Anemia and blood transfusions

anemia

decreased amount or dysfunctional red blood cells(RBCs) and/or hemoglobin(Hgb) leading to decreased O2 and tissue hypoxia

anemia causes

decreased production due to low hormones(T4-hypothyroidism, erythropoietin) decreased nutrients(iron, Vit. B12) drugs/toxins(cancer, chemo, ETOH)

blood loss

increased destruction of red blood cells(sickle cell, incompatible blood)

anemia diagnostics

complete blood count(CBC, H&H) HGB 12-18, HCT 40-50%, RBC 4.2-6.2

Blood smear to show size(macrocytic, microcytic) shape and color

mild-moderate anemia clinical manifestations

Mild HGB 10-12: no s/s, increased HR, SOB and mild fatigue with activity

Moderate HGB 6-10: s/s at rest

severe anemia clinical manifestations

Severe HGB less than 6: s/s at rest, pallor in skin and eyes, severe fatigue, headache, poor concentration, murmur

anemia complications

severe and long enough anemia leads to heart failure, chest pain and myocardial infarction

anemia treatment

alternate rest and activity, aid with activities, monitor cardiopulmonary status during activity, treat specific anemia, blood products

iron deficiency anemia

inability to make enough hemoglobin due to decreased iron intake, chronic blood loss, decreased GI absorption or increased iron need(pregnancy) MOST COMMON TYPE

iron deficiency anemia clinical manifestations

early, asymptomatic then general s/s, glossitis(swollen large tongue), headache and pica

iron deficiency anemia diagnostics

MCV, Fe, ferritin, transferrin

iron deficiency anemia treatment

iron replacement through diet(meat ,egg, dark leafy greens), supplements(dilute and use straw, take with vit. C, take on empty stomach), IV/IM injection

cobalamin deficiency anemia

decreased vitamin D(cobalamin) leading to decreased RBC production

cobalamin deficiency anemia causes

pernicious anemia, can’t absorb vit. B12(no intrinsic factor or ileum disease)

can be from decreased intake but rare

cobalamin deficiency anemia clinical manifestations

general s/s, glossitis, neuro(paresthesia/balance and gait disturbances), GI upset(anorexia)

cobalamin deficiency anemia diagnostics

decreased B12, levels, increased MCV size, blood smear

cobalamin deficiency anemia treatment

supplement vitamin B12

acute blood loss anemia

sudden RBC volume loss commonly caused by GI bleed, trauma, surgery

acute blood loss anemia clinical manifestations

10%/500 mL: none

20-30%/1000-1500 mL: postural hypotension, increased HR and RR with exercise

40%/2000 mL: increased HR worsens, decreased BP, decreased UO, decreased LOC, SOB, pale/cold/clammy skin

50%/2500 mL: hypovolemic shock, potential death

S/S related to hypoxia and hypovolemia is SEVERE blood loss

acute blood loss anemia diagnostics

find bleeding source, stool occult blood test, colonoscopy, endoscopy, wound

acute blood loss anemia treatment

decreased blood pressure lay flat or Trendelenburg, apply pressure if applicable, O2, IV fluids, find bleeding source, iron

blood transfusions

whole blood: use for massive hemorrhage

packed red blood cells: use for anemia/blood loss

fresh frozen plasma: use for decreased clotting factors and adding volume

albumin: use for hypovolemia hyperosmolar protein expands blood volume by 3.5x

platelets: use for thrombocytopenia

before blood transfusion

patent large bore IV, informed consent, type and cross match, start transfusion within 30min of receving blood, baseline VS and lung sounds, prime filter Y tubing NS

during blood transfusions

blood runs alone, start slow(2ml/min, plasma infuse in 15-30 minutes), stay with pat 1st 15min watch for reaction, increase rate if tolerated(fully infuse within 2-4hrs) Q30min VS during and 1hr after infusion

transfusion reactions

allergic: s/s rash, itching, flushing, give IV benadryl and monitor for anaphylactic shock(give epi and cortico)

febrile: increased temp, chills, headache, give tylenol

hemolytic: incompatible blood(human error), IV site or back pain, fever, chills, decreased BP and increased HR, SOB, AKI, shock

blood transfusion reaction steps

stop transfusion, new NS TKO, VS, call MD, obtain urine and blood specimen, save tubing bag to send to blood bank, document

blood transfusion other complications

circulatory overload: pt can’t tolerate blood rate or volume, pt at risk for HF/kidney failure, increased BP/RR, SOB. Slow transfusion

hypothermia: when large volumes of cold blood is infused rapidly, warm blood

hypocalcemia: citrates bind with Ca then is excreted

sepsis, hyperkalemia

autotransfusion/autologous transfusion

remove whole blood and transfuse it back into the same pt(avoids incompatibility, allergic reaction and disease transmission problems)

planned, pt donates blood weeks before and its stored

unplanned, blood lost collected in container and automatically/continuously reinfused