RBC diseases

• Anemia: a condition that occurs when the blood doesn't have enough healthy red blood cells or hemoglobin to carry oxygen to the body's tissues

  • also can be defined as a reduction in one or more of the major red blood cell measurements: RBC count, hemoglobin, hematocrit
• Clinical Manifestations: ALL depends on the severity of the anemia
• Mild Clinical Manifestations of anemia:

  • dyspnea with exertion
  • may report no symptoms
  • mild fatigue
  • heart palpitations with exertion
  • may report heavy menstrual bleeding or blood in stool
• Moderate Clinical Manifestations of anemia:

  • worsening dyspnea with exertion
  • moderate fatigue
  • heart palpitations
  • may report heavy menstrual bleeding or blood in stool
• Severe Clinical Manifestations of anemia:

  • glossitis (smooth, beefy, red and enlarged tongue)
  • dyspnea at rest
  • tachycardia
  • chest pain (if person has CAD)
  • cold Intolerance
  • headache
  • lightheadedness or fainting
  • reduced ability to concentrate
  • severe fatigue
  • pallor
  • jaundice
• Iron Deficiency Anemia pathophysiology:

  • An anemia resulting from decreased dietary intake of iron, reduced absorption of iron or blood loss
  • Most common cause of anemia in the US and in the world
• Iron Deficiency Anemia: Clinical Manifestations

  • Fatigue
  • Pallor
  • SOB
  • Dizziness
  • Cold hands and feet
  • Brittle nails
  • Pica
• Diagnostic Findings for IDA:

  • Decreased hemoglobin
  • Decreased hematocrit
  • Low mean corpuscular volume (microcytic)
  • Low mean corpuscular hemoglobin (hypochromic)
  • Decreased Serum Ferritin
• Collaborative Management for IDA

  • Iron supplementation, best absorbed in an acidic environment
• What causes inhibition of Iron Absorption?

  • Antacids
  • Calcium
  • Dietary fiber
  • Tea
  • Coffee
  • Eggs
• Anemia of Chronic Disease (inflammation): pathophysiology

  • A very common anemia found in people with certain long-term medical conditions that involve inflammation
  • Examples: chronic infection, cancer, rheumatoid arthritis
• Clinical Manifestations for Anemia of Chronic Disease

  • Fatigue
  • Pallor
  • SOB
  • Dizziness
  • Mild jaundice
  • Weight loss and loss of appetite
  • Abdominal pain
  • Fever
  • Joint Pain
• Diagnostic findings for Anemia of Chronic Disease

  • Hemoglobin levels moderately low
  • RBC indices normal or slightly low MCV, MCHC
  • Ferritin level is normal or elevated
  • C-reactive protein (CRP) is often high
• Collaborative Management for Anemia of Chronic Disease

  • Monitor
  • Anemia is usually mild to moderate
  • Decreased serum iron may be protective (prevents nourishment of bacteria and cancer cells)
  • Iron supplements COULD be harmful
• Megaloblastic Anemias:

  • A type of anemia characterized by the presence of very large (macrocytic) red blood cells
  • Commonly caused by Vitamin B12 deficiency and folate deficiency
• Vitamin B12 Deficiency Anemia: pathophysiology

  • The body doesn't have enough vitamin B12 which is important for the production of RBC and the function of the nervous system
• Vitamin B12 Deficiency Clinical Manifestations

  • S/S of anemia (fatigue, SOB, pallor)
  • Glossitis: firey red, sore tongue
  • GI problems: anorexia, nausea, vomiting, abdominal pain
  • Neurological problems: muscle weakness numbness in hands and feet
  • Can result in ataxia, memory loss, disorientation and dementia
• Vitamin B12 Deficiency Diagnostic Findings:

  • Low hemoglobin
  • Low hematocrit
  • Low levels of vitamin B12
• Collaborative Management for Vitamin B12 Deficiency:

  • Increase dietary intake of red meats, liver, eggs and B12 fortified foods
  • Vitamin B12 replacement
  • Parenteral Vitamin B12 replacement
  • This is only for those who cannot absorb oral replacement (those with pernicious anemia)
• Folic Acid Deficiency Anemia Pathophysiology

  • This develops due to having low levels of folic acid which is essential for the production of red blood cells
• Clinical Manifestations for Folic Acid Deficiency

  • Similar to vitamin B12 deficiency but NO neurologic problems
• Diagnostic Findings for Folic Acid Deficiency

  • Hgb/Hct are LOW
  • RBCs are macrocytic
  • Ferritin is normal
  • Folate levels are LOW
• Collaborative management for Folic Acid Deficiency

  • Folic acid supplementation
• Aplastic Anemia Pathophysiology

  • A blood condition where the bone marrow fails to produce blood cells in sufficient numbers
  • most often caused by an autoimmune disorder
  • Radiation and chemotherapy can cause this or it can be idiopathic
• Clinical Manifestations of aplastic anemia:

  • fatigue
  • SOB
  • Pallor
  • Bruising and bleeding easy
  • Frequent infections
  • Tachycardia
  • Fever
  • Excessive menstrual bleeding
• Diagnostic findings for Aplastic Anemia

  • CBC shows pancytopenia:
  • a reduction in RBC, WBC, platelets
  • Diagnosed with bone marrow biopsy
• Collaborative Management for Aplastic Anemia

  • Blood transfusions
  • Immunosuppressive therapy
  • Allogeneic stem cell transplant or hematopoietic stem cell transplant (HSCT)
• Anemia caused by blood loss pathophysiology

  • Decrease of RBC in the circulating blood due to blood loss
• Anemia caused by blood loss clinical manifestations

  • fatigue
  • SOB
  • dizziness
  • pallor
  • heart palpitations
  • tachycardia
• Diagnostic Findings for anemia caused by blood loss:

  • After 36-48 hours
  • Hgb, Hct, and RBC decreased
  • MCV, MHC will be normal
  • Reticulocyte count may increase
  • In 3-4 weeks
  • Hgb, Hct, RBC count will return to normal if sufficient iron is available
  • Without iron, Hgb and Hct rise will be slowed and MCV and MCH will drop
• Collaborative management for anemia caused by blood loss

  • Supplement O2 if sat is <90%
  • PRBC transfusion
  • Platelets, FFP, clotting factor replacements if indicated
  • Recovery phase: iron supplementation
• Anemia caused by RBC Destruction pathophysiology

  • Hemolytic anemia is characterized by the premature destruction (lysis) of RBCs
  • Can be caused by Hereditary disorders (intrinsic) or acquired conditions (extrinsic)
  • Examples of hereditary disorders that can cause this condition:
  • Sickle cell disease
  • Thalassemia
  • Examples of acquired conditions that can cause this condition:
  • Blood transfusion reaction
  • Autoimmune hemolytic anemia
  • Physical destruction- mechanical heart valves, LVAD, splenomegaly
  • Infections- malaria
• Clinical Manifestations of anemia caused by RBC destruction

  • Jaundice
  • Increased serum bilirubin levels
  • Dark urine (increased urobilinogen)
  • Enlarged spleen and liver
  • General manifestations of anemia
• Diagnostic Findings for anemia caused by RBC destruction

  • low hemoglobin
  • low hematocrit
  • high reticulocyte count
  • low RBC count
  • high bilirubin levels due to lysing of the RBCs
  • Dark colored urine
• Collaborative Management of anemia caused by RBC destruction

  • Transfusion with PRBCs if needed
  • Immunosuppressants to help suppress the immune response that is lysing the RBCs
• Pathophysiology of Hemochromatosis:

  • An iron overload disorder
  • Primary hemochromatosis: A hereditary disorder characterized by excessive intestinal absorption of dietary iron
  • Secondary hemochromatosis: Occurs as the consequence of chronic blood transfusions
• Clinical manifestations of hemochromatosis

  • fatigue, joint pain, bronze skin, stomach pain, heart palpitations, DM
  • liver cirrhosis
• Diagnostic findings for hemochromatosis

  • High ferritin levels
  • Hgb and Hct are not directly affected by this
• Collaborative management of hemochromatosis

  • dietary modifications
  • routine therapeutic phlebotomy
  • chelation therapy to bond excess iron
• Polycythemia pathophysiology

  • A disorder that results in an increased number of red blood cells in the bloodstream
  • Primary polycythemia:
  • the bone marrow makes too many blood cells, especially RBCs
  • results in enhanced blood viscosity and blood volume
  • Secondary polycythemia:
  • most often a response to chronic hypoxemia