hema diseases

HEMATOLOGIC DISORDERS

BY: JOHN ARBIE T. TATTAO, RN

ANEMIAA reduction in RBC that in turn ↓ the oxygen carrying capacity of the blood

MAJOR CAUSES OF ANEMIA

Loss of RBC’sDeficiencies and abnormalities of erythrocyte production

Destruction of RBC

MAJOR CLASSIFICATION OF ANEMIA

A. Hypoproliferative Anemia

Bone marrow cannot produce adequate number of RBC

MAJOR CLASSIFICATION OF ANEMIA

B. Hemolytic AnemiaResults in premature destruction of RBC

MAJOR CLASSIFICATION OF ANEMIA

C. Anemia resulting from loss of RBC

> ex: bleeding from GIT, trauma, menorrhagia, chronic epistaxis

IRON- DEFICIENCY ANEMIA

PROBLEM: chronic, microcytic, hypochromic anemia resulting from inadequate absorption or excessive loss of iron leading to hypoxemic tissue injury

IRON- DEFICIENCY ANEMIA

CAUSES:Predisposing FactorsA.Chronic blood loss 1. Trauma2. Menorrhagia3. GIT bleeding

IRON- DEFICIENCY ANEMIAB. Inadequate intake of food rich in iron

1. Chronic diarrhea2. Malabsorption syndrome3. High cereal intake with low

animal protein ingestion4. Subtotal gastrectomy

IRON- DEFICIENCY ANEMIAS/SX OR CLINICAL MANIFESTATIONS:

Plummer Vinsons SyndromeEarly Sx are nonspecific, includes fatigue, weakness, SOB, pale conjunctiva

KoilonychiaCheilosisPICA

IRON- DEFICIENCY ANEMIA Peripheral blood smear reveals microcytic and hypochromic RBC

CBC reveals:↓ Hgb to as low as 6-9 g/dl↓ total RBC count↓ Hct levels in relation to ↓ HgbRBC indices reveals ↓ MCV, MCH, MCHC

IRON- DEFICIENCY ANEMIA Serum iron reveals ↓ levels

IDA - ↓ 10mg/dl N: 50 – 150 mg/dl

Decreased serum ferritin levels

Complete absence of hemosiderin

IRON- DEFICIENCY ANEMIAMANAGEMENT:Drugs/Pharmacology:Iron Supplementa. Oral (Ferrous sulfate, Ferrous

gluconate, Ferrous Fumarate)NURSING RESPONSIBILITY:1. Advice pt. to take supplement 1

hr. Before meal

IRON- DEFICIENCY ANEMIA2. Administer iron supplement with meals if taking it on empty stomach causes gastric distress

3. Administer w/ straw if diluting in iron liquid prep.

4. Do not take antacids or dairy products w/ Fe

IRON- DEFICIENCY ANEMIA5. ↑ intake of Fe: Take iron w/ orange juice

6. Monitor and inform patient for S/E

a. Melenab. Anorexiac. Diarrhea/Constipationd. N/Ve. Abdominal pain

IRON- DEFICIENCY ANEMIAParenteral Iron TherapyAdministered to pt. Who:a. Have an intolerance to oral

preparationsb.Continue to suffer blood lossc. Habitually forgetting to take

their medication

IRON- DEFICIENCY ANEMIANURSING RESPONSIBILITY1. Administer with the use of Z tract

method2. Don’t massage injection site3. Ambulate4. Monitor pt for S/E

a. Fever/chillsb. Lymphadenopathyc. Urticartia

IRON- DEFICIENCY ANEMIAd. Pain at injury sitee. Localized abscessf. Hypotension sec. to anaphylactic shock

DIET: Iron rich foods (ex: egg yolk, legumes, raisins, beans, organ meat, GLV)

IRON- DEFICIENCY ANEMIA

Monitor signs of bleeding

Advice pt. to have CBRProvide good oral care Instruct pt. to avoid taking tea/coffee

IRON- DEFICIENCY ANEMIAEncourage intake of Fe rich foods

Encourage pts. to continue Fe therapy as long as it is prescribed even though patient may no longer feel fatigued

Inform pt. that iron causes the stool to become dark green or black in color

IRON- DEFICIENCY ANEMIA

Administer meds as ordered

Blood transfusion as necessary

MEGALOBLASTIC/MACROCYTIC ANEMIA Anemias caused by deficiencies of Vit. B12 and folic acid

Characterized by the appearance of megaloblasts (large, primitive RBC’s) in blood and bone marrow

PERNICIOUS ANEMIA

PROBLEM: Chronic, macrocytic, hyperchromic anemia caused by failure of absorption of Vit. B12 due to deficiency of intrinsic factor leading to hypochlorhydria

PERNICIOUS ANEMIACAUSES: Total gastrectomy/Ileal resection

Atrophy of gastric mucosa Imflammatory disease of ileum

Strict vegetarian diet Absence of intrinsic factor Heredity

PERNICIOUS ANEMIAS/SX: Red beefy tongue Headache, dizziness, dyspnea, palpitations, generalized body malaise, pallor

PERNICIOUS ANEMIAGIT changes – mild diarrheaDyspepsia Neurologic Manifestations:a. Peripheral Neuropathy and

loss of balanceb. Confusionc. Paresthesia in extremities

PERNICIOUS ANEMIA Lack of balance, uncoordinated movement

Loss of proprioception Depression, psychosis Achlorhydria

PERNICIOUS ANEMIALABS/DX EVALS: Schillings Test – measure the absorption of orally administered radioactive Vit B12 before and after parenteral administration of intrinsic factor

Purpose: Used to detect Vit B12 absorption

PERNICIOUS ANEMIA Procedure:1.Administration of oral

radioactive vit B122.Administration of large,

nonradioactive parenteral dose of vit b12 followed in a few hrs.

Interpretation: Cause of deficiency

PERNICIOUS ANEMIAProcedure:3. The same procedure is repeated, but this time intrinsic factor is added to the oral radioactive Vit b12

Interpretation: Absorption of Vit B12

PERNICIOUS ANEMIANursing Responsibility:1. Collect 24 hour urine

specimen2. Keep pt NPO, except for H2O

8-12 hours before the test3. Promote pt understanding

on proc. And emphasize ability to comply with urine collection

PERNICIOUS ANEMIAMANAGEMENT:Drug/Pharmacology:a. Vit B12 injectionsNx. Resp:1. Administer Vit B12 injections at

monthly intervals for lifetime as ordered.

2. Oral administration is used only in cases of nutritional deficiency

PERNICIOUS ANEMIADiet:↑ calorie or CHO, ↑ CHON, iron and Vit. C

Nursing Intervention:1. Enforce CBR2. Administer medication as

ordered3. Avoid irritating mouthwash.

Use of soft bristled tb is encouraged

PERNICIOUS ANEMIANursing Intervention:4. Avoid applying electric heating pads

5. Administer blood transfusion as needed

6. Physical examination q 6 months

FOLIC ACID DEFICIENCY ANEMIAPROBLEM: malabsorption of dietary folic acid due to lack of intake or absorption

CAUSE:a. Poor dietary intakeb.Poor GI absorptionc. Folate antagonistsd. Increased req.

FOLIC ACID DEFICIENCY ANEMIA

d. Increase requirementS/SX:Same to PA but w/o neurologic involvement

Signs of poor oxygenationa. Dizzinessb. Irritabilityc. dyspnea

FOLIC ACID DEFICIENCY ANEMIA

d. Pallore. Headachef. Oral ulcersg. Tachycardia

FOLIC ACID DEFICIENCY ANEMIALabs/Dx Evals:1. RBC indices reveals ↑ MCV and ↓MCHC2. Serum folate levels reveals less than 4

mg/ml (N: 7 to 20 mg/ml)3. Schilling test reveals normal finding4. Blood smear reveals large RBC5. Therapeutic trial reveals client

responding to 50 to 100mg folic acid administered IM for 10 days.

FOLIC ACID DEFICIENCY ANEMIAMANAGEMENT:Drug/Pharma Therapy1.Administer oral doses of

folic acid 0.1 to 5.0 mg/day until the blood profile improves or until the cause of intestinal malabsorption is corrected

FOLIC ACID DEFICIENCY ANEMIA2. Clients with malabsorption syndromes may need parenteral folic acid initially, followed by maintenance therapy with oral doses

Diet/Nutritional Therapy↑ foods high in FA (mostly plant sources)

Daily req: 100 to 200 mg/day

FOLIC ACID DEFICIENCY ANEMIA

Nursing Intervention:1.Administer meds as

ordered2.Referral to AA for

alcoholic patients3.Proper food preparation