Etiology and Pathophysiology

■ ↓RBCs secondary to blood loss, ↓production or ↑destruction of RBCs; ↓O2
carrying capacity of blood, ↑cardiac workload, heart failure

Signs and Symptoms

■ ↑P, ↑R, fatigue, weakness, pallor, confusion, ↓Hgb, ↓Hct


■ Correct cause, provide O2, administer transfusions (whole blood, packed
RBCs), administer meds depending on type

Nursing Management

■ Monitor S&S; balance rest/activity; ↑protein diet; teach iron supplements
will cause black stools and constipation; packed red blood cells if ordered

Microcytic Anemia

Etiology and pathophysiology: ↓Iron secondary to ↓dietary intake
(vegetarians, teens); blood loss from GI bleeding (ulcers, cancer,
inflammation) or menorrhagia; ↓iron absorption after gastric surgery
Signs and symptoms: MCV <80fl; style="font-weight: bold; color: rgb(0, 0, 153);">Treatment: Oral iron best absorbed with ↓pH (give with vitamin C between
meals); use straw with liquid iron (stains teeth); ↑dietary sources of iron
(raisins, eggs, meat [liver], green vegetables)

Macrocytic Anemia

Etiology and pathophysiology: ↓Folate due to ↓dietary intake; alcohol; B12
deficiency due to lack of intrinsic factor (pernicious anemia); ↓folate
absorption after gastric surgery or Crohn’s disease
Signs and symptoms: MCV >100fl; ↓folate; ↓B12 (Schilling Test for
pernicious anemia); sore, smooth, red, tongue; diarrhea; neuro changes
due to ↓myelin (paresthesias, ataxia); screen for stomach Ca
Treatment: Oral folic acid; avoid alcohol; IM B12; ↑dietary sources of folic
acid (green vegetables, liver, mushrooms)

Normocytic Anemia

Etiology and pathophysiology:
-Hemolytic anemia (HA): RBCs break down rapidly → ↑bone marrow
release of reticulocytes; examples: sickle cell anemia, toxins,
thalassemia, G-6-PD deficiency
-Anemia in renal disease: ↓erythropoietin → ↓RBC synthesis

Signs and symptoms: MCV 80-100fl; HA → ↑reticulocytes; jaundice due to
Hgb breakdown; hepatomegaly; sickle cell vaso-occlusive crisis → tissue
hypoxia, necrosis, pain
  • Acute hemolysis: ↑T, chills, abdominal and back pain, hemoglobinuria
  • Treatment: Sickle cell anemia: bone marrow transplant, hydroxyurea
  • Sickle cell crisis: Analgesic, hydration, O2
  • Renal disease: Iron, folate, recombinant erythropoietin
Aplastic Anemia

Etiology and pathophysiology: Bone marrow stem cells destroyed →
↓RBCs, ↓WBCs (neutropenia) and ↓platelets (thrombocytopenia);
idiopathic or caused by radiation, infection, or chemicals

Signs and symptoms: MCV >100fl; no reticulocytes; ↓WBCs, ↓platelets;
infection; bleeding (purpura, retinal hemorrhage)

Treatment: Bone marrow transplant; peripheral blood stem cell transplant;
immunosuppressants (cyclosporine)
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