Chapter 31

Blood Dyscrasias

Abnormalities in the total numbers, development, or function of blood cells.

Coagulopathies

Bleeding disorders resulting from defects or deficiencies in platelets or plasma clotting factors.

Iron-Deficiency Anemia in Older Adults

Unusual under normal circumstances due to increased total body iron stores with age.

Chronic Blood Loss

Anemia in older adults should immediately raise suspicion of _______ from the gastrointestinal or genitourinary tract.

Socioeconomic Factors

Inadequate iron intake in older adults may occur due to factors like living on a fixed income or inability to shop.

Pernicious Anemia

Vitamin B12 deficiency that produces neurological manifestations including memory loss and confusion.

Vitamin B12 Absorption

Age-related decline in gastric acidity impairs _______ absorption.

Folic Acid Deficiency

Contributes to depression, cognitive decline, and psychosis in older adults.

Acute Lymphoblastic Leukemia (ALL)

Carries a very poor prognosis in older adults due to inability to tolerate prolonged pancytopenia.

Normocytic

Normal cell size.

Microcytic

Abnormally small cell size.

Macrocytic

Abnormally large cell size.

Megaloblastic

Abnormally large, immature precursor cell.

Normochromic

Normal concentration of hemoglobin.

Hypochromic

Decreased concentration of hemoglobin (pale color).

Hyperchromic

Increased concentration of hemoglobin.

Aplastic

Severe decrease in cell production.

Hemolytic

Premature destruction of circulating erythrocytes.

Complete Blood Count (CBC)

A laboratory test that provides information about the cellular components of blood.

Red Blood Cells (Erythrocytes) Reference Values - Adult Males

$4.6-6.2 \times 10^6/\text{mm}^3$.

Hematocrit Reference Values - Adult Males

40-54\text{ %}.

Hemoglobin Reference Values - Adult Males

$13.5-18.0\text{ g/dL}$.

Mean Cell Volume (MCV) Reference Values - Adult Males

$80-94\text{ }\text{µg/m}^3$.

Mean Cell Hemoglobin (MCH) Reference Value

$27-31\text{ pg/cell}$ (males and females).

Mean Cell Hemoglobin Concentration (MCHC) Reference Value

$32-36\text{ g/dL}$ (males and females).

Reticulocyte Count Reference Value

0.5\text{-}2.0\text{%} of total RBCs.

Platelets Reference Value

$150,000-450,000/\text{mm}^3$.

Definition of Anemia

A reduction below normal in erythrocyte numbers, hematocrit, or hemoglobin concentration.

Primary Anemia Mechanisms

Blood loss, inadequate or defective erythrocyte production, or accelerated premature destruction.

Clinical Manifestations of Anemia

Orthostatic hypotension, thready pulse, fatigue, and pallor.

Hypovolemic Anemia Etiology

Results from loss of circulating intravascular blood volume.

Acute Severe Blood Loss Causes

Trauma or gunshot wounds.

Chronic Blood Loss Conditions

Peptic ulcer disease or uterine fibroids.

Assessment Findings in Acute Hypovolemia

Marked pallor, severe tachycardia, hypotension.

Treatment for Acute Severe Blood Loss

Transfusions and treating the underlying cause.

Iron-Deficiency Anemia Pathophysiology

Depletion of iron stores leads to inadequate hemoglobin synthesis.

Iron Absorption Percentage

Diets absorb less than 10\text{%} of ingested iron.

Dietary Sources of Heme Iron

Beef, pork, lamb, and dark meat poultry.

Iron Supplement Administration

Recommended to be taken every other day.

Sickle Cell Disease Genetics

Autosomal recessive disorder affecting 1 in 365 Black infants.

Sickle Cell Disease Trigger Factors

Hypoxia, cold, infection, or dehydration.

Sickle Cell Disease Complications

Vaso-occlusive crises, stroke, acute chest syndrome.

Diagnostics for Sickle Cell Disease

Hemoglobin electrophoresis to differentiate trait from disease.

Management for Sickle Cell Pain Crises

Scheduled IV opioids and hydration.

Thalassemias

Hereditary hemolytic anemias divided into Alpha and Beta-thalassemias.

Cooley Anemia Symptoms

Severe beta-thalassemia causing bronzing of skin and severe anemia.

Pernicious Anemia Increase Causes

Intrinsic Factor deficiency prevents absorption of Vitamin B12.

Pernicious Anemia Neurological Symptoms

Glossitis, paresthesias, confusion, and depression.

Folic Acid Deficiency vs B12 Deficiency

Folic acid deficiency does NOT cause irreversible neurological damage.

Management for Folic Acid Deficiency

Oral folic acid or parenteral folate for malabsorption.

Polycythemia Vera Definition

Unregulated marrow proliferation of erythrocytes, leukocytes, and platelets.

Polycythemia Vera Complications

Hyperviscosity leads to hypertension, stroke, and heart failure.

Agranulocytosis

Severe reduction in granulocytes due to drug toxicity.

Pancytopenia Causes

Bone marrow failure leading to deficiency of all blood cell types.

Assessment in Pancytopenia

Severe anemia symptoms, opportunistic infections, and bruising.

Thrombocytopenia Definition

Deficiency of platelets caused by decreased production or destruction.

Hemophilia Types

Classification includes Hemophilia A, B, and C.

Hemophilia Risk Management

Eliminate aspirin and NSAIDs; avoid injury.

Recombinant Factor Concentrates

Used in the medical management of hemophilia.

Client Education for Hemophilia

Use soft toothbrush, avoid trauma, report bleeding.

Multiple Myeloma Definition

Malignancy of plasma cells leading to bone lesions.

CRAB Acronym in Multiple Myeloma

Calcium elevation, Renal insufficiency, Anemia, Bone lesions.

Drug Therapy Options in Multiple Myeloma

Includes chemotherapeutics, immunomodulators, and bisphosphonates.

Nursing Management for Multiple Myeloma

Fluid intake to prevent renal damage; gentle handling.

Evidence-Based Practice in Sickle Cell Disease

Hydroxyurea dose escalation reduces stroke risk in children.

Skin Changes in Sickle Cell Disease

Joint swelling, pain, and potential for skin ulcers.

Nursing Process for Leukemia

Assessment for weakness, fatigue, and frequent infections.

Absolute Neutrophil Count (ANC) Calculation

\text{ANC} = \frac{\text{WBC} \times (\text{% neutrophils} + \text{% bands})}{100}.

Neutropenic Precautions

Private room, strict hygiene, and no raw foods.

Bleeding Risk Monitoring in Leukemia

Monitor platelet count and signs of mucosal bleeding.

Client Teaching for Aplastic Anemia

Gentle oral hygiene and soft food diet.

Management for Agranulocytosis

Withdraw drug and administer neupogen or pegfilgrastim.

Thrombocytopenia Management

Eliminate cause, corticosteroids, and possible splenectomy.

Nursing Education for Coagulopathy Patients

Avoid activities that could result in injury.

Hematologic Disorders Overview

Many have overlapping diagnostic approaches despite differing causes.

Iron Chelation Therapy

Treats iron overload from frequent blood transfusions.

Monitoring Requirements for Vitamin B12 Deficiency

Lifelong monitoring required in patients with pernicious anemia.