Without cobalamin, patient will die. Lifelong treatment. 1000mcg/day of cobalamin IM for 2 weeks until hemoglobin is normal, then monthly for life. Longstanding neuromuscular may not be reversible. Folic Acid Deficiency Anemia (Megaloblastic Anemia) GI disturbances, dyspepsia, smooth beefy red tongue. No neurologic problems. Serum folate is low while cobalamin is normal. Treatment by replacement therapy of 1-5mg/day PO. Nursing Care for Megaloblastic Anemia Sensation to heat and cold may be impaired. Falling, burns, trauma. Assess neurological difficulties. Potential gastric cancer may be increased. Anemia of Chronic Disease/Anemia of Inflammation Caused by chronic inflammation, autoimmune, and infectious disorders, HF, or malignant disease. Associated with underproduction of RBC and mild RBC life. Interleukin 6: cause increased uptake and retention of iron within macrophages. This leads to diversion of iron from circulation into storage and affects erythropoiesis. There is reduced RBC life, suppressed production of erythropoietin, and ineffective bone marrow response to erythropoietin. Kidney disease results to decreased erythropoietin. Elevated serum ferritin and increased iron stores distinguish it from iron-deficiency anemia. Normal folate and cobalamin level. Blood transfusion may be indicated for severe anemia. Erythropoietin therapy. Erythropoietin therapy may increase risk of thromboembolism and death. Aplastic Anemia Pancytopenia (suppressed WBC, RBC, PLT) and hypocellular bone marrow—increased yellow marrow. 4
Congenital or Acquired. 75% idiopathic thought to be autoimmune. Manifestation May have symptoms caused by suppression of any or all bone marrow elements. Anemia: fatigue, dyspnea, cardiovascular, cerebral. Neutropenia is susceptible to infection. Thrombocytopenia risk for bleeding—Petechiae, ecchymosis, epistaxis Care . prognosis of severe untreated aplastic anemia is poor. ATG horse serum contains antibodies against human T cells. Can cause anaphylactic and serum sickness—idiopathic anemia is considered immune disorder resulting from activated cytotoxic T cell that target and destroy own hematopoietic stem cell. Blood transfusion with chelating iron therapy. Acute Blood Loss Sudden hemorrhage 10% loss or 500ml—none or rare vasovagal syncope. 20% loss or 100ml—no s/s at rest. Tachycardia with activity and slight postural hypotension. 30% loss or 1500ml—normal BP on supine and pulse at rest. Postural hypotension and tachycardia with exercise. 40% loss or 2000ml—BP,CVP,CO below normal at rest. Air hunger, rapid pulse, cold clammy skin. 50% loss or 2500ml—shock, lactic acidosis, and death. Internal hemorrhage: cause pain because of tissue distention, organ displacement, and nerve compression.
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