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Alterations: Erythrocytes
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The Blood
Makes 7 10% of Total Body Weight (TBW) (F) 4 5 L; (M) 5 6 L pH: 7.35 7.45 Specific Gravity: 1.048 1.066 Functions as a: o Link To the different organ systems o Transporter / carrier Oxygen and nutrients, CO2, Glucose o Controller IF you lose blood homeostasis o Defender To foreign activities
Topics Discussed Here Are: 1. Anatomy and Physiology Of Blood 2. Anemia Iron Deficiency Anemia Megaloblastic Anemia Folic Acid Deficiency Anemia Pernicious Anemia (Vit B12) Hemolytic Anemia Aplastic Anemia 3. Polycythemia
Plasma
Liquid part of the blood; yellow in color Transporter medium for nutrients, wastes, hormones, electrolytes, gases Plasma is: o 30% - 96% H2O o 2% other small molecular substances o 6.5% to 8% Protein Albumin NORMAL VALUES: Prevents colloidal osmotic pressure Hemoglobin: Male: 13 18 gm/dL Big protein molecules Female: 12 16 gm/dL Remains in the interstitial space Regulates blood volume preventing Hematocrit: the occurrence of edema Male: 42 52% Female: 35 47% Prevents the shifting of water Serum Globulin Red Blood Cell: Alpha, Beta, Gamma Male: 4.6 6.2x1012 / L Female: 4.2 5.4x1012 / L For clotting factors Fibrinogen, Prothrombin, Plasminogen Iron: 50 160 ug/dL For clotting factors
Plasma 55% of Total Blood Leukocytes and Platelets < 1% Erythrocytes 45% of total Blood
Cellular Components
Red Blood Cells, White Blood Cells, Platelets
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RBC Production o Requirements for RBC Production Precursor Cells Proper microenvironment Iron, Vit. B12, Folic Acid, Protein, Pyridoxine and Copper RBC Differentiation o Reticulocytes = Body is attempting to compensate
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RBC Regulation o Tissue Oxygenation: (PPALL) Poor Blood Flow Pulmonary Disease Anemia Low Hemoglobin Low Blood Volume
RBC Maturation o 2 Important Vitamins 1. Folic Acid Green leafy vegetables 2. Vitamin B12 Meat ONLY! Formation of Hemoglobin
Nuclear Maturation and Division Iron Cycle o Absorbs and stored in the duodenum o Forms of iron in body 4 5 grams of Fe 65% Hmg 15 35% ferritin (Stored iron in liver) 4% Myoglobin (muscles) 19% variations heme compounds needed for intracellular oxidation 0.1% transferrin o After RBC death, Fe is being phagocytized by the Spleen o Fe is being reused
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GOALS OF MANAGEMENT:
1. 2. Correction of underlying cause Treatment through diet and supplemental iron preparations (Vitamin C)
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Fatigue - Adequate rest periods - Proper scheduling of activities Prepare patient for diagnostic testing - Schedule all tests to avoid disrupting patient meal, sleep and visiting hours - Finish first life activities before doing heavy ones Prevent complications - Observe for signs of bleeding - Monitor transfusions - Warn patient to change position slowly to minimize dizziness induced by cerebral hypoxia Set limitations on acts - Assess level of tolerance on acts - Frequent rest periods - Pace activities
Megaloblastic Anemia
Characterized by the production and peripheral proliferation of large, immature and dysfunctional RBCs Macrocytic Anemia
Types:
Vitamin B12 Deficiency (Pernicious) Anemia Folic Acid Deficiency Anemia
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Pernicious Anemia
Causes: (VAAGGGO) - Vitamin B12 Deficient in diet (no meat) - Auto-immune reaction Body attacking on B12 (Intrinsic factor) To be absorbed in the ileum for RBC production - Alcoholics - Gastric atrophy - Gastrectomy (no IF) - Gastritis, chronic - Older individuals Assessment Findings - Beefy red tongue - General S/Sx of anemia Weakness, Smooth Sore Tongue, Diarrhea - Paresthesia Abnormal sensation Tingling sensation in the fingertips - Impaired coordination and position sense - Confusion and behavioral change Laboratory Findings - Serum Folate Levels - Serum Vit B12 - Schillings Test Measure of excretion of orally administered radionuclide labeled B12 Urine Samples are collected Stage 1: Patient is given radionuclide labeled Vit B12 to drink or to eat IM is given at around the same time (temporary saturate B12 receptors in liver without normal B12) Normal result at least 5% radiolabeled Vit B12 in urine over 1st 24hrs Pernicious anemia less than 5% radiolabeled Vit B12 Stage 2: If abnormal, test is repeated with additional oral IF Normal urine collection = lack IF or pernicious anemia Low Result = abnormal intestinal absorption Result: No trace in urine (+) PERNICIOUS ANEMIA To absorb Vit B12, give IF After giving IF > Trace seen > (+)
Vitamin B12 Administration o Cyanocobalamine (oral, IV, IM) o Do not expose crystalline injection to light o Assess for other drugs o Administer parenteral doses IM or Deep SQ to local irritation o A burning sensation with injection is temporary o No to alcohol o Monitor Hmg, RBC, Reticulocyte count and K levels o Medication is taken for life Special Considerations o Monitor PR (Heart PUMPS!) o Compliance with lifelong Vit B12 o Diet, Plan activities (Fatigue) o Good Oral Hygiene (Angular Cheilitis) CNS complications
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Sickling Process
Exposure to low O2
Triggers: Stress (Anxiety, etc) Infections Cold Environment Physical exercise Acidosis, Altitudes (high) Dehydration
Defective Hmg
Sickle Cells
Signs and Symptoms o Severe anemia Pallor, weakness, tachycardia o Hyperbilirubinemia Jaundice o Splenomegaly o Vascular occlusions Pain, ulcers, infarcts, tissue death
Impede circulation
Tissue hypoxia
Microinfarcts
Diagnostics - Hb Electrophoresis Diagnostic test - DNA screening (neonates) - X-ray - Abdominal UTZ - Transcranial CT-Scan
Sickle Cell Crisis o Occurs when client experiences O2 resulting in the enlargement of rigid sickleshaped cells Vaso-occlusive crises/pain crises Aplastic crisis Infection with human parovirus Hyperhemolytic crises Sequestration crises
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Supportive Management: Acute Pain Assess PQRST Monitor effectiveness of analgesia Monitor I&O When dehydrated = O2 Apply heat to joints as ordered Provide rest periods Administer fluids Oral fluid intake Drugs: (MAN) Morphine Acetaminophen NSAIDS Other Pharmacological Management Hydroxyurea Sodium cromoglycate Folic acid supplement Fe supplement Blood transfusion Penicillin prophylaxis (Prevent infection) Pneumococcal vaccination (Prevent infection) Readiness for Enhanced Self-Care Client Education Explain nature of disease Adherence to treatment regimen, follow up Routine CBC count Genetic counseling Alert young women with sickle cell anemia that pregnancy carries a high-risk for them Explain complications and how to prevent crises
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Bone Marrow Transplant (BMT) - 3 Categories Autologous From Patient Syngeneic Transplant taken from identical twin Allogenic Transplant from an HLA-matched sibling or an unrelated HLA matching donor HLA = Human leukocyte antigen; match required to prevent rejection - Steps (Hindi naman ata important tooo) Conditioning Pre-treatment of bone marrow transplant recipient with high doses of chemotherapy +/- total body irradiation to destroy malignancy Bone Marrow Harvesting Needle is inserted into pelvis Bone marrow is collected from the donor under general anesthetic, 500 1200 mL of bone marrow from pelvis Processing Removal of red cells and to concentrate the mononuclear cells Transplantation Processed donor cells are injected into the recipient where they find their way to the bone marrow and attach Most critical days: First 100 days (post-transplantation) Before Transplantation: o Patient understanding o Procedure o Treatment protocol to be used o Venous access During Transplantation o Monitor VS o Maintain sterility o WOF: Complications After implementation: o Monitor VS o Administer meds o Provide good oral care o Meticulous skin care o Observe nursing care - Antithymocyte Globulin (ATG) Immunosuppressive agent Selectively destroys T-lymphocytes Gamma globulin from rabbits/horses that have been immunized against human thymocytes Indication: Aplastic anemia, transplant rejection WHY T CELLS? They attack the bone marrow
Polycythemia
Erythrocytosis Excessive of RBCs Hct higher than 55% Can be Primary, Secondary, or Relative
Secondary Polycythemia
Something that is normal Physiologic disease (Physiologic Polycythemia) Occurs as a response to an elevated erythropoietin levels
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Relative Polycythemia
Not due to excess RBC production Fluid DEFICIT RBC count is normal but fluid loss increases cell concentration Corrected by rehydration
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