RBC Disorders

Decreased

Production of RBC

Iron Deficiency Anemia

Vitamin B12 Deficiency Anemia
Folic Acid Deficiency Anemia
Aplastic Anemia

Fe Deficiency Anemia
Common

world wide
Affects 10-30% of population in US
Common in premenapausal woman,
infants, children, adolescents, &
elderly
Develops slowly

A&P
Occurs

when supply of Fe is too low

for optimal RBC formation
Iron RDA
10mg/d M,
F 12-49 15 mg
Typical American diet provides 10 to 20
mg/d
Many woman consume only 12.4mg/d

Cause of Development

Inadequate absorption or excess Fe loss

Inadequate dietary intake of foods high in
Fe
Principal cause in adults acute or chronic
bleeding
Secondary to trauma
Excessive menses
GI bleeding
Blood donation

Diagnostics
Hgb

Panic value < 5g/dl

Hgb level can drop to 3.6g/dl
Total RBC count rarely below 3
million/dl
MCH < 27 pg
MCHC 20 to 30 g/dl
Serum Fe as low as 10mcg./dl

Diagnostics
HCT

< 47 ml/dl M
HCT < 42 ml/dl F
Fe binding capacity
Serum ferritin level
Bone marrow may also be indicated

Symptoms
Pallor,

glossitis
Dizziness, irritability, numbness &
tingling in limbs, fatigue, decreased
concentrated & HA
Tachycardia & dyspnea on exertion
Sensitivity to cold, brittle hair & nails
Atrophic glossitis, stomatitis,
dysphagia

Treatment
Diet

high in Fe rich foods

Red meats, organ meats, kidney beans,

whole-wheat products, spinach, egg
yolks, carrots & raisins

Treatment
Hematinic

agents

Ferrous Sulfate (Feosol) 0.2 g tid with meals

Ferrous Gluconate (Fergon) 0.3 g bid
Oral irritating to GI mucosa, GI upset,
nausea, etc. blackish green stool,
contraindicated in PUD, inflammatory bowel
disease
Liquid preparation taken mixed with H2O or
juice & sipped thought straw

Treatment
Hematinic

agents

Iron-dextan (Imferon) 100 to 250 mg/d

Ascorbic acid as indicated
Deep IM use Z-track to prevent
subcutaneous irritation & discoloration
from leaking med
Can be given IV to pregnant or elderly
with severe Fe deficiency anemia

Treatment
Side

effects: Nausea, constipation,

epigastric pain, black & red tarry stools,
Contraindicated with hypersensitivity,
ulcerative colitis/regional enteritis,
peptic ulcer disease, hemolytic anemia,
cirrhosis
absorption with antiacids, cimetidine,
cholestramine, Vit E, dairy products,
caffeine, eggs

Treatment
False

positive occult blood

Toxicity: nausea, vomiting, diarrhea,
hematemesis, pallor, cyanosis,
shock, coma
Over dose: Diarrhea, fever severe
stomach pain, nausea, vomiting
Fe binding Agent Deferoxamine

Nursing Care

Oral hygiene & dental care

Preventing irritations & infections in oral
cavity
Nail & hair & hygiene
Assist with maintenance proper diet
Fe supplement
Aware of changes in stool
Safety to prevent falls

Folic Acid Deficiency

Vitamin

B complex
Seen in alcoholism, malabsorption
syndromes, and pregnancy
Most prevalent in infants,
adolescents, pregnant & lactating
females, alcoholics & elderly
Increase incidence in drug use and
pregnancy

Food Sources
Found

in asparagus spears, beef

liver, broccoli, collards, mushrooms,
oatmeal, peanut butter, red beans,
wheat germ

Clinical Manifestations
Develop

slowly over a period of

months
Symptoms related to tissue hypoxia
Glossitis
Jaundice
Splenomegaly

Treatment
Administer

folic acid every day until

deficiency is corrected
High dises to patients with
malabsorption problems
Folvite ; adults 250 to 1,000 mcg/d
until hematological responses
increases
Maintainance 400 mcg/day X 2

Aplastic Anemia
Inherited,

but can be acquired from

chemical exposure or radiation
Failure of bone marrow to produce
adequate amounts of RBCs,
leukocytes, & platelets
Pancytopenia
Usually seen in young individual,
median age 25 years

Aplastic Anemia, cont.

BM

supression, detruction or aplasia

resulting in failure of BM to produce
adequate # stem cells

Clinical manifestations

Fatigue
Dyspnes
Multipel infections
temperature
Headache
Waskness
Anorexia
Gingivitis

Epistaxia
Purpra
Petechiae
Ecchymosis
Pallor
Palpitations
Tachycardia
Tachypnes
Melena

Diagnostic Tests

Prepheral blood smear

pancytopenia

Hemtoaplogy
granulocutes, thrombocytes, RBC

Stool for occult blood

positive

Uring chemistry
hematuria

Bone Marrow biopsey

Fatty narrwo with of stem cells

Treatment of Aplastic
Anemia
Blood

transfusion for disabled or

bleeding thrombocytopenia
Immunosuppressants for individual
with disease causes similar to
autoimmune problems
Antilymphocyte globim (ALG)
Antihymocyte globin (ATG)
Cyclosporine (Sandimmune0

Treatment
For

severe, general
immunosuppression agents
Prednisone % cylophosphamide

Splenectomy;

considered in clients
with enlarged spleen
Either destroying normal RBCs or
suppressing their development

BMT

replaces defective stem cells

Cure for some patients

RBC Disorders
Hyperplasia

of bone marrow results

in production
Overproduction results in blood
viscosity, total blood volume, &
severe congestion of all organs &
tissues

Polycythemia
Myeloproliferative

disorder that
results in the increaed productions of

Erthrocytes
Hemoglobin
Myelcytes
Thrombocytes

Polycythemia Vera
Hyperplasia

of the bone marrow

results in increased production
Overproduction results inincreased
blood viscosity, increased total blood
volume, & severe congestion of all
organs & tissues

Clinical Manifestations

Ruddy complexion
Dusky mucosa
Vertigo
Headaches
Dyspnea &
orthopnea
Tachycardia
Ecchymosis

Heaptomaeglay &
spelnomegaly
gastric secretions
Weakness &
fatigue
Pururitus
Epistaxis
GI bleeding
Angina

Diagnostic Tests

Blood Chemistries
UA, unconjugated bilirubin, vitamine B12,
alkaline phosphatase, SGOT, SGPT, LDH

Hematology
RBCs, WBCs, platelets, Hct, Hgb,

Bone Marrow biopsy

# of immature cells forms, Fe in marrow

Urine chemistry
hematuria

Management
Soft

diet, low Fe
Antacids
Histamine antagonists
Antigout
Radioactive phosphorus (P32)
Phlebotomy
Myelosuppressants