RBC Disorders

 Decreased Production of RBC

– Iron Deficiency Anemia
– Vitamin B12 Deficiency Anemia
– Folic Acid Deficiency Anemia
– Aplastic Anemia
 Fe Deficiency Anemia
 Common world wide
 Affects 10-30% of population in US
 Common in premenapausal woman,
infants, children, adolescents, & elderly
 Develops slowly
 A&P
 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
 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
 Diagnostics
 Hgb Panic value < 5g/dl
 Hgb level can drop to 3.6g/dl
 Total RBC count rarely below 3 million/dl
 MCH < 27 pg
 MCHC 20 to 30 g/dl
 Serum Fe as low as 10mcg./dl
 Diagnostics
 HCT < 47 ml/dl M
 HCT < 42 ml/dl F
 Fe binding capacity 
 Serum ferritin level 
 Bone marrow may also be indicated
 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
 Treatment
 Diet high in Fe rich foods
– Red meats, organ meats, kidney beans,
whole-wheat products, spinach, egg yolks,
carrots & raisins
 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
 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
 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
 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
 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
 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
 Food Sources
 Found in asparagus spears, beef liver,
broccoli, collards, mushrooms, oatmeal,
peanut butter, red beans, wheat germ
 Clinical Manifestations
 Develop slowly over a period of months
 Symptoms related to tissue hypoxia
 Glossitis
 Jaundice
 Splenomegaly
 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
 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
 Aplastic Anemia, cont.

 BM supression, detruction or aplasia

resulting in failure of BM to produce
adequate # stem cells
 Clinical manifestations
 Fatigue  Epistaxia
 Purpra
 Dyspnes
 Petechiae
 Multipel infections
 Ecchymosis
  temperature  Pallor
 Headache  Palpitations
 Waskness  Tachycardia

 Anorexia  Tachypnes
 Melena
 Gingivitis
 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
 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
 Treatment
 For severe, general immunosuppression
agents
– Prednisone % cylophosphamide
 Splenectomy; considered in clients with
enlarged spleen
– Either destroying normal RBC’s or suppressing
their development
 BMT replaces defective stem cells
– Cure for some patients
 RBC Disorders
 Hyperplasia of bone marrow results in 
production
 Overproduction results in  blood
viscosity,  total blood volume, & severe
congestion of all organs & tissues
 Polycythemia
 Myeloproliferative disorder that results in
the increaed productions of
– Erthrocytes
– Hemoglobin
– Myelcytes
– Thrombocytes
 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
 Clinical Manifestations
 Ruddy complexion  Heaptomaeglay &
 Dusky mucosa spelnomegaly
 Vertigo   gastric secretions
 Headaches  Weakness & fatigue
 Dyspnea & orthopnea  Pururitus
 Tachycardia  Epistaxis
 Ecchymosis  GI bleeding
 Angina
 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
 Management
 Soft diet, low Fe
 Antacids
 Histamine antagonists
 Antigout
 Radioactive phosphorus (P32)
 Phlebotomy
 Myelosuppressants