BLOOD DISORDERS Dhuha F Shamsaldeen

What is blood ?

Blood is a combination of plasma (watery liquid) and cells that float in it. It is a specialized bodily fluid that supplies essentials substances and nutrients, such as sugar, oxygen, and hormones to our cells, and carries waste away from those cells

Types of blood cells

Red blood cells - also known as RBCs or erythrocytes. These are the most abundant cells, and contain hemoglobin (Hb or Hgb). Hemoglobin is a protein which contains iron; it transports oxygen from the lungs to body tissues and cells. 97% of a human's red blood cell's dry content is protein. 

White blood cells (leukocytes) - these are the cells of our immune system; they defend the body against infections and foreign materials. 

Platelets (thrombocytes) - are involved in the clotting (coagulation) of blood. When we bleed the platelets clump together to help form a clot.

ANEMIA

• Anemia is a condition in which the hemoglobin concentration is lower than the normal; it reflects the presence of fewer than the normal number of erythrocytes within the circulation.

• As a result, the amount of oxygen delivered to the body tissues is also diminished.

• Anemia is not a specific disease state but a sign of an underlying disorder. It is by far the most common hematologic condition.

Classification of anemia

hypoproliferative

Results from defective RBC production

bleeding

Results from RBC loss

hemolytic

Results from RBC destruction

hypoproliferative

Iron deficiency.

Vitamin B12 deficiency (megaloblastic)

Folate deficiency (megaloblastic)

Decreased erythropoitin production

Cancer/ inflammation

Bleeding

Bleeding from GI tract, epistaxis (nosebleed),

trauma, bleeding from genitourinary

tract (menorrhagia)

Hemolytic

Sickle anemia Hypersplenism ( hemolysis)

Drug-induced anemia

Autoimmune anemia

Mechanical heart valve-

related anemia

Stressors

Physiological

• Reduced RBC production.

• Excessive RBC destruction.

sociocultural • Diet habits.

developmental• Age group.• sex

Clinical manifestations:

Special complications of

the condition that produced

anemia

The duration

of anemia

The speed of anemia

IRON DEFICIENCY ANEMIA

• Iron deficiency anemia typically results when the intake of dietary iron is inadequate for hemoglobin synthesis.

• Iron deficiency anemia is the most common type of anemia in all age groups, and it is the most common anemia in the world.

Causes • The most common cause of iron deficiency anemia in

men and women is bleeding from ulcers gastrirtis, inflammatory bowel disease, or GI tumors. The most common causes of IDA in premenopusal woman are menorrhagia ( ie, excessive menstrual bleeding) and pregnancy with inadequate iron supplementation. Other causes include iron malabsorption, as is seen after gastroctomy.

Sings and symptoms

Fatigue Weakness Headache

Dyspnea Palpitations Chest pain

Jaundice Smooth; sore tongue

Diagnostic tests

Serum iron

( female 8.9-30.4 umol/l)

( male 11.6-30.4 umol/l)

SERUM Hb ( normal

13.2-17.5 g/dk)

CBC

Bone marrow

aspiration

Treatment • Correction of the underlying cause, iron supplements

including :

Oral • Ferrous phosphate, ferrous

glucanate

IV or IM

• Administer small dose

Patient education ( taking oral iron supplements ):

• Take iron on an empty stomach ( 1 hr before or 2 hrs after the meal). Iron absorption is reduced with food, especially dairy products.

• To prevent GI distress, the following schedule may work better if more than one tablet a day is prescribed. Start with only one tab/day for a few days, then increase to 2 tab/day, then 3 tab/day. This method permits the body to adjust gradually to the iron.

• Increase the intake of vit C , to enhance iron absorption.• Eat foods high in fiber to minimize problems with

constipation.• Remember that stool will become dark in color.

SICKLE CELL ANEMIA

• Sickle cell anemia is a severe hemolytic anemia results from inheritance of the sickle hemoglobin gene.

• The sickle hemoglobin (HbS) acquires a crystal-like formation when exposed to low oxygen tension.

Clinical manifestations:

Always anemic (Hb= 7-10gm/dl)

Sometimes enlargement of the bones of face and

skull.

Jaundice

Tachycardia

Sings and symptoms:

Pallor

Decrease urinary output,

Dark urine-smoky,brownish

Abdominal or chest pain.

Swelling and pain in the joint

Weakness

Mental depression

Difficulty concentrating

Diagnostic test • CBC• Hgb—men 14-18g/dl, women 12-16g/dl• Platelet count—150,000-350,000/100ml 0f blood.• Haematocrit – packed cell volume (PCV).• Bone marrow puncture

Medical management:

long term RBC transfusion.

hydroxyurea (chemotherapy)

Bone marrow transplant

NURSING DIAGNOSIS AND INTERVENTIONS For all anemic patients

Diagnosis: Activity intolerance related to poor tissue oxygenation.

Give oxygen

Bed rest

Monitor vital signs

Observe urine for signs of blood

Give prescribed

fe medication

Diagnosis: Pain related to joint inflammation

Assess level of

pain

Apply warm packs

Use distraction technique

Give pain medication