Anemia

Iron deficiency anemia early s/s

pale
tachycardia
sob
forgetfulness
fatigue

iron deficiency anemia late s/s

cheilosis
glossitis

pica

iron deficiency lab findings

low RBC

low HGB & HCT

hypochromic cells
microcytic cells

misshapen cells

heme iron

comes from animal productsno

non-heme iron

comes from plant sources (vegetables, fortified cereals)

non-heme iron should be taken with

VITAMIN C

non-heme iron should not be taken with [3]

calcium
alkaline foods
antacids

Glossitis and Oral Complications Management [5]

non-alc mouthwash
soft toothbrush

chapstick

nonacid foods

room temp foods

iron supplementation should be taken on

an empty stomach

ferrous sulfate se [4]

gi upset

constipation

liquid iron staining teeth

dark or black stools

IV iron

bypass GI upset

still have constipation

no teeth staining

vitamin b12/pernicious anemia results from [4]

pernicious anemia
surgical removal of stomach or small bowel

gi absorption diseases
metformin & ppi long term uses

pernicious anemia s/s

slow onset
n/v/d
glossitis

woolen tongue

anorexia

decreased reflexes

memory loss

ataxia

biggest signs of pernicious anemia

neurological changes

hyperpigmentation of knuckles and fingers (darker in color)

pernicious anemia labs

MACROCYTIC cells

misshapen RBCs

fragile RBCs

pernicious anemia treatment

dietary changes

IV/B12 injections

vitamin b12 look out for

POTASSIUM levels

folate deficiency anemia

results in stunted growth, immature RBCsf

folate is found in [3]

leafy greens

legumes

citrus fruits

people @ risk for folate deficiency [5

ppl w/ poor diets
elderly
alcoholics
athletes
children
drug use hx

TPNNNNNNNN

folate anemia s/s

slow onset
n/v/d

GI upset

glossitis

flaky skin

pallor

sob

tachycardia

NO NEUROLOGICAL SYMPTOMS

low folate in pregnancy causes [2]

neutral tube defects

spina bifida

blood loss anemia is caused by

fast, extreme blood loss

hemodilution causes low iron

blood loss anemia initial s/s [3]

vasoconstriction

tachycardia

fluid shifts

blood loss anemia late s/s

cyanosis

hypotension

bradycardia

initial blood loss anemia lab findings

NORMAL RBCs

blood loss anemia treatment

stop bleeding
blood transfusion
IV fluid bolus

chronic blood loss late symtpoms

microcytic & hypochromic RBCsc

chronic blood loss treatment

stop bleeding

avoid blood thinners

hemolytic anemia def

rbcs destroyed faster than body can create them

hemolytic anemia etiology [5]

cellular defects

enzyme deficiencies

drugs or chemicals

severe venoms

trauma

genetic disorders

what is released in hemolytic anemias?

reticulocytes

thalassemia

genetic condition
rbc missing internal portion of structure

thalassemia treatment

1. blood transfusions

2. stem cell therapy

3. bone marrow transplant

acquired hemolytic anemia

destroyed RBCs NOT genetic

common causes of acquired hemolytic anemia [5]

burn patients

autoimmune diseases

hemodialysis

transfusion reactions

infections

treatment of acquired hemolytic anemia

treat the underlying cause
hemolysis stops when trigger factor treated

G6PD Deficiency

INBORN DEFECT IN METABOLISM OF RED BLOOD CELLS

causes increased RBC hemolysis

results in increased metabolic demand on RBCs

G6PD Presentation

asymptomatic
disease manifests when triggers apparent

triggers for G6PD [6]

fava beans

chocolate

mothballs

certain infections

stress

certain medications [aspirin, methylene blue, sulfa drugs]

medications that trigger hemolytic crisis [3]

aspirin

methylene blue

sulfa drugs

hemolytic crisis s/s

initial: gi upset
extreme: anemia [dark urine, jaundice]

sickle cell anemia genetics

both parents have trait

sickle cell crisis [3]

reduced oxygen carrying capacity

vessel obstruction

pain

sites for vaso-occlusive crisis [4]

hands & feet

back & abdomen
chest
joints

triggers for vaso-occlusive crisis [6]

dehydration
weather changes

infections

stress

intense exercise

cold exposure

sickle cell crisis treatment

PAIN MANAGEMENT: OPIOIDS

PCA

HEAT

positioning

distraction

relaxation

exchange transfusion for sickle cells

double rubber cathether
blood removed, sickled cells filtered & removed

replaced with normal RBCs

hydroxyurea

stops cells from forming sickle shape

splenic sequestration

causes splenomegaly

treatment: splenectomy

acute chest syndrome immediate assessment

chest x-ray

aplastic anemia

bone marrow unable to produce RBCs

gets replaced by fats

panctyopenia

all types of blood cells are low

aplastic anemia s/s

weakness

fatigue

bleeding

aplastic anemia treatment

bone marrow transplant

neonatal anemia

syphilis, hiv, sepsis

iron deficiencies can develop in children if they have…

cleft palate or latching issues

breast feeding paretn has nutritional deficiencies

formula diluted w/ water

structural challenges to feeding

physiologic anemia of newborns

NORMAL

6-12 weeks: develops, but usually resovles on own

critical periods of increased iron needs in infants/young children

4-6 months

1-6 years

infant nutrition

no cow’s milk until 12 months

iron fortified foods @ 6 months

no diluting formula

#1 cause of anemia in pregnancy

iron deficiency

body uses iron stores for fetal development

plasma volume increases —> hemodilution

elderly iron considerations

kidneys fails to produce adequate erythropoietin

erythropoetin admin

indication: kidney disease patients

mech: stimulates bone marrow to release RBCs

erythropoietin considerations [4]

increased clot risk
monitor BP

provide iron supplementation

neuro status monitoring

corticosteroids indication

aplastic anemia

mech: anti-inflammatory

corticosteroid se [4]

hyperglycemia

moon face

weight gain

othersb

blood transfusion hemoglobin threshold

hgb < 7