hemotology(exam 3)

• tissue hypoxia
• decreased rbc

• not enough are being produced
• they are lost from bleed
• destroyed

• 1) decreased RBC production(nutritional and thalassemia
• 2)blood loss anemia
• 3)increased RBC destruction

• lack of o2 strains heart
• tachycardia
• palpatiations
• heart attack

lack of o2, doe, dob

• mild: hgb 10-12
• moderate: hgb 6-10
• severe: hgb <6

anemia

transfusions are considered when hgb falls to 7

• mild: no s/s, pals, dyspnea, response(heavy exercise), fatigue
• moderate: cardio s/s at rest, bounding pulse, fatigue, ears ringing
• severe: multiple body systems

• pale or ashen
• dyspnea at rest
• tachy
• jaundice
• increased bili
• ha
• vertigo
• dizzy
• glottis(swollen tounge)
• hepta/splenomegaly
• cold sensitivity

• nutritional deficits
• thalassemia minor and major
• anemia of chronic disea
• aplastic anemia

decreased rbc production

• iron
• b12
• folic acid

• essential for hgb
• absorbed in small intestine

• poor nutrition
• poor absorp d/t gi surgery, duodoneum,tion
• blod loss

• decreased hgb
• decrease serum iron 
• decreased transferrin and ferritin(help bind iron to rbc)
• increased TIBC(total iron binding capacity)

• liver, meats,dark leafy, grain, eggs
• supplement 1 hr before eating
• im or iv

• dark stool, black and tary is normal
• to much iron can cause constipation
• vit c enhances iron absorption

• decreased rbc production
• nutritional defecit
• colbamin and folic acid deficiency
• charecturized by presence of large RBC

• cause of decreased vit b12
• -intrinsic factor is secreted by parietal cells in gi
• -IF is required for colbamin absorption
• -IF not secreated= colbalmin not absorbed

• pernicious
• poor absorption
• poor dietary

• most common
• no IF
• decreased Hcl

• RBC smear shows large, deformed rbc
• increased MCV(size of rbc)
• decreased vit b12

• s/s are d/t tissue hypoxia
• sore/red/beffytounge
• anorexia
• n/v
• neuromuscular(numb, tingle)
• ataxia
• weak
• pins and needles
• confusion

• must have IF for nutritional and oral supplement
• 1000mcg/day im x2 weeks, then 100mcg/month/life

• poor diet(alcoholics)
• med interaction(methotrexate;RA, Dilantin;seizure)
• hemodialysis(ESRD)

same as colbalmin but NO NEURO

• increased MCV
• vit b12 normal
• folate low
• hgb/hct low

• same nutritional
• folate 1mg po/qday
• folate 5mg po/day for alcholics/malabsorptive issues

• recessive genetic
• decreased hgb
• decreased mature rbc
• inadequate rbc production
• d/t absent or reduced globulin protien

• asymptomatic
• mild/moderate anemia
• 1 gene copy
• heterozygous

• anemia s/s
• phys and mental retardation and growth
• jaundice
• splenomegaly
• bone marrow hyperplasia= large bones, large facial bones
• 2 genes
• homozygous

• no tx
• body adapts on its own

• blood transfusion + iron chelation FOR LIFE
• chelating agents= iv or po, binds iron excreated in kidneys
• keep hgb >10

blood transfussions= give mature rbc but also give to much iron

iron chelation= removes excess iron

NEVER USE IRON REPLACEMENT

• develops after 1-2 months of illness
• chronic inflammation destroys and reduces production of rbc
• underlying disease

• decrease hgb/hct
• increase iron storage and ferritin
• vb12 and folate are normal

treat underlying disease

• cause  unknown
• increased risk for infection and bleeds

• general anemia
• NEUTROPENIA
• THROMBOCYTOPENIA

low rbc, wbc, plt

• stem cell transplant
• antithyomcyte globulin

• id cause
• monitor labs
• monitor temp
• safety
• prevent infection/hemmorage

• trauma
• complication of surgery
• conditions that affect vascular integrity

• hypovolemic shock
• increased plasma volume

• tachy
• hypotensive
• thread pulse
• shock

• ID and STOP BLEED
• REPLACE VOLUME TO PREVENT SHOCK
• iv fluids(LR, NS and hetastarch)
• albumin and crytalloid electrolyte solutions
• blood transfussions
• WATCH TUBES AND DRESSINGS asses q4

• bleeding ulcers
• hemmroids
• mestration

same as iron defeciency

• id source and stop bleeding
• iron

rbc are being destroyed faster than they can be produced

• physical destruction
• abnormal av microcirculation
• antibodies
• infectious agents
• clotting and bleeding at the same time

• jaundice
• spleen enlargement(destroyed rbc causes increased bili)
• lupus 
• malaria
• immune

• support kidney
• HYDRATION AND ELECTROLYTE
• blood
• steroids
• splenectomy

• increased iron
• increase absorption of iron from small intestine

• genetic
• liver disease, too many blood transfusions

• fatigue
• arthralgia
• impotence
• abdominal pain

• live large
• skin pigment
• organ failure
• increase serum iron
• increase TIBC
• increase ferritin

2-6g

• remove excess iron
• 500ml of blood removes once a week for 2-3 years
• iron chelation
• NO IRON SUPPLEMENT