HEMATOLOGI

C
DISORDERS
BY: JOHN ARBIE T.
TATTAO, RN
ANEMIA
A reduction in
RBC that in turn ↓
the oxygen
carrying capacity
of the blood
 Major causes of
anemia
Loss of RBC’s
Deficiencies and
abnormalities of
erythrocyte production
Destruction of RBC
Major classification of
anemia
A. Hypoproliferative
Anemia
ØBone marrow cannot
produce adequate
number of RBC
Major classification of
anemia
B. Hemolytic
Anemia
ØResults in
premature
destruction of
Major classification of
anemia
C. Anemia resulting
from loss of RBC
> ex: bleeding from
GIT, trauma,
menorrhagia, chronic
 iron- deficiency
anemia
PROBLEM: chronic,
microcytic, hypochromic
anemia resulting from
inadequate absorption or
excessive loss of iron
leading to hypoxemic
 iron- deficiency
anemia
CAUSES:
Predisposing Factors
C.Chronic blood loss
4.Trauma
5.Menorrhagia
6.GIT bleeding
iron- deficiency
anemia
B. Inadequate intake of food
rich in iron
2.Chronic diarrhea
3.Malabsorption syndrome
4.High cereal intake with low
animal protein ingestion
5.Subtotal gastrectomy
 iron- deficiency
anemia
S/SX OR CLINICAL
MANIFESTATIONS:
ØPlummer Vinsons Syndrome
ØEarly Sx are nonspecific, includes
fatigue, weakness, SOB, pale
conjunctiva
ØKoilonychia
ØCheilosis
 iron- deficiency
anemia blood smear reveals
Peripheral
microcytic and hypochromic RBC
CBC reveals:

Ø↓ Hgb to as low as 6-9 g/dl

Ø↓ total RBC count
Ø↓ Hct levels in relation to ↓ Hgb
ØRBC indices reveals ↓ MCV, MCH,
MCHC
 iron- deficiency
Serum
anemia iron reveals ↓
levels
IDA - ↓ 10mg/dl N: 50 – 150
mg/dl
Decreased serum ferritin
levels
Complete absence of
 iron- deficiency
anemia
MANAGEMENT:
Drugs/Pharmacology:
ØIron Supplement
d.Oral (Ferrous sulfate, Ferrous
gluconate, Ferrous Fumarate)
NURSING RESPONSIBILITY:
1. Advice pt. to take supplement 1
hr. Before meal
 iron- deficiency
2.anemia
Administer iron
supplement with meals if
taking it on empty stomach
causes gastric distress
3. Administer w/ straw if
diluting in iron liquid prep.
4. Do not take antacids or
 iron- deficiency
5.anemia
↑ intake of Fe: Take iron w/
orange juice
6. Monitor and inform patient for
S/E
c.Melena
d.Anorexia
e.Diarrhea/Constipation
f. N/V
 iron- deficiency
anemia Iron Therapy
ØParenteral
Administered to pt. Who:
c.Have an intolerance to oral
preparations
d.Continue to suffer blood loss
e.Habitually forgetting to take
their medication
 iron- deficiency
anemia
NURSING RESPONSIBILITY
2.Administer with the use of Z tract
method
3.Don’t massage injection site
4.Ambulate
5.Monitor pt for S/E
a. Fever/chills
b. Lymphadenopathy
c. Urticartia
 iron- deficiency
anemia
d. Pain at injury site
e. Localized abscess
f. Hypotension sec. to
anaphylactic shock
DIET:
ØIron rich foods (ex: egg yolk,
legumes, raisins, beans, organ
meat, GLV)
 iron- deficiency
anemia
Monitor signs of bleeding
Advice pt. to have CBR
Provide good oral care
Instruct pt. to avoid
taking tea/coffee
 iron- deficiency
anemia intake of Fe rich
Encourage
foods
Encourage pts. to continue Fe
therapy as long as it is
prescribed even though patient
may no longer feel fatigued
Inform pt. that iron causes the
stool to become dark green or
iron- deficiency
anemia
Administer meds
as ordered
Blood transfusion
as necessary
Megaloblastic/macrocytic
anemia
Anemias caused by
deficiencies of Vit. B12 and
folic acid
Characterized by the
appearance of
megaloblasts (large,
primitive RBC’s) in blood
 Pernicious anemia
PROBLEM: Chronic,
macrocytic, hyperchromic
anemia caused by failure of
absorption of Vit. B12 due
to deficiency of intrinsic
factor leading to
 Pernicious anemia
CAUSES:
Total gastrectomy/Ileal
resection
Atrophy of gastric mucosa
Imflammatory disease of
ileum
Strict vegetarian diet
 Pernicious anemia
S/SX:
Red beefy tongue
Headache, dizziness,
dyspnea, palpitations,
generalized body malaise,
pallor
 Pernicious anemia
GIT changes – mild diarrhea
Dyspepsia
Neurologic Manifestations:

d.Peripheral Neuropathy and

loss of balance
e.Confusion
f. Paresthesia in extremities
 Pernicious anemia
Lack of balance,
uncoordinated movement
Loss of proprioception
Depression, psychosis
Achlorhydria
 Pernicious anemia
LABS/DX EVALS:
Schillings Test – measure the
absorption of orally
administered radioactive Vit
B12 before and after
parenteral administration of
intrinsic factor
Purpose: Used to detect Vit
 Pernicious anemia
Procedure:

2.Administration of oral
radioactive vit B12
3.Administration of large,
nonradioactive parenteral
dose of vit b12 followed in a
few hrs.
 Pernicious anemia
Procedure:
3. The same procedure is
repeated, but this time
intrinsic factor is added to
the oral radioactive Vit b12
Interpretation: Absorption of
Vit B12
 Pernicious anemia
Nursing Responsibility:
2.Collect 24 hour urine
specimen
3.Keep pt NPO, except for H2O
8-12 hours before the test
4.Promote pt understanding on
proc. And emphasize ability
 Pernicious anemia
MANAGEMENT:
Drug/Pharmacology:
c.Vit B12 injections
Nx. Resp:
5.Administer Vit B12 injections at
monthly intervals for lifetime as
ordered.
6.Oral administration is used only
in cases of nutritional deficiency
 Pernicious anemia
Diet:
Ø↑ calorie or CHO, ↑ CHON, iron
and Vit. C
Nursing Intervention:
4.Enforce CBR
5.Administer medication as
ordered
6.Avoid irritating mouthwash.
 Pernicious anemia
Nursing Intervention:
4. Avoid applying electric
heating pads
5. Administer blood
transfusion as needed
6. Physical examination q 6
months
 Folic acid deficiency anemia
PROBLEM: malabsorption of
dietary folic acid due to lack
of intake or absorption
CAUSE:
c.Poor dietary intake
d.Poor GI absorption
e.Folate antagonists
 Folic acid deficiency
d.anemia
Increase requirement
S/SX:
ØSame to PA but w/o neurologic
involvement
ØSigns of poor oxygenation
e.Dizziness
f. Irritability
g.dyspnea
Folic acid deficiency
anemia
d. Pallor
e. Headache
f. Oral ulcers
g. Tachycardia
Folic acid deficiency
anemia
Labs/Dx Evals:
2. RBC indices reveals ↑ MCV and ↓MCHC
3. Serum folate levels reveals less than 4
mg/ml (N: 7 to 20 mg/ml)
4. Schilling test reveals normal finding
5. Blood smear reveals large RBC
6. Therapeutic trial reveals client
responding to 50 to 100mg folic acid
administered IM for 10 days.
Folic acid deficiency
anemia
MANAGEMENT:
Drug/Pharma Therapy
3.Administer oral doses of
folic acid 0.1 to 5.0
mg/day until the blood
profile improves or until
the cause of intestinal
Folic acid deficiency
anemia
2. Clients with malabsorption
syndromes may need parenteral
folic acid initially, followed by
maintenance therapy with oral
doses
Diet/Nutritional Therapy
↑ foods high in FA (mostly plant
sources)
Folic acid deficiency
anemia
Nursing Intervention:
2.Administer meds as
ordered
3.Referral to AA for
alcoholic patients
4.Proper food preparation