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IRON DEFICIENCY ANEMIA

Hematological Disorders

Introduction

  • Speaker: Gary Michael Lose Cheshire, MBA, BSN, RN, CMSRN, MSN(c)

Use of Artificial Intelligence

  • This presentation incorporates AI-assisted content for drafting and editing purposes.

  • Portions of the content and phrasing were generated or refined using OpenAI’s ChatGPT.

  • Reference: OpenAI. (n.d.). ChatGPT [Large language model]. https://chat.openai.com/

Objectives

  1. Describe the causes, manifestations, and treatment of macrocytic and microcytic anemias.

  2. Discuss polycythemia vera and its causes.

  3. Identify the causes of leukocytosis and leukopenia.

  4. Describe the etiologies, manifestations, and treatment of thrombocytopenia and thrombocythemia.

  5. Explain the normal clotting mechanisms and alterations in function.

Overview of Anemia

Definition

  • Anemia: Reduction in RBC, hemoglobin, or hematocrit leading to decreased oxygen delivery to tissues.

Clinical Manifestations

  • General: Fatigue, weakness, pallor.

  • Specific: Tachycardia, shortness of breath, dizziness.

Classification

  • Types Covered: Microcytic hypochromic (Iron deficiency), Macrocytic normochromic (Pernicious anemia, folic acid deficiency).

Iron Deficiency Anemia (IDA)

Definition

  • Most common anemia type worldwide due to insufficient iron for hemoglobin synthesis.

Pathophysiology

  • Iron is essential for hemoglobin production; deficiency reduces oxygen delivery.

  • Resulting RBCs are microcytic and hypochromic.

Causes

  1. Inadequate intake: Poor diet, exclusively cow's milk for infants.

  2. Increased demand: Pregnancy, growth spurts.

  3. Chronic blood loss: GI bleeding, menorrhagia.

  4. Malabsorption: Celiac disease.

Clinical Manifestations

  • Symptoms similar to general anemia; unique signs include glossitis, cheilitis, koilonychia, and pica.

Diagnostics

  • CBC: Shows microcytic, hypochromic anemia; iron studies indicate low serum iron and ferritin.

Complications

  • Impaired growth in children; severe untreated cases risk angina and heart failure.

Treatment

  1. Oral iron supplements (Ferrous sulfate); dietary improvements.

  2. IV iron for severe cases or malabsorption.

Nursing Responsibilities

  • Administer iron supplements with Vitamin C for efficacy.

  • Monitor lab values (Hgb, Hct, ferritin).

Pernicious Anemia

Definition

  • A type of megaloblastic anemia due to vitamin B12 deficiency, specifically lack of intrinsic factor.

Pathophysiology

  • Intrinsic factor absence leads to malfunction in B12 absorption and subsequent RBC development.

Causes

  1. Autoimmune destruction of gastric parietal cells.

  2. Gastric surgery leading to loss of intrinsic factor.

Clinical Manifestations

  • General anemia symptoms with neurologic signs like paresthesias and cognitive changes.

Diagnostics

  • CBC shows macrocytic anemia; anti-intrinsic factor antibodies present.

Treatment

  • Lifelong B12 replacement therapy through IM injections or high-dose oral formulas.

Folic Acid Deficiency Anemia

Definition

  • Megaloblastic anemia due to insufficient folate.

Pathophysiology

  • Folate deficiency leads to impaired DNA synthesis and anemia.

Causes

  1. Dietary insufficiency or malabsorption.

Clinical Manifestations

  • Symptoms resemble general anemia; unique signs notably lack neuro symptoms.

  • Associated with increased neural tube defects in pregnancy.

Diagnostics

  • CBC shows macrocytic anemia; serum folate levels low.

Treatment

  • Oral folic acid supplements; IV/IM as needed; diet rich in folate.

Complications

  • Associated with increased neural tube defects in pregnancy.

Polycythemia

Definition

  • Abnormal increase in RBC mass leading to increased blood viscosity and clotting risk.

Pathophysiology

  • RBC mass increases due to primary conditions like Polycythemia Vera or secondary causes such as chronic hypoxia.

Causes

  • Primary polycythemia (Polycythemia vera): Myeloproliferative disorder.

  • Secondary polycythemia: Chronic hypoxia or excess EPO from renal tumors.

Clinical Manifestations

  • Symptoms include headache, dizziness, ruddy complexion, and potential thrombotic events.

Diagnostics

  • CBC shows elevated RBC, Hgb, and Hct levels; JAK2 mutation testing for PV.

Complications

  • Hypertension, clot formation, stroke/MI (from overproduction of RBCs).

  • Increased blood viscosity and clotting risk, potential thrombotic events.

Treatment

  • Phlebotomy for PV; hydroxyurea for high-risk patients; managing secondary conditions.

Thrombocytopenia

Definition

  • Reduction of circulating platelets below 150,000/\mu L, impairing clot formation.

Pathophysiology

  • Reduced platelet count leads to increased bleeding risks due to various factors including bone marrow suppression, drug-induced destruction, and sequestration.

Causes

Decreased Production

  • Aplastic anemia, leukemia, chemotherapy.

Increased Destruction

  • ITP, HIT, DIC.

Sequestration

  • Hypersplenism related to liver disease.

Clinical Manifestations

  • Symptoms include petechiae, bruising, mucosal bleeding.

Diagnostics

  • CBC showing platelet counts; peripheral smears for abnormalities, bone marrow evaluations.

Complications

  • Increased bleeding risks.

Treatment

  • Depends on the underlying cause; may require transfusions, corticosteroids, or monoclonal antibodies.

Thrombocythemia

Definition

  • Elevated platelet counts leading to increased clotting and paradoxical bleeding risk.

Pathophysiology

  • High platelet production may stem from primary (essential thrombocythemia) or secondary conditions.

Causes

  • Primary (essential thrombocythemia) or secondary conditions.

Clinical Manifestations

  • Asymptomatic often; can lead to thrombotic events or bleeding symptoms.

Diagnostics

  • CBC showing elevated platelets; peripheral smears and genetic testing for ET.

Complications

  • Increased clotting and paradoxical bleeding risk, thrombotic events.

Treatment

  • Low-dose aspirin for low-risk scenarios, cytoreductive therapy for high-risk patients.

Clotting Mechanisms

Overview

  1. Vascular Response: Initial vasoconstriction reduces blood loss.

  2. Platelet Phase: Platelets aggregate and form a temporary plug.

  3. Clotting Factors: Cascade activates factors leading to fibrin formation.

Pathophysiology

  • Platelets play essential roles in adhesion and aggregation during injury response (normal clotting).

Clotting Disorders

Classification (Causes/Definitions)

  • Bleeding Disorders (Hypocoagulable):

    • Examples: Hemophilia, vitamin K deficiency.

  • Clotting Disorders (Hypercoagulable):

    • Examples: Factor V Leiden, antiphospholipid syndrome.

Clinical Manifestations

  • Bleeding: Easy bruising, prolonged bleeding.

  • Thromboembolism: DVT, PE, stroke.

Complications

  • DVT, PE, stroke.

Disseminated Intravascular Coagulation (DIC)

Definition

  • Life-threatening condition characterized by widespread microthrombi leading to severe bleeding.

Pathophysiology

  • Triggering of coagulation leads to consumption of clotting factors and simultaneous bleeding issues.

Causes

  • Includes sepsis, trauma, malignancies, obstetric complications.

Clinical Manifestations

  • Symptoms variable depending on severity; may include bleeding and thrombosis throughout the body.

Complications

  • Widespread microthrombi leading to severe bleeding, life-threatening condition.

Treatment

  • Address underlying cause, supply blood products for present bleeding, monitor closely in ICU situations.

References

  • Capriotti, T. M. (2023). Davis Advantage for Pathophysiology: Introductory Concepts and Clinical Perspectives (2nd ed.). F.A. Davis Company.