Description
In this collection we will go over the hematologic system, Components of blood, Structures of the Hematologic System, Oncologic Disorders and anemias
This collection is useful for all medical students
Study Set Content:
Cobalamin (Vitamin B
12
) Deficiency
Clinical manifestations
General symptoms of anemia
Sore tongue
Anorexia
Weakness
Parathesias of the feet and hands
Altered thought processes
Confusion
dementia
41
Cobalamin Deficiency
Diagnostic Studies
RBCs appear large
Abnormal shapes
Structure contributes to erythrocyte
destruction
Schilling Test: a medical investigation used
deficiency. The
purpose of the test is to determine if the
42
Cobalamin Deficiency
Collaborative Care
Parenteral administration of cobalamin
↑
Dietary cobalamin does not correct the anemia
Still important to emphasize adequate dietary intake
Intranasal form of cyanocobalamin (Nascobal) is
available
High dose oral cobalamin and SL cobalamin can
use be used
43
Cobalamin Deficiency
Nursing Management
Familial disposition
Early detection and treatment can lead to reversal of
symptoms
Potential for Injury r/t patient’s diminished
sensations to heat and pain
Compliance with medication regime
Ongoing evaluation of GI and neuro status
Evaluate patient for gastric carcinoma frequently
44
Folic Acid Deficiency
Folic Acid Deficiency also causes megablastic
anemia (RBCs that are large and fewer in
number)
Folic Acid required for RBC formation and
maturation
Causes
Poor dietary intake
Malabsorption syndromes
Drugs that inhibit absorption
Alcohol abuse
Hemodialysis
45
Folic Acid Deficiency
Clinical manifestations are similar to those of
cobalamin deficiency
Insidious onset: progress slowly
Absence of neurologic problems
Treated by folate replacement therapy
Encourage patient to eat foods with large amounts
of folic acid
Leafy green vegetables
Liver
Mushrooms
Oatmeal (
شورجملا نافوشلا
)
Peanut butter
Red beans
46
Anemia of Chronic Disease
Underproduction of RBCs, shortening of RBC
survival
2
nd
most common cause of anemia (after iron
deficiency anemia
Generally develops after 1-2 months of sustained
disease
Causes
Impaired renal function
Chronic, inflammatory, infectious or malignant disease
Chronic liver disease
Folic acid deficiencies
Splenomegaly
Hepatitis
47
Aplastic Anemia
Characterized by Pancytopenia
↓
of all blood cell types
RBCs
White blood cells (WBCs)
Platelets
Hypocellular bone marrow
Etiology
Congenital
Chromosomal alterations
Acquired
Results from exposure to ionizing radiation, chemical
agents, viral and bacterial infections
48
Aplastic Anemia
Etiology
Low incidence
Affecting 4 of every 1 million persons
Manageable with erythropoietin or blood transfusion
Can be a critical condition
Hemorrhage
Sepsis
49
Aplastic Anemia
Clinical Manifestations
Gradual development
Symptoms caused by suppression of any or all bone
marrow elements
General manifestations of anemia
Fatigue
Dyspnea
Pale skin
Frequent or prolonged infections
Unexplained or easy bruising
Nosebleed and bleeding gums
Prolonged bleeding from cuts
Dizziness
headache
50
Aplastic Anemia
Diagnosis
Blood tests
CBC
Bone marrow biopsy
51
Aplastic Anemia
Treatment
Identifying cause
Blood transfusions
Antibiotics
Immunosuppressants (neoral, sandimmune)
Corticosteroids (Medrol, solu-medrol)
Bone marrow stimulants
Filgrastim (Neupogen)
Epoetin alfa (Epogen, Procrit)
Bone marrow transplantation
52
Aplastic Anemia
Nursing Management
Preventing complications from infection and
hemorrhage
Prognosis is poor if untreated
75% fatal
53
Anemia Caused By Blood Loss
Acute Blood Loss
Chronic Blood Loss
54
Acute Blood Loss
Result of sudden hemorrhage
Trauma, surgery, vascular disruption
Collaborative Care
1.
Replacing blood volume
2.
Identifying source of hemorrhage
3.
Stopping blood loss
55
Chronic Blood Loss
Sources/Symptoms
Similar to iron deficiency anemia
GI bleeding, hemorrhoids, menstrual blood loss
Diagnostic Studies
Identifying source
Stopping bleeding
Collaborative Care
Supplemental iron administration
56
Anemia caused by Increased Erythrocyte
Destruction
Hemolytic Anemia
Sickle Cell disease (peds)
Acquired Hemolytic Anemia
Hemochromatosis
Polycythemia
57
Hemolytic Anemia
Destruction or hemolysis of RBCs at a rate that
exceeds production
Third major cause of anemia
Intrinsic hemolytic anemia
Abnormal hemoglobin
Enzyme deficiencies
RBC membrane abnormalities
Extrinsic hemolytic anemia
Normal RBCs
Damaged by external factors
Liver
Spleen
Toxins
Mechanical injury (heart valves)
58
Sequence of Events in Hemolysis
59
Acquired Hemolytic Anemia
Causes
Medications
Infections
Manifestations
S/S of anemia
Complications
Accumulation of hemoglobin molecules can
obstruct renal tubules
Tubular necrosis
Treatment
Eliminating the causative agent
60
