Overview
This lecture covers the main types of anemia, their causes, symptoms, treatments, and focuses on sickle cell anemia including its crises, diagnosis, management, and patient education.
Causes and Types of Anemia
- Anemia is a decrease in red blood cells or hemoglobin, resulting in reduced oxygen to tissues.
- Three main causes: blood loss, insufficient red blood cell production, or excess red blood cell destruction.
- Blood loss anemia commonly results from GI bleeding, trauma, or menorrhea.
- Iron deficiency anemia is caused by low iron intake or absorption, common in pregnant women and children.
- Vitamin-deficiency anemia results from low intake of folic acid or B12, including pernicious anemia due to lack of intrinsic factor.
- Aplastic anemia occurs from bone marrow damage, often due to cancer, autoimmune disorders, or chemotherapy.
- Hemolytic anemia is due to destruction of red blood cells from genetic disorders, infection, autoimmune disorders, or medications.
Signs, Symptoms, and Treatments
- Symptoms include shortness of breath, pallor, fatigue, weakness, and tachycardia.
- General treatments: oxygen therapy and blood transfusions if needed.
- Iron deficiency: treat with iron supplements (ferrous sulfate, iron dextran).
- Vitamin-deficiency: treat with B12 or folic acid; pernicious anemia needs non-oral (e.g., intranasal) B12.
- Aplastic anemia: use erythropoiesis-stimulating agents (epoetin alfa), immunosuppressants, or bone marrow transplant.
- Hemolytic anemia: provide immunosuppressants or consider splenectomy.
Sickle Cell Anemia and Related Crises
- Sickle cell anemia is an autosomal recessive genetic disorder replacing normal HbA with sickle HbS, leading to sickle-shaped cells.
- Sickle cells obstruct blood flow, causing tissue hypoxia, chronic anemia, pain, infection, and organ damage.
- Higher risk in those with family history, African Americans, and Middle Eastern descent.
- Symptoms: pain, fatigue, shortness of breath, pallor, jaundice.
- Major crises:
- Vaso-occlusive crisis: severe pain, swelling in hands and feet; requires opioid analgesics.
- Splenic sequestration crisis: splenic enlargement, hypovolemic shock.
- Aplastic crisis: severe anemia linked to viral infection.
- Acute chest syndrome: impaired lung blood flow, causing dyspnea, fever, cough.
- Hyperhemolytic crisis: rapid hemoglobin drop.
Diagnosis and Patient Management
- Diagnosis via sickle turbidity test and hemoglobin electrophoresis.
- Treatment includes scheduled opioid analgesics, antibiotics for infection, IV fluids to lower blood viscosity, blood products, and oxygen.
Patient Teaching for Sickle Cell Anemia
- Encourage adequate fluid intake to prevent dehydration and crises.
- Teach strict hand hygiene and avoiding crowds to prevent infection.
Key Terms & Definitions
- Anemia — deficiency in red blood cells or hemoglobin, reducing oxygen transport.
- Menorrhea — excessive menstrual bleeding.
- Intrinsic factor — gastric protein needed for vitamin B12 absorption.
- Pernicious anemia — B12 deficiency due to lack of intrinsic factor.
- Aplastic anemia — anemia from bone marrow failure.
- Hemolytic anemia — anemia from red blood cell destruction.
- Vaso-occlusive crisis — blockage and pain from sickled RBCs.
- Splenic sequestration crisis — spleen enlargement from trapped sickled cells.
- Sickle cell anemia — inherited disorder with abnormal hemoglobin (HbS).
Action Items / Next Steps
- Review causes and treatments for each type of anemia.
- Memorize signs, symptoms, and crises related to sickle cell anemia.
- Practice patient education points for sickle cell.
- Complete assigned readings or practice flashcards if available.