Med-Surg - Cardiovascular System, part 19: Anemia, Sickle Cell Anemia
by Cathy Parkes October 20, 2021 Updated: December 07, 2022 5 min read
Hi, I am Cathy, with Level Up RN. In this video, I am going to talk about anemia. So I'll be covering several different types of anemia, and then spending a little more time on sickle cell anemia. At the end of the video, I'm going to give you guys a little quiz. So definitely stay tuned for that so you can test your understanding of some of the key facts I'll be covering in this video. And if you have our medical-surgical nursing flashcards, definitely pull those out so you can follow along with me.
Anemia is a blood disorder that results in a decrease in red blood cells or a decrease in hemoglobin.
And there's basically three causes of anemia. We have blood loss, we have insufficient red blood cell production, or we have excess destruction of red blood cells.
And no matter the cause, we end up with decreased oxygenation to the body's tissues. So let's talk about some of the more common types and forms of anemia.
First of all, we have blood loss. So what can cause blood loss?
Well, GI bleeding is actually the most common cause of blood loss that results in anemia.
Other causes include trauma, as well as menorrhea, which is like excess bleeding with periods.
Then we have iron deficiency anemia.
So this is where an individual has insufficient intake or absorption of iron, and it's common with pregnant women as well as children. So in children, they often drink a lot of milk. And milk is a poor source of iron. So if they drink so much milk that it really takes away their appetite for any other foods which may be higher in iron, then they can end up with iron-deficiency anemia. So that excess milk intake often leads to this disorder.
We also have a vitamin-deficiency anemia.
This is where an individual has insufficient intake of folic acid, or B12.
This is also caused by something called pernicious anemia.
So with pernicious anemia, the individual lacks something called intrinsic factor in their gastric mucosa, and this intrinsic factor allows for absorption of B12. So someone with pernicious anemia can take in tons of B12 orally. It's not going to matter because they're not going to absorb it due to that lack of intrinsic factor. So they will need to get their B12 through another route. So they will need to get it parenterally instead of through the GI system.
Then we have aplastic anemia. This is where we have bone marrow damage that can occur from based on like cancer.
It can be caused by autoimmune disorders, as well as medications such as chemotherapy.
And then finally, we have hemolytic anemia.
And this is where we have red blood cell destruction that occurs due to genetic disorders, infection, autoimmune disorders, and possibly medications as well.
Signs and symptoms of anemia include shortness of breath, pallor, fatigue, weakness, as well as tachycardia.
In terms of treatment, we may need to provide the patient with oxygen and possibly a blood transfusion. And then, depending on the types of anemia, we have other treatment options. For example, with iron deficiency anemia, we can provide an iron supplement such as ferrous sulfate or iron dextran. For vitamin-deficiency anemia, we can provide B12 or folic acid if needed. However, like I mentioned, if the patient has pernicious anemia, we will need to give them their B12 through another route. So intranasal B12 is common. And then we have aplastic anemia. For that, we can provide an erythropoiesis-stimulating agent such as epoetin alfa to help increase the amount of red blood cells that are being produced. We can also provide immunosuppressants if we're dealing with an autoimmune disorder. Or the patient may require a bone marrow transplant. With hemolytic anemia, we can provide immunosuppressants, again, if we're dealing with an autoimmune disorder. The patient may also require a splenectomy.
Now let's talk about sickle cell anemia, which is an autosomal recessive genetic disorder that causes chronic anemia, pain, infection, as well as organ damage.
So the pathophysiology behind this disorder is that our normal hemoglobin, which is HbA, is replaced with abnormal sickle hemoglobin, which is HbS.
And this causes sickling of the red blood cells. So normally red blood cells are nice and round. When we have the sickling, they kind of turn into this C shape. And these red blood cells get easily caught in the blood vessels, which obstructs blood flow to the organs and can result in tissue hypoxia.
So in terms of risk factors associated with this condition, a family history is obviously going to be a risk factor because this is a genetic disorder. Also, African Americans and those of Middle Eastern descent are at higher risk for sickle cell anemia.
Overall, signs and symptoms include pain, fatigue, shortness of breath, pallor, as well as jaundice. When a patient has sickle cell anemia, they will often experience crises, and there are several crisses to be familiar with.
Probably the most important one to know is called a vaso-occlusive crisis. So during this type of crisis, the patient will have severe pain that will need to be treated with opioid analgesics around the clock. They may also have swelling in their hands and feet during this type of crisis.
Another type of crisis is a splenic sequestration crisis. So with this type of crisis, blood flow is blocked out of the spleen due to that sickling of the red blood cells, and this causes enlargement of the spleen. The patient may also exhibit hypovolemic shock.
Then we have an aplastic crisis. So this is where we have severe anemia that is typically related to a viral infection. Then we have something called an acute chest syndrome, which is a type of crisis where blood flow to the lungs is impaired. So the patient will have dyspnea, fever, and cough.
And then we have a hyperhemolytic crisis, which is characterized by a rapid decrease in hemoglobin levels.
In terms of diagnosis of sickle cell anemia, we can do what's called a sickle turbidity test, which will detect that abnormal hemoglobin, that HbS. We can also do something called hemoglobin electrophoresis.
In terms of treatment, we're going to give those opioid analgesics on a schedule. In addition, we need to provide antibiotics if there's an infection present. In addition, we will need to administer IV fluids to help decrease the viscosity of the blood. So we're trying to help the flow of blood get to the organs, which will help prevent tissue hypoxia. And then we would give blood products and oxygen as ordered.
In terms of patient teaching, we're definitely going to want to encourage our patients to get enough fluid intake to help prevent dehydration and prevent the onset of a vaso-occlusive crisis. We also want them to avoid getting infection. So they need to perform meticulous hand hygiene and avoid crowds as well.
All right, time for a quiz. I had a hard time figuring out my three questions because there are many questions I could ask about this topic. But first question. What type of anemia is caused by a lack of intrinsic factor, which impairs absorption of B12? The answer is pernicious anemia. Question number two. What type of sickle cell crisis is characterized by severe pain? The answer is a vaso-occlusive crisis. Question number three. What two key teaching points do you need to provide your patient with sickle cell anemia? The answer is get adequate fluid intake and avoid infection. There are actually other teaching points you could provide as well, like getting enough rest, etc. But really avoiding dehydration is going to be key for our sickle cell patients, in addition to avoiding infection. Okay. I hope this video has been helpful. Thank you so much for watching. Take care and good luck studying.
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