RBC Disorders

Decreased Production of RBC

Iron Deficiency Anemia
Vitamin B12 Deficiency Anemia
Folic Acid Deficiency Anemia
Aplastic Anemia

Fe Deficiency Anemia
Common world wide
Affects 10-30% of population in US
Common in premenapausal woman,
infants, children, adolescents, & elderly
Develops slowly
A&P
Occurs when supply of Fe is too low for
optimal RBC formation
Iron RDA
10mg/d M,
F 12-49 15 mg
Typical American diet provides 10 to 20 mg/d
Many woman consume only 12.4mg/d
Cause of Development
Inadequate absorption or excess Fe loss
Inadequate dietary intake of foods high in Fe
Principal cause in adults acute or chronic
bleeding
Secondary to trauma
Excessive menses
GI bleeding
Blood donation

Diagnostics
Hgb Panic value < 5g/dl
Hgb level can drop to 3.6g/dl
Total RBC count rarely below 3 million/dl
MCH < 27 pg
MCHC 20 to 30 g/dl
Serum Fe as low as 10mcg./dl

Diagnostics
HCT < 47 ml/dl M
HCT < 42 ml/dl F
Fe binding capacity
Serum ferritin level
Bone marrow may also be indicated
Symptoms
Pallor, glossitis
Dizziness, irritability, numbness & tingling
in limbs, fatigue, decreased concentrated
& HA
Tachycardia & dyspnea on exertion
Sensitivity to cold, brittle hair & nails
Atrophic glossitis, stomatitis, dysphagia
Treatment
Diet high in Fe rich foods
Red meats, organ meats, kidney beans,
whole-wheat products, spinach, egg yolks,
carrots & raisins
Treatment
Hematinic agents
Ferrous Sulfate (Feosol) 0.2 g tid with meals
Ferrous Gluconate (Fergon) 0.3 g bid
Oral irritating to GI mucosa, GI upset,
nausea, etc. blackish green stool,
contraindicated in PUD, inflammatory bowel
disease
Liquid preparation taken mixed with H2O or
juice & sipped thought straw


Treatment
Hematinic agents
Iron-dextan (Imferon) 100 to 250 mg/d
Ascorbic acid as indicated
Deep IM use Z-track to prevent subcutaneous
irritation & discoloration from leaking med
Can be given IV to pregnant or elderly with
severe Fe deficiency anemia
Treatment
Side effects: Nausea, constipation,
epigastric pain, black & red tarry stools,
Contraindicated with hypersensitivity,
ulcerative colitis/regional enteritis, peptic
ulcer disease, hemolytic anemia, cirrhosis
absorption with antiacids, cimetidine,
cholestramine, Vit E, dairy products,
caffeine, eggs
Treatment
False positive occult blood
Toxicity: nausea, vomiting, diarrhea,
hematemesis, pallor, cyanosis, shock,
coma
Over dose: Diarrhea, fever severe
stomach pain, nausea, vomiting
Fe binding Agent Deferoxamine
Nursing Care
Oral hygiene & dental care
Preventing irritations & infections in oral cavity
Nail & hair & hygiene
Assist with maintenance proper diet
Fe supplement
Aware of changes in stool
Safety to prevent falls

Folic Acid Deficiency
Vitamin B complex
Seen in alcoholism, malabsorption
syndromes, and pregnancy
Most prevalent in infants, adolescents,
pregnant & lactating females, alcoholics &
elderly
Increase incidence in drug use and
pregnancy
Food Sources
Found in asparagus spears, beef liver,
broccoli, collards, mushrooms, oatmeal,
peanut butter, red beans, wheat germ
Clinical Manifestations
Develop slowly over a period of months
Symptoms related to tissue hypoxia
Glossitis
Jaundice
Splenomegaly
Treatment
Administer folic acid every day until
deficiency is corrected
High dises to patients with malabsorption
problems
Folvite ; adults 250 to 1,000 mcg/d until
hematological responses increases
Maintainance 400 mcg/day X 2