Anemias: Fe deficiency and Blood transfusions

A set of practice flashcards covering anemia, iron deficiency, and blood transfusion procedures and safety.

What is the primary site of gas exchange in the lungs?

Alveoli

In the alveolus, which gas moves from the alveolar air into the blood?

Oxygen

In the alveolus, which gas moves from the blood into the air to be exhaled?

Carbon dioxide

Anemia is a reduction in which CBC indicators?

RBC count, hemoglobin, and hematocrit

Name the three main categories that cause a decrease in RBCs.

Increased destruction (e.g., autoimmune hemolytic anemia, G6PD deficiency); Decreased production (e.g., iron deficiency); Blood loss (acute trauma, gastritis, menstruation, hemorrhoids)

What does Hemoglobin (Hgb) measure?

Iron-rich protein in RBCs that carries oxygen

What is hematocrit?

The percentage of blood that is composed of packed red blood cells per deciliter; varies with age and sex

Normal hematocrit cutoffs (approximate) for men and women?

Men <38%, Women <35%

Two common causes of low hemoglobin.

Low iron intake/absorption; Menstrual bleeding

Two factors commonly associated with high hemoglobin.

Polycythemia vera; Chronic hypoxia (lung/heart disease, smoking)

Normal hemoglobin ranges by group

Adult male 13.5-17.5 g/dL; Adult female 11.5-15.5; Child 11.0-13.5; Newborn 15.0-21.0 g/dL

Common causes of anemia

Dietary problems, genetic disorders, bone marrow disease, GI bleeding

List the types of anemia mentioned.

Iron deficiency; Sickle cell disease; Vitamin B12 deficiency; Folic acid deficiency; Hemolytic anemia; Aplastic anemia; G6PD deficiency

Features of iron deficiency anemia.

Most common worldwide; decreased iron from blood loss, poor absorption, inadequate diet, chronic alcoholism; RBCs microcytic and hypochromic

How does anemia affect gas exchange?

Reduced oxygen transport leading to tissue hypoxia

Common signs of anemia on the skin and nails.

Pallor; cool to touch; brittle/concave nails

Key cardiovascular signs of anemia.

Tachycardia (especially with meals/activity); possible murmurs; orthostatic hypotension

Severity categories for anemia by hemoglobin.

Mild 10-14 g/dL; Moderate 6-10 g/dL; Severe <6 g/dL

Iron deficiency anemia labwork pattern.

Decreased Hgb/Hct; Decreased serum iron; Elevated TIBC; Decreased ferritin; Transferrin normal or decreased; Decreased MCV/MCH

Ferritin level indicating iron deficiency.

Ferritin <10 ng/mL (normal is 10-300 ng/mL)

Main treatment goal for Fe deficiency anemia.

Treat underlying cause and replace iron

Dietary sources of iron.

Iron-rich foods such as spinach, broccoli, lentils (also liver, beef, iron-fortified cereals, dried beans, green peas, potatoes with skin)

Oral iron therapy considerations: absorption and timing.

Use non-enteric-coated forms; absorbed best in duodenum/proximal jejunum; take 1 hour before meals; with vitamin C to enhance absorption; avoid with meals; 150-200 mg elemental iron daily

Indications for parenteral iron.

Malabsorption, intolerance of oral iron, need beyond oral limits, or poor adherence

Parenteral iron administration risks.

Can cause allergic reactions (IV forms); IM injections may stain skin; use proper technique (e.g., Z-track)

Nursing interventions for Fe deficiency anemia.

ADLs with rest/activity balance; monitor cardiorespiratory response; educate on meds and diet; increase protein, iron, and vitamin C intake

At-risk groups for Fe deficiency across the lifespan.

Infants (preemies), adolescent girls, pregnant women, older adults; NSAID gastritis; colon cancer; chronic disease

Reasons for blood transfusions.

RBC transfusions to replace cells after trauma or hemorrhagic shock or symptomatic anemia; Platelet transfusions for low counts/bleeding/procedures; Plasma transfusions to replace volume and clotting factors

Pretransfusion responsibilities.

Verify order with another RN; type/crossmatch; ABO/Rh compatibility; verify patient identity; inspect blood bag label; check expiration; prepare Y tubing with filter; have NS ready

During transfusion monitoring.

Baseline vitals; monitor every 15 min for first hour, then every 30 min, then hourly; use 0.9% NS; start slowly; stay with patient; report symptoms; monitor for hyperkalemia

Common transfusion reactions.

Febrile, Hemolytic, Allergic, Bacterial, Circulatory overload, GVHD

Febrile transfusion reaction symptoms.

Fever, headache, chills, flushing, tachycardia, anxiety; stop transfusion and notify physician

Hemolytic transfusion reaction signs.

Low back pain, hypotension, tachycardia, fever/chills, chest pain, tachypnea, hemoglobinuria; immediate onset

Allergic transfusion reaction signs.

Mild: hives/pruritus/flushing; Severe: shortness of breath, bronchospasm

Nursing actions for suspected transfusion reactions.

Stop transfusion, notify physician, change IV tubing, treat symptoms, recheck crossmatch

Hemolytic transfusion reaction diagnostics.

Obtain 2 blood samples distal to infusion site; first urinalysis for hemoglobinuria; monitor fluids/electrolytes