Hematology III

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<ul><li><p>RBC DisordersDecreased Production of RBC Iron Deficiency AnemiaVitamin B12 Deficiency AnemiaFolic Acid Deficiency AnemiaAplastic Anemia</p></li><li><p>Fe Deficiency AnemiaCommon world wideAffects 10-30% of population in USCommon in premenapausal woman, infants, children, adolescents, &amp; elderlyDevelops slowly</p></li><li><p>A&amp;POccurs when supply of Fe is too low for optimal RBC formationIron RDA10mg/d M, F 12-49 15 mgTypical American diet provides 10 to 20 mg/dMany woman consume only 12.4mg/d</p></li><li><p>Cause of DevelopmentInadequate absorption or excess Fe lossInadequate dietary intake of foods high in FePrincipal cause in adults acute or chronic bleedingSecondary to traumaExcessive mensesGI bleedingBlood donation</p></li><li><p>DiagnosticsHgb Panic value &lt; 5g/dlHgb level can drop to 3.6g/dlTotal RBC count rarely below 3 million/dlMCH &lt; 27 pgMCHC 20 to 30 g/dlSerum Fe as low as 10mcg./dl</p></li><li><p>DiagnosticsHCT &lt; 47 ml/dl MHCT &lt; 42 ml/dl FFe binding capacity Serum ferritin level Bone marrow may also be indicated</p></li><li><p>SymptomsPallor, glossitisDizziness, irritability, numbness &amp; tingling in limbs, fatigue, decreased concentrated &amp; HATachycardia &amp; dyspnea on exertionSensitivity to cold, brittle hair &amp; nailsAtrophic glossitis, stomatitis, dysphagia</p></li><li><p>TreatmentDiet high in Fe rich foodsRed meats, organ meats, kidney beans, whole-wheat products, spinach, egg yolks, carrots &amp; raisins</p></li><li><p>TreatmentHematinic agentsFerrous Sulfate (Feosol) 0.2 g tid with mealsFerrous Gluconate (Fergon) 0.3 g bidOral irritating to GI mucosa, GI upset, nausea, etc. blackish green stool, contraindicated in PUD, inflammatory bowel diseaseLiquid preparation taken mixed with H2O or juice &amp; sipped thought straw </p></li><li><p>TreatmentHematinic agentsIron-dextan (Imferon) 100 to 250 mg/dAscorbic acid as indicatedDeep IM use Z-track to prevent subcutaneous irritation &amp; discoloration from leaking medCan be given IV to pregnant or elderly with severe Fe deficiency anemia</p></li><li><p>TreatmentSide effects: Nausea, constipation, epigastric pain, black &amp; red tarry stools,Contraindicated with hypersensitivity, ulcerative colitis/regional enteritis, peptic ulcer disease, hemolytic anemia, cirrhosis absorption with antiacids, cimetidine, cholestramine, Vit E, dairy products, caffeine, eggs </p></li><li><p>TreatmentFalse positive occult bloodToxicity: nausea, vomiting, diarrhea, hematemesis, pallor, cyanosis, shock, comaOver dose: Diarrhea, fever severe stomach pain, nausea, vomitingFe binding Agent Deferoxamine</p></li><li><p>Nursing CareOral hygiene &amp; dental carePreventing irritations &amp; infections in oral cavityNail &amp; hair &amp; hygieneAssist with maintenance proper diet Fe supplementAware of changes in stoolSafety to prevent falls</p></li><li><p>Folic Acid DeficiencyVitamin B complexSeen in alcoholism, malabsorption syndromes, and pregnancyMost prevalent in infants, adolescents, pregnant &amp; lactating females, alcoholics &amp; elderlyIncrease incidence in drug use and pregnancy</p></li><li><p>Food SourcesFound in asparagus spears, beef liver, broccoli, collards, mushrooms, oatmeal, peanut butter, red beans, wheat germ</p></li><li><p>Clinical ManifestationsDevelop slowly over a period of monthsSymptoms related to tissue hypoxiaGlossitisJaundiceSplenomegaly </p></li><li><p>TreatmentAdminister folic acid every day until deficiency is correctedHigh dises to patients with malabsorption problemsFolvite ; adults 250 to 1,000 mcg/d until hematological responses increasesMaintainance 400 mcg/day X 2</p></li><li><p>Aplastic AnemiaInherited, but can be acquired from chemical exposure or radiationFailure of bone marrow to produce adequate amounts of RBCs, leukocytes, &amp; plateletsPancytopeniaUsually seen in young individual, median age 25 years</p></li><li><p>Aplastic Anemia, cont.</p><p>BM supression, detruction or aplasia resulting in failure of BM to produce adequate # stem cells</p></li><li><p>Clinical manifestationsFatigueDyspnesMultipel infections temperatureHeadacheWasknessAnorexiaGingivitis</p><p>Epistaxia PurpraPetechiaeEcchymosisPallorPalpitationsTachycardiaTachypnesMelena</p></li><li><p>Diagnostic TestsPrepheral blood smearpancytopeniaHemtoaplogy granulocutes, thrombocytes, RBCStool for occult bloodpositiveUring chemistryhematuriaBone Marrow biopseyFatty narrwo with of stem cells</p></li><li><p>Treatment of Aplastic AnemiaBlood transfusion for disabled or bleeding thrombocytopeniaImmunosuppressants for individual with disease causes similar to autoimmune problemsAntilymphocyte globim (ALG)Antihymocyte globin (ATG)Cyclosporine (Sandimmune0</p></li><li><p>TreatmentFor severe, general immunosuppression agentsPrednisone % cylophosphamideSplenectomy; considered in clients with enlarged spleenEither destroying normal RBCs or suppressing their developmentBMT replaces defective stem cellsCure for some patients</p></li><li><p>RBC DisordersHyperplasia of bone marrow results in production Overproduction results in blood viscosity, total blood volume, &amp; severe congestion of all organs &amp; tissues</p></li><li><p>PolycythemiaMyeloproliferative disorder that results in the increaed productions ofErthrocytesHemoglobinMyelcytesThrombocytes</p></li><li><p>Polycythemia VeraHyperplasia of the bone marrow results in increased productionOverproduction results inincreased blood viscosity, increased total blood volume, &amp; severe congestion of all organs &amp; tissues</p></li><li><p>Clinical ManifestationsRuddy complexionDusky mucosaVertigoHeadachesDyspnea &amp; orthopneaTachycardiaEcchymosisHeaptomaeglay &amp; spelnomegaly gastric secretionsWeakness &amp; fatiguePururitusEpistaxisGI bleedingAngina</p></li><li><p>Diagnostic TestsBlood Chemistries UA, unconjugated bilirubin, vitamine B12, alkaline phosphatase, SGOT, SGPT, LDHHematology RBCs, WBCs, platelets, Hct, Hgb, Bone Marrow biopsy # of immature cells forms, Fe in marrowUrine chemistryhematuria</p></li><li><p>ManagementSoft diet, low FeAntacidsHistamine antagonistsAntigoutRadioactive phosphorus (P32)PhlebotomyMyelosuppressants</p></li></ul>