Raw Basic Anemias

17 Jan

Since everybody else as done a very good job with some in depth coverage of the different anemias, guess I’ll throw out a basic “easy memory” review with pictures!

Lets start with anemias with normal looking blood cells (General Anemias)

— The RBCs in general anemia appear to be normal however they may be in the wrong place due to patient bleeding. This bleeding could be occult, from a traumatic injury, or due to another bleeding disorder. There can also be less blood cells produced or more of them destroyed such as the fragmented RBC on the bottom right of the diagram.

-Heart must pump harder and faster in order to keep the body oxegenated with less O2 carriers around. Patient becomes fatigued and week and may have chest pain and confusion.

-Patient treated by stoping the cause of the bleeding, keeping them calm, comfortable, hydrated, and 02 perfused.
(more under the cut)

IRON DEFICIENT ANEMIA (pale pink blood cell second down on left)

–Most common type of anemia; not enough iron needed for making heme so what RBCs patient has tend to be amlformed, small, and pale. Can be caused by chronic bleeding, inadiquate diet and malabosprtion secondary to GI disorders, pregancy without supplementation and alcohol/substance abuse.

-Patient will have brittle nails and hair, be pale and tired, have smooth painful red tongue, low feritin when tested, cracks at corners of the mouth, and weird food cravings (Pica).

–Treat with the stoppage of blood loss, suppliments (12-15mg/day) and watch for anaphalxis. Always have Epi on hand when giving IV/IM iron and use Ztrack method as to not tattoo your patient. Give PO med with straw and orange juice

MEGOBLASTIC ANEMIAS (B-12 and Folic acid)

Big fragil cells with short life spans here like the one on the top right. They have a large nucleus and are big and bloated. Caused by the cell not being made correctly.

–Both Pernicious and Folic acid anemias have the same symptoms (smooth, sore, red beefy tongue, pallor/jaundice, diahrrea, britter spoon shaped nails, cracking at mouth corners) HOWEVER only B12 has CNS alternation (numbness, tingling, poor spacial perception) REmember: NO B-12 = no Balance!

Treat both with supplimentation.

SICKLE CELL (see funky looking RBC on bottom left)

–Genetic cause. Cells “sickle” when offloading O2 then get stick in vessels causing tissue ischemia, severe pain, damage to major joints. Can be managed but not cured.

–Can lead to Acute Chest syndome or Aplastic Anemia.

TReat patient with good FORM: Fluids, O2, Rest, Morphine (opiod pain reliever)

–Crisis can be brought on from anything from extreme post, dehydration, infection, stress, excessive activity, or living at high altitudes.

APLASTIC ANEMIA , Pancytopenia

–Not enough RBCs or other formed items in blood which means the patient has no defense against invading pathogens, and also trouble with blood clotting.

–Usually ideopathic but can be a complication of sickle cell, abnormal immune responce, viral infection, chemcial exposure (Benzine, paint remover, Nitrogen mustard, chemo drugs), radiation etc.

Many patients treated with Cyclosporin (http://books.google.com/books?id=5zd_W_PUwvYC&lpg=PA663&ots=SUAjrp2O9F&dq=cyclosporine%20nursing%20care&pg=PA663#v=onepage&q=cyclosporine%20nursing%20care&f=false)

When giving Cyclosporin there are some things we should know and teach to patients who are getting the drug at home:

LIQUID PO: measure carefully, give with apple or orange juice to help with flavor and mix in a GLASS glass, not plastic if possible. Stir, give to patient and have them drink it right away. Refill glass with dilutent and give again to make sure they got all of the dose. Do not give with fatty foods. This drug interacts with many others.

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