
- Splenectomy (if spleen is destroying RBCs)
- Stem cell transplantation
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| Serum ferritin tests detect | Iron storage protein
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| Hemoglobin electrophoresis detects | Hemolytic anemia
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| Schilling test detects | Vitamin B12 absorption
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| Bone marrow examination detects | Aplastic anemia
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| Polycythemia | Excess of RBCs (hyper viscous with hematocrit > 55%
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| Three types of polycythemia | - Primary
- Secondary
- Relative
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| Primary polycythemia |
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| Secondary polycythemia | Overproduction of RBCs due to increased erythropoietin levels
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| Relative polycythemia | Caused by fluid deficit (not RBCs)
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