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Transcript of Axis design template - Eastern Kentucky Universitycourses.justice.eku.edu/NSC834a/ppt/Lesson4/834...
Mary DeLetter, PhD, RNAssociate ProfessorDept. of Baccalaureate and Graduate NursingEastern Kentucky University
Hematology Alterations:Altered Erythrocyte Function
Macrocytic and Microcytic Anemia
Anemia
Definition↓ total number of circulating erythrocytes↓ quality or quantity of hemoglobin
Causes (individual or combined)Impaired erythrocyte productionIncreased erythrocyte destructionBlood loss
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AnemiaClassification
CausesChanges in morphology
-cytic – changes in cell size-chromic – changes in Hgb content
Erythrocyte Volume Hgb ContentNormal Normocytic Normochomic
Increased Macrocytic Hyperchromic(↑ MCV) (↑ Hgb)
Decreased Microcytic Hypochromic (↓ MCV) (↓ Hgb)
Terminology for ErythrocyteAssessment
3_____________________________________McCance & Huether, 2014, Table 28-2
Anemia
Classification by Etiology
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Anemia
Overall effect Reduced O2 carrying capacity of the blood
Compensatory mechanisms↑ preload↑ HR↑ SV↓ afterload
↑ CO↓
Maintain adequate tissue oxygenation
Hypoxia
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6_____________________________________McCance & Huether, 2014, Figure 28-2
Anemia: Progression and Manifestations
Anemia - Clinical Manifestations
Body System Clinical ManifestationsCardiovascular ↑ HR, CHF, Angina, MIPulmonary ↑ RR, orthopnea, dyspneaNeurologic H/A, vertigo, depression, impaired cognitionGastrointestinal Anorexia, hepatomegaly, splenomegaly Musculoskeletal Fatigue, bone painIntegumentary Pallor, pruritisGeneral Lethargy, sensitivity to cold, weight loss
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Macrocytic (Megaloblastic) Anemias
Pathophysiology
TypesPerniciousFolate Deficiency
Vitamin deficiencies (B12 or Folate)↓
Defective erythrocyte precursorDNA synthesis
↓Unusually large stem cells in bone marrow
↓Erythrocyte changes:Unusually large size
No pale centerNormal Hgb
↑ cell size
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Pernicious Anemia – Vit B12
Most common megaloblastic anemiaDeficiency of B12
Common over age 50
PathophysiologyAbsence of Intrinsic Factor (IF) (gastric parietal cells)↓ IF binding with dietary B12 ↓ small intestine absorption of B12 Defective DNA synthesis in erythrocytes
Macrocytic
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Pernicious Anemia – Vit B12Causes
Chronic atrophic gastritis (autoimmune) – Type AGeneticOther endocrine autoimmune disorders
Excessive damage to gastric mucosaAlcohol, caffeine, smoking
Gastrectomy (partial/full)
Helicobacter pylori gastritis - Type B
Unique Clinical ManifestationsInsidious onset – B12 liver storage Severe at time of diagnosis
Macrocytic
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Folate Deficiency Anemia
Pathophysiology↓ RBC production and maturation:
Altered DNA synthesis Megaloblastic cells with clumped nuclear chromatin
Apoptosis of erythrocytes during late stage of erythropoesis
Macrocytic
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Folate Deficiency Anemia
Complications of Folate deficiencyPregnancy - Neural tube defects↑ circulating homocysteine atherosclerosisColorectal cancers
Unique Clinical ManifestationsUlcerations of lips, mouth, buccal mucosa
Macrocytic
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Microcytic Anemia
CharacteristicsErythrocytes: Small
Reduced Hgb
Caused by disorders of:Iron metabolismSynthesis of hemoglobin components:
Heme (porphyrin) - pigmentGlobin - protein
↓ cell size
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Iron-deficiency Anemia
Most common anemia world-wideCauses
Inadequate dietary intakeInfants, small children, adolsescents, pregnant women
Chronic blood lossGI bleeding
PathologicMedication-induced (ASA, NSAIDS)
Menorrhagia
Impaired GI absorptionDecreased gastric acid production – proton pump inhibitors –Omeprozole
Lead Poisoning
Microcytic
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Pathophysiology1. Depletion of iron stores
↓
2. Metabolic dysfunction↓
Iron-deficiency Anemia
Microcytic
Inadequate iron intakeExcessive blood loss
Less iron available in bone marrow↓ Hgb Synthesis
Insufficient iron delivery to bone marrowImpaired iron use by bone marrow ↓ Hgb Synthesis
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Pathophysiology: Iron needs > iron availability
Iron-deficiency Anemia
Microcytic
Pathophysiology ErythropoiesisStage 1 • Depletion of iron stores
• Serum ferritin level drops• Normal – Hgb normal
Stage 2 • Ferritin depletion• ↓ transportation of iron to
bone marrow• Serum iron level drops
• Iron-deficiency erythropoesis
• ↓ Hgb production
Stage 3 • Iron-deficient RBC in circulation outnumber mature RBC
• Iron stores depleted
• Erythrocytes are hypochromic and microcytic
• ↓↓↓ Hgb production• S/S Iron-deficiency anemia
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Unique Clinical ManifestationsEarly
Fatigue, weakness, SOB
ProgressiveEpithelial tissue changes (nails)GlossitisDysphagia
HyposalivationEsophageal web development
Iron-deficiency Anemia
Microcytic
17_____________________________________McCance & Huether, 2014, Figure 28-4
Hematology Alterations:Altered Erythrocyte Function
Macrocytic and Microcytic Anemia
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