Anemia

Definition/Etiology:

• Definition
  • ↓RBCs or ↓ Hemoglobin
  • Women <12 & Men < 14
  • Clinically = Hgb below 7 g/dL
    • symptomatic
• Etiology
  • Inadequate RBC production
    • Iron deficiency, folate and vitamin B12 deficiency
    • Chronic Kidney Disease
    • Cancers
  • Increased RBC destruction
    • Transfusion reaction
    • Sickle Cell Disease
    • Enlarged Spleen
  • Acute Blood loss
    • Gi Bleeds
    • Surgeries
    • Trauma

Pathophysiology:

• No matter what the cause we have the same results. Our organs are suffocating.
• The body responses to anemia by s increasing cardiac output and respiratory rate, redistribution of blood to sustain blood supply to the brain and heart through a reduction in blood supply to the skin, bowels, and kidneys, and increasing the kidney’s production of erythropoietin to stimulate erythropoiesis.
• Think of this as “cause and effect” response of the body. It opts to “sacrifice” the blood distribution to less vital places.

Noticing: Assessment & Recognizing Cues:

• Subjective
  • Fatigue
  • SOB/Activity intolerance
  • Headache
  • MS Changes (Severe)
• Objective
  • Vitals
    • ↑HR, ↓BP, ↓ 02 sat (late)
    • Orthostatic → syncope
      • Less they tolerate = worse they are
  • Skin
    • Pale? Cool? Jaundiced?
  • Hepatosplenomegaly
    • Usually seen in hemolytic anemia from destruction of RBCs and slow flow of liver

Interpreting: Analyzing & Planning:

• Labs – Transfuse + Cause
  • Hemoglobin (12 & 14)
    • Under 7 = transfuse
  • Iron & Ferritin & folate
    • Iron or B12 deficiency
  • Urine & Stool
    • Bleed somewhere?
• Diagnostics – Not as urgent and sometimes deferred to specialists so anticipate consults
  • GI studies
  • Bone Marrow Biopsy

Responding: Patient Interventions & Taking Action:

• ABCs & Underlying Cause
  • 02 <92%
  • Elevate HOB
• Pharmacology
  • TRANSFUSION –
    • Don’t forget consent
    • Leukocyte depleted blood for immunosuppressed or frequent like sickle cell disease (Self vs non-self)
  • Blood builders like Procrit (JW patients especially)
• Nonpharmacological
  • Frequent vitals
• Adjunct medical therapy
  • hematologists

Reflecting: Evaluating Patient Outcomes:

• Monitor for Reaction (check your protocol)
  • Febrile – Fever rise of 1 Degree C
  • Allergic – Hives itching rash, wheezing →anaphylaxis
  • Hemolytic – ↓BP, CP, Flank Pain, Shock/DIC
  • Bacterial – High Fever & kidney involvement
  • TACO (Transfusion-associated circulatory overload) – Signs/Sx Heart Failure
• Treatment pretty similar
  • Always stop transfusion – blood back to lab
  • Start NS (except TACO)
  • Then look at symptoms
    • Fever = Tylenol
    • Allergy = IV Benadryl
    • Shock = Pressors + ICU
    • Infection – IV ABX
    • Overload = Diuretics

Linchpins (Key Points):

• Notice
  • Signs/Sx of Anemia and connect Etiology
• Interpret
  • Labs FIRST
    • Other diagnostics help with CAUSE.
    • Example Hgb = transfusion
• Respond
  • Transfusion
    • Look for questions asking about consent or what to do with blood if a patient has a reaction.
• Reflect
  • Patient tolerating?
    • Fever? Chills? Wheezing? Flank Pain? Heart Failure? Shock? DIC?
    • Notice these just get worse.
    • Stay on top of vitals and lung sounds.