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ENCARNACION, Katrisha Angelica D. BSN II-7 March 4, 2010

DISEASES AFFECTING RED BLOOD CELLS

DISEASE DESCRIPTION ASSESSMENT [Signs & symptoms] DIAGNOSIS & NURSING

INTERVENTIONS

1. Iron Deficiency

Anemia [IDA]

A type of anemia which results when

the intake of dietary iron is inadequatefor haemoglobin synthesis. It is the

most common type of anemia in all agegroups, and is the most common type of

anemia in the world.The most commoncause of IDA in men and

postmenopausal women is bleeding in

the GI tract. The most common cause ofIDA in premenopausal women is

menorrhagia and pregnancy with

inadequate iron supplementation.Patients with chronic alcoholism often

have chronic blood loss from the GItract, which causes iron loss, and

eventually, IDA. Another cause is ironmalabsorption.

Pallor, fatigue & weakness, fainting,

dyspnea, polyphagia or pica, hair loss,twitching muscles, koilonychias, light-

headedness, palpitations, constipation

Laboratory findings: decreasedreticulocytes, iron, ferritin, iron

saturation, mean cell volume; increased

total iron binding capacity

Severe cases: smooth & sore tongue,

brittle & rigid nails, angular cheilosis

Diagnosis:

Altered nutrition: less than bodyrequirements related to inadequate

intake of essential nutrient Iron.

Intervention:

Encourage healthy diet

Emphasize limitation of alcohol

intake

Emphasize intake of iron

supplementation and food rich in

iron such as organ meats

2. AplasticAnemia

A rare disease caused by a decrease inor damage to marrow stem cells,

damage to the microenvironment withinthe marrow, and replacement of the

marrow with fat. The precise etiology isunknown, but it is said that the bodysT-cells mediate an inappropriate attack

against the bone marrow, resulting inbone marrow aplasia. Therefore, in

addition to severe anemia, significant

neutropenia and thrombocytopenia arealso seen.

Pallor, fatigue & weakness, fainting,dyspnea, polyphagia or pica, hair loss,

twitching muscles, koilonychias, light-headedness, palpitations, constipation,

purpura

Specific to Aplastic Anemia: cervical

lymphadenopathy, spenomegaly, retinalhemorrhage.

Diagnosis:Activity Intolerance related to

weakness, fatigue.

Intervention: Encourage frequent rest periods

Inform patient regarding

bleeding tendencies

Assess for bleeding and

infection risks

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3. MegaloblasticAnemia

Anemia caused by vitamin B-12 orFolic acid deficiency, where identical

bone marrow and peripheral blood

changes occur. The erythrocytesproduced are abnormally large.


twitching muscles, koilonychias, light-

headedness, palpitations, constipation,purpura

Laboratory findings: decreased red

blood cell count and hemoglobin levels,increased mean corpuscular

volume (>95 fl) and mean corpuscular

hemoglobin , normal mean corpuscularhemoglobin concentration (32-36 g/dL),

decreased reticulocyte count, reducedplatelet count, Senile neutrophil,

poikilocytosis, Macrocytes are present,

Ovalocytes are present, Howell-Jollybodies are present.

Diagnosis:Altered nutrition: less than body

requirements related to inadequate

intake of essential nutrient Folic Acid/Vit B-12.

Intervention:

Encourage intake of nutrientsupplements in the diet

4. PerniciousAnemia

(Biermer'sanemia, Addison's

anemia,or Addison

Biermer anemia)

Usually seated in an atrophic gastritis,the autoimmune destruction

of gastric parietal cells leads to a lackof intrinsic factor, and since the

absorption from the gut of vitamin B-12, is dependent on intrinsic factor this

leads to vitamin B-12 deficiency, one of

the many causes ofmegaloblastic

anemia.


twitching muscles, koilonychias, light-headedness, palpitations, purpura

Specific in Pernicious Anemia:

difficulty in proprioception, mild

cognitive impairment, colloquially

referred to as brain fog, neuropathicpain, frequent diarrhea, paresthesias,jaundice, glossitis, personality or

memory changes

Diagnosis:Activity intolerance related to

imbalance between oxygen supply &demand, and cognitive and neurological

complications

Intervention:

Assist during performance of

ADL especially in ambulation Promote Vit B-12

supplementation

Ensure clients safety

5. Hemolytic

Anemia

A type of anemia where the

erythrocytes have a shortened life span;thus, their number in circulation is



Diagnosis:

Impaired gas exchange related todecreased RBC

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reduced. Fewer erythrocytes result indecreased available oxygen, causing

hypoxia.

headedness, palpitations, constipation,purpura

In chronic hemolysis: gallstones,pulmonary hypertension, syncope, chest

pain, and progressive breathlessness

Interventions:

Teach patient how to do chest

physio-therapy and perform

Oxygen therapy per nasalcannula or face mask

Promote resting periods6. Sickle Cell

Anemica

A genetic life-long blood

disorder characterized by red bloodcells that assume an abnormal,

rigid, sickle shape. Sickling decreasesthe cells' flexibility and results in a risk

of various complications. The sickling

occurs because of a mutation inthe haemoglobin gene. Life expectancy

is shortened, with studies reporting an

average life expectancy of 42 and 48years for males and females,respectively.

Hemoglobin values of 7-10 mg/dL,

jaundice, tachycardia, heart murmurs,cardiomegaly, dysrhythmia.

Sickle cell crisis, acute chest syndrome,

pulmonary hypertension.

Heart failure may occur in adults

Diagnosis:

Ineffective tissue perfusion related todecreased Hb concentration in the blood

Interventions:

Administer anticoagulants for

thrombosis, steroids

Elevate HOB & maintain

head/neck in midline position

Encourage quiet, restfulenvironment

7. Thalassemia A group of hereditary anemias

characterized by hypochromia, extrememicrocytosis, hemolysis. It is associated

with defective synthesis of the

hemoglobin chain; the production ofone or more globulin chains within the

hemoglobin molecule is reduced, which

leads to the rigidity of erythrocytes andpremature destruction of these cells.



headedness, palpitations, constipation,

purpura

Diagnosis:

Activity intolerance related toimbalanced oxygen supply and demand

Intervention:

Assist patient during ADLs

Perform CPT

Oxygen administration

8. Hereditary

Hemochromatosis

A genetic condition in which iron is

abnormally [excessively] absorbed in

the GI tract.

Weakness, lethargy, arthralgia, weight

loss, skin may be hyperpigmented with

melanin deposits & appears bronze,cardiac dysrhythmia, cardiomyopathy,

dyspnea, edema, hypothyroidism, DM,

Diagnosis:

Imbalanced nutrition: more than body

requirements

Intervention:

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hypogonadism, cirrhosis. Advice decreased intake of iron

9. Hereditary

Spherocytosis

Characterized by an abnormal

permeability of the erythrocytemembrane; this causes the cells to

change into a spherical shape. These

erythrocytes are destroyed prematurelyin the spleen.

Fatigue, pallor, intermittent jaundince,

sphenomegaly

Intervention:

Surgical removal of the spleen

Encourage protein & vitamin C

intake for healing

10. Immune

Hemolytic

Anemia

Anemia that can result from exposure

of the erythrocytes to antibodies.

Alloantibodies result from theimmunization of a person with foreign

antigens, they cause immediatedestruction of the sensitized

erythrocytes either inside the bloodvessels or inside the liver.

Fatigue, pallor, intermittent jaundince,

sphenomegaly, dizziness,

hepatomegaly, lymphadenopathy

Intervention

Blood transfusion

Surgical removal of the spleen

Administration ofcorticosteroids

11. Glucose 6 PhosphateDehydrogenase

[G-6-PD]Deficiency

The G-6-PD gene is the source of theabnormality in this disorder; this geneproduces an enzyme within the

erythrocyte that is essential formembrane stability. Ingestion of

oxidant drugs[anti-malarial,sulfonamides, nitrodurantoin,

chloramphenicol] have hemolytic

effects for people with G-6-PDdeficiency.

Asymptomatic no oxidant drugs areingested.

If triggered: pallor, jaundice,hemoglobinuria, hemolysis, Heinz

bodies within erythrocytes,

Diagnosis:Risk for ineffective tissue perfusion

Intervention

Client teaching regardingmedications to avoid

Encourage use of MedicAlertbracelets for identification

12. PolycythemiaVera [Primary

polycythemia]

A proliferative disorder in which themyeloid stem cells seem to have

escaped normal control mechanisms.This causes an erythrocyte elevation.

Ruddy complexion, sphenomegaly.Decreased BV: headache, tinnitus,

fatigue, paresthesias; increased BV:blurred vision, angina, claudication,

dyspnea, thrombophlebitis. Increased

BP, increased uric acid, gout, renalstone formation, generalized pruritus,

erythromelelgia

Diagnosis:Excess fluid volume related to

increased erythrocyte production.

Intervention:

Decrease sodium from diet

Assist in Phlebotomy

Emphasized avoidance of

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smoking

References:

Brunner & Suddarths Textbook of Medical-Surgical Nursing 11eNurses Pocket Guide 8e

http://en.wikipedia.org/wiki/Red_blood_cell#Diseases_and_diagnostic_tools

http://en.wikipedia.org/wiki/Hemolytic_anemiahttp://en.wikipedia.org/wiki/Pernicious_anemia

http://en.wikipedia.org/wiki/Sickle-cell_disease

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