Non-Malignant Disorders: Anemias (Includes Thrombocytopenia)

anemia

lower than normal hemoglobin and fewer than normal circulating erythrocytes

a sign of an underlying disorder

results in diminished oxygen-carrying capacity and delivery to tissues and organs

goal of treatment is to restore and maintain adequate tissue oxygenation

anemia causes

hypoproliferative: defect in production of RBCs

• caused by iron, vitamin B12 or folate deficiency, decreased erythropoietin production, cancer

hemolytic: excess destruction of RBCs

• caused by altered erythropoiesis, or other causes such as hypersplenism, drug-induced or autoimmune processes, mechanical heart valves

blood loss

anemia risk factors

blood loss: acute or chronic

hemolysis

dietary intake/malabsorption

bone marrow suppression

age

anemia risk factors: increased iron loss

GI bleed (ulceration)

regular blood donation

menstruation

elite athletes: iron loss through sweating

drugs: NSAIDs, aspirin, blood thinners

anemia risk factors: increased iron requirement

children aged 0 to 5, adolescent girls

pregnancy

women of childbearing age

anemia risk factors: decreased intake and malabsorption

vegetariansim or veganism

drugs that reduce stomach acidity

lack of balanced diet

GI ulcers or infections

foods: tea, coffee, calcium, flavonoids, oxalates, phylates

What are anemia s/s dependent on?

severity

onset

duration

metabolic requirements

concurrent problems

anemia manifestations

eyes: yellowing

skin: paleness, coldness, yellowing

resp: SOB

muscular: weakness

intestinal: changed color of stool

neuro: fatigue, dizziness, fainting

blood vessels: low BP

heart: palpitations, tachycardia, CP, angina, MI

spleen: enlargement

assessing anemia: Hg

expressed as grams per deciliter (100mL)

female adults: 12 - 16

male adults: 14 - 17

decreases after middle age

critical level: < 7

assessing anemia: Hct

% of volume of RBC in the blood

female adults: 36 - 48%

male adults: 42 - 52%

assessing anemia: iron studies

ferritin level

iron levels

assessing anemia: RBC indices

MCV/MCH

• normal = normocytic

• high = macrocytic

• low = microcytic

RDW

• high = large variation in RBC size

• low = all RBCs same size

hyperproliferative anemias examples

iron deficiency anemia

anemia in renal disease: kidneys produce EPO

anemia of inflammation

aplastic anemia

megaloblastic anemia: folic acid, vit B12 deficiency