PATHOPHYSIOLOGY

Aplastic, or hypoplastic, anemia

a bone marrow failure that is characterized by a decrease in all formed elements of peripheral blood and its bone marrow. Resulting to pancytopenia - loss of production of healthy erythrocytes, platelets, and granulocytes Onset is often insidious to chronic and may become rapid (due to myelotoxin)
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PATHOPHYSIOLOGY-CONT.

Complete bone marrow suppression -result in infections, greatly reducing the chances for complete recovery May produce fatal bleeding or infection, however, especially if it is idiopathic or stems from chloramphenicol or infectious hepatitis

CAUSES:

Injury or damage to the stem cells that inhibit red blood cell (RBC) production-most common Acquired- drugs: antibiotics, anticonvulsants Toxic agents : benzene and chloramphenicol, pregnancy, or radiation Severe diseases : hepatitis, viral illnesses, preleukemic & neoplastic infiltration of the bone marrow Congenital (Fanconis anemia)
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ASSESSMENT

1. Determine exposure to risk factors: recent tx w/ chemo drugs, radiation therapy, or accidental exposure to organic solvents. these agents can cause
bone marrow supression

2. Establish a history of dyspnea, headache, intolerance for activity, progressive fatigue, malaise, chills and possibly fever, easy bruising, or frank bleeding. 3. P.E. : Examine skin for pallor or jaundiced-appearance Inspect mucous membranes for bleeding Inspect mouth and throat for lesions
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ASSESSMENTCONT. Palpate lymph nodes, liver and spleen for enlargement. Auscultate chest for tachycardia & adventitious lung sounds. 4. PSYCHOSOCIAL Assess mental status as an indicator of cerebral perfusion; Assess the sensorimotor status to evaluate nervous system oxygenation. Patients may be anxious or fearful because of their low level of energy. Assess for irritability- due to mouth pain
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Diagnostic Highlights

Normal Results

Abnormality with conditions

Explanation

Complete blood Count

Red blood cells (RBCs) 4.05.5 million/L

Reticulocyte count 0.52.5% of total RBCs;

Decreased to < 1.0 million/L; usually normochromic and normocytic,but may be macrocytic (enlarged) and anisocytotic (excessive variation in erythrocyte size) Decreased

Injury to the stem cells decreases production of blood cells

Platelets 150,000400,000/L
Decreased Bone marrow aspiration and biopsy Bone marrow is hypocellular/empty ; Greatly reduced/ absent hematopoiesis
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MANAGEMENT 1. Removal of causative agent or toxin. 2. Allogeneic bone marrow transplantation (BMT)treatment of choice, provides long term survival for 75% to 90% of patients, depending on the age of the patient, history of prior blood transfusions, and source of marrow 3. Immunosuppressive treatment -corticosteroids, cyclosporine, cyclophosphamide, antithymocyte globulin or antilymphocyte globulin as single treatments or in combinations; provides long-term survival for 70% to 80% of patients.
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MANAGEMENT-CONT.
4. Androgens (oxymetholone or testosterone enanthate) may stimulate bone marrow regeneration; significant toxicity encountered. They may be used when other treatments have failed 5. Supportive treatment includes platelet and RBC transfusions, antibiotics, and antifungals.

NURSING DIAGNOSES

1. Risk for Infection related to granulocytopenia secondary to bone marrow aplasia 2. Risk for Injury related to bleeding

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NURSING INTERVENTIONS
A. Minimizing Risk of Infection 1. Care for patient in protective environment while hospitalized private room with strict hand washing and avoidance of any contaminants

2. Encourage good personal hygiene, including daily shower or bath with mild soap, mouth care, and perirectal care after using the toilet. 3. Monitor vital signs, including temperature, frequently; notify health care provider of oral temperature of 101 F (38.3 C) or higher.

4. Minimize invasive procedures or possible trauma to skin or mucous membranes.

5. Obtain cultures of suspected infected sites or body fluids.
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B. Minimizing Risk of Bleeding 1. Use only soft toothbrush or toothette for mouth care and electric razor for shaving; keep nails short by filing. 2. Avoid I.M. injections and other invasive procedures. 3. Prevent constipation with stool softeners as prescribed. 4. Restrict activity based on platelet count and active bleeding. 5. Monitor pad count for menstruating patient; avoid use of vaginal tampons. 6. Control bleeding by applying pressure to site, using ice packs and prescribed topical hemostatic agents. 7. Administer blood product replacement as ordered; monitor for allergic reaction, anaphylaxis, and volume overload.
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