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RBC Disorders

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RBC Disorders Decreased Production of RBC Iron Deficiency Anemia Vitamin B12 Deficiency Anemia Folic Acid Deficiency Anemia Aplastic Anemia Fe Deficiency Anemia ... – PowerPoint PPT presentation

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Title: RBC Disorders


1
RBC Disorders
  • Decreased Production of RBC
  • Iron Deficiency Anemia
  • Vitamin B12 Deficiency Anemia
  • Folic Acid Deficiency Anemia
  • Aplastic Anemia

2
Fe Deficiency Anemia
  • Common world wide
  • Affects 10-30 of population in US
  • Common in premenapausal woman, infants, children,
    adolescents, elderly
  • Develops slowly

3
AP
  • Occurs when supply of Fe is too low for optimal
    RBC formation
  • Iron RDA
  • 10mg/d M,
  • F 12-49 15 mg
  • Typical American diet provides 10 to 20 mg/d
  • Many woman consume only 12.4mg/d

4
Cause of Development
  • Inadequate absorption or excess Fe loss
  • Inadequate dietary intake of foods high in Fe
  • Principal cause in adults acute or chronic
    bleeding
  • Secondary to trauma
  • Excessive menses
  • GI bleeding
  • Blood donation

5
Diagnostics
  • Hgb Panic value lt 5g/dl
  • Hgb level can drop to 3.6g/dl
  • Total RBC count rarely below 3 million/dl
  • MCH lt 27 pg
  • MCHC 20 to 30 g/dl
  • Serum Fe as low as 10mcg./dl

6
Diagnostics
  • HCT lt 47 ml/dl M
  • HCT lt 42 ml/dl F
  • Fe binding capacity ?
  • Serum ferritin level ?
  • Bone marrow may also be indicated

7
Symptoms
  • Pallor, glossitis
  • Dizziness, irritability, numbness tingling in
    limbs, fatigue, decreased concentrated HA
  • Tachycardia dyspnea on exertion
  • Sensitivity to cold, brittle hair nails
  • Atrophic glossitis, stomatitis, dysphagia

8
Treatment
  • Diet high in Fe rich foods
  • Red meats, organ meats, kidney beans, whole-wheat
    products, spinach, egg yolks, carrots raisins

9
Treatment
  • Hematinic agents
  • Ferrous Sulfate (Feosol) 0.2 g tid with meals
  • Ferrous Gluconate (Fergon) 0.3 g bid
  • Oral irritating to GI mucosa, GI upset, nausea,
    etc. blackish green stool, contraindicated in
    PUD, inflammatory bowel disease
  • Liquid preparation taken mixed with H2O or juice
    sipped thought straw

10
Treatment
  • Hematinic agents
  • Iron-dextan (Imferon) 100 to 250 mg/d
  • Ascorbic acid as indicated
  • Deep IM use Z-track to prevent subcutaneous
    irritation discoloration from leaking med
  • Can be given IV to pregnant or elderly with
    severe Fe deficiency anemia

11
Treatment
  • Side effects Nausea, constipation, epigastric
    pain, black 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

12
Treatment
  • False positive occult blood
  • Toxicity nausea, vomiting, diarrhea,
    hematemesis, pallor, cyanosis, shock, coma
  • Over dose Diarrhea, fever severe stomach pain,
    nausea, vomiting
  • Fe binding Agent Deferoxamine

13
Nursing Care
  • Oral hygiene dental care
  • Preventing irritations infections in oral
    cavity
  • Nail hair hygiene
  • Assist with maintenance proper diet
  • Fe supplement
  • Aware of changes in stool
  • Safety to prevent falls

14
Folic Acid Deficiency
  • Vitamin B complex
  • Seen in alcoholism, malabsorption syndromes, and
    pregnancy
  • Most prevalent in infants, adolescents, pregnant
    lactating females, alcoholics elderly
  • Increase incidence in drug use and pregnancy

15
Food Sources
  • Found in asparagus spears, beef liver, broccoli,
    collards, mushrooms, oatmeal, peanut butter, red
    beans, wheat germ

16
Clinical Manifestations
  • Develop slowly over a period of months
  • Symptoms related to tissue hypoxia
  • Glossitis
  • Jaundice
  • Splenomegaly

17
Treatment
  • Administer folic acid every day until deficiency
    is corrected
  • High dises to patients with malabsorption
    problems
  • Folvite adults 250 to 1,000 mcg/d until
    hematological responses increases
  • Maintainance 400 mcg/day X 2

18
Aplastic Anemia
  • Inherited, but can be acquired from chemical
    exposure or radiation
  • Failure of bone marrow to produce adequate
    amounts of RBCs, leukocytes, platelets
  • Pancytopenia
  • Usually seen in young individual, median age 25
    years

19
Aplastic Anemia, cont.
  • BM supression, detruction or aplasia resulting in
    failure of BM to produce adequate stem cells

20
Clinical manifestations
  • Fatigue
  • Dyspnes
  • Multipel infections
  • ? temperature
  • Headache
  • Waskness
  • Anorexia
  • Gingivitis
  • Epistaxia
  • Purpra
  • Petechiae
  • Ecchymosis
  • Pallor
  • Palpitations
  • Tachycardia
  • Tachypnes
  • Melena

21
Diagnostic Tests
  • Prepheral blood smear
  • pancytopenia
  • Hemtoaplogy
  • ? granulocutes, thrombocytes, RBC
  • Stool for occult blood
  • positive
  • Uring chemistry
  • hematuria
  • Bone Marrow biopsey
  • Fatty narrwo with ? of stem cells

22
Treatment of Aplastic Anemia
  • Blood transfusion for disabled or bleeding
    thrombocytopenia
  • Immunosuppressants for individual with disease
    causes similar to autoimmune problems
  • Antilymphocyte globim (ALG)
  • Antihymocyte globin (ATG)
  • Cyclosporine (Sandimmune0

23
Treatment
  • For severe, general immunosuppression agents
  • Prednisone cylophosphamide
  • Splenectomy considered in clients with enlarged
    spleen
  • Either destroying normal RBCs or suppressing
    their development
  • BMT replaces defective stem cells
  • Cure for some patients

24
RBC Disorders
  • Hyperplasia of bone marrow results in ?
    production
  • Overproduction results in ? blood viscosity, ?
    total blood volume, severe congestion of all
    organs tissues

25
Polycythemia
  • Myeloproliferative disorder that results in the
    increaed productions of
  • Erthrocytes
  • Hemoglobin
  • Myelcytes
  • Thrombocytes

26
Polycythemia Vera
  • Hyperplasia of the bone marrow results in
    increased production
  • Overproduction results inincreased blood
    viscosity, increased total blood volume, severe
    congestion of all organs tissues

27
Clinical Manifestations
  • Ruddy complexion
  • Dusky mucosa
  • Vertigo
  • Headaches
  • Dyspnea orthopnea
  • Tachycardia
  • Ecchymosis
  • Heaptomaeglay spelnomegaly
  • ? gastric secretions
  • Weakness fatigue
  • Pururitus
  • Epistaxis
  • GI bleeding
  • Angina

28
Diagnostic Tests
  • Blood Chemistries
  • ? UA, unconjugated bilirubin, vitamine B12,
    alkaline phosphatase, SGOT, SGPT, LDH
  • Hematology
  • ? RBCs, WBCs, platelets, Hct, Hgb,
  • Bone Marrow biopsy
  • ? of immature cells forms, ? Fe in marrow
  • Urine chemistry
  • hematuria

29
Management
  • Soft diet, low Fe
  • Antacids
  • Histamine antagonists
  • Antigout
  • Radioactive phosphorus (P32)
  • Phlebotomy
  • Myelosuppressants
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