ANEMIAS

NURS 500 – Advanced

Patho
Week 15
WHAT DO THE BLOOD INDICES MEAN?
 Reticulocyte count: the immature RBC’s made in
the bone marrow, and released into the blood where
they mature in ~ 2 days. Iron, B12, folate are all
necessary for production of RBC’s.
 Mean Corpuscular Hgb (MCH): the average mass of
Hgb per RBC
 Serum Iron: the circulating iron bound to
transferrin (90%) or ferritin (10%)in the blood
 Total Iron-binding Capacity: transferrin binds to ~
90% of iron in blood. If iron is low, binding capacity
is increased
 Ferritin level: binds to ~ 10% of iron in blood and
indicates level of iron stores
 B12: measured in blood and needed for making HgB

 Folate: measured in blood and needed for making

HgB
FACTS ABOUT IRON-DEFICIENCY ANEMIA
 Iron-Deficiency Anemia is the most prominent
nutritional deficiency worldwide

 Caused by hemorrhage, malabsorption, decreased

RBC production, increased/excessive demands,
inadequate intake of vitamins and/or minerals –
(need B12, folate, and iron in diet).

 Risk factors include age, activities, living

conditions, diet, gender, genetics
PATHOPHYSIOLOGY
 Iron stores are located in hemoglobin, myglobin,
and enyzmes

 Transported by proteins including ferritin

helosiderin, and transferrin

 Iron balance maintained primarily through small

intestine. Most iron is “recycled” after released
from dying RBC’s.
SIGNS & SYMPTOMS OF ANEMIA --
MAY DEVELOP SLOWLY (DEPENDS ON CAUSE)

 Skin pallor
 Fatigue/weakness/ feeling lightheaded

 Shortness of breath

 Chest pain, tachycardia/palpitations

 Cold hands & feet

 Brittle hair and nails, dry skin and lips, mouth

sores, tongue inflammation and sores and/or
smoother surface
 Restless leg syndrome

 Increased frequency of infections

DIAGNOSING ANEMIAS
 H&P (be sure to include dietary intake!)
 Need bloodwork to determine cause of anemia and
determine appropriate tx.

 Remember that Iron-Deficiency Anemia is the

most common. With this you will see:
 Micocytic RBC’s

 Low Hgb and HCT

 Low reticulocyte count

 Low MCH

 Low Serum iron

 Low Ferritin level

 High iron-binding capacity

 Normal B12 and Folate levels

ANEMIA OF CHRONIC DISEASE
 Second most common type of anemia

 Often results secondary to diseases such as

infections, autoimmune disease, cancers,
inflammatory conditions

 Sxs will vary dependent upon primary cause and

the severity of the resulting secondary anemia
 Dx: H&P, and blood work. You will generally see:

 Normal or microcytic RBC’s

 Low reticulocyte count
 Other values may all be normal– bu,t serum
iron may be a bit decreased, while ferritin may
be increased
B12 DEFICIENCY ANEMIA
(AKA PERNICIOUS ANEMIA)
 This type of anemia is common in older
adults, those who have had gastric bypass
surgery or who have GI absorption
problems, those on long-term antacids, use
of certain medications such as metformin,
alcoholics

 Sxs generally come on very slowly because

the liver can store enoughB12 to meet needs
for a few years

 Sxs
may include numbness, tingling,
memory problems, difficulty with walking
PERNICIOUS ANEMIA DX*
 H&P
 Blood work. You will see:

 Normal or low Hgb and HCT

 Normal MCH, total iron-binding capacity, & folate level
 Low reticulocyte count
 Low B12 level
 High serum iron
 High Ferritin level

* Be aware that a person may have concurrent iron-

deficiency anemia and pernicious anemia in which
case you would also see low MCH, low serum iron,
increased IBC, low ferritin,