Blood disorders have an impact on the main components of the blood – red blood cells, which carry oxygen throughout the body; white blood cells, which fight infection; and platelets, which help through their blood clotting mechanism. Some blood disorders are caused by genes. However, blood disorders can also result from other diseases, medications, or lack of nutritional intake.
Diagnostic Tests for Blood Disorders
- CBC (Complete Blood Count) – haemoglobin, haematocrit, reticulocyte count, red blood cell indices, MCV (mean corpuscular volume i.e. RBC size), and RDW (RBC distribution width)
- Blood Chemistry Tests – Electrolytes, Fats, Proteins, and Glucose
- Blood Enzyme Tests – Myoglobin, Troponin, and Creatine-Kinase
- Blood Clotting Tests – PT (Prothrombin Time), aPTT (activated partial thromboplastin time), TT (Thrombin Time)
- Serum Vitamin B12 and folate levels, haptoglobin, erythropoietin levels
- Bone Marrow aspiration
Anaemia
Anaemia is a blood disorder in which there is a deficiency in erythrocytes or haemoglobin, leading to tissue oxygen deprivation.
Causes
- bleeding (eg. menstruation, childbirth, NSAIDs overuse [may cause ulcers and gastritis], GI conditions [ulcers, haemorrhoids, gastritis and cancer]
- decreased or abnormal RBC production (eg. sickle-cell anaemia, iron-deficiency anaemia, vitamin deficiency, problems related to the bone marrow and/or stem cells)
- premature RBC destruction (RBCs inability to withstand circulation stress, leading to premature rupture, causing haemolytic anaemia)
Possible complications
- Confusion
- Parathesias (a burning or prickling sensation usually felt in the hands, arms, legs, or feet, but can also extend to other body parts)
- Congestive Heart Failure
- Death
1. Iron-Deficiency Anaemia
Iron-Deficiency Anaemia is a type of anaemia in which there is lack of iron in the body. Iron is required for the production of haemoglobin for red blood cells to carry oxygen throughout the body.
2. Pernicious Anaemia
Pernicious Anaemia is a type of anaemia in which the intrinsic factor is missing. This results in lack of Vitamin B12 absorption. While Pernicious Anaemia is very common in older individuals and individuals who have had a gastric resection, it may also result from malnutrition in which B12 intake is low, such as in vegetarian diets or lack of dairy products intake.
3. Aplastic Anaemia
Aplastic Anaemia is caused by a deficiency of all blood cell types due to bone marrow development failure. Aplastic Anaemia is considered to be a rare disease.
4. Thalassemia
The term ‘Thalassemia’ refers to a group of hereditary disorders in which there is defective haemoglobin-chain synthesis. In Thalassemia there is an abnormal decrease in RBCs’ haemoglobin (hypochromia), small RBCs (microcytosis), blood element destruction (haemolysis) and anaemia.
Anaemia Clinical Manifestations
Anaemia Nursing Care
Assessment
- What type of anaemia is involved?
- What symptoms is it exhibiting, and to what extent?
- How are these symptoms leaving an impact on the patient’s daily life?
- What medication has the patient been on – past and present? Was the patient on medications which may have caused a reduction in bone marrow activity, caused haemolysis, or affected folate metabolism?
Diagnosis
- Fatigue (due to haemoglobin decrease i.e. reduced oxygen saturation)
- Malnutrition (lack of required nutrition and nutrient intake)
- Decreased Tissue Perfusion (due to reduced blood volume – hematocrit)
- Poor Medication Compliance
Implementation
- ensure adequate rest to reduce fatigue along with periods of feasible activities to promote physical activity, whilst also assessing for other conditions such as pain, depression, and insomnia, which may further exacerbate fatigue
- encourage and/or ensure adequate nutritional intake through a healthy diet comprising of adequate iron, vitamin B12, folic acid, and protein intake (if required supplements may be recommended), whilst avoiding alcohol
- ensure adequate tissue perfusion through blood transfusions, IV fluids, and if required supplemental oxygen (monitor vital signs and SPO2)
- educate about the importance of medication compliance and management of side effects
- promote complication avoidance by assessing for heart failure, assessing the patient neurologically, evaluating the patient’s gait and balance, and complaints of parathesias
Evaluation
- assess for signs and symptoms of heart failure
- measure and document the patient’s weight on a daily basis
- intake and output charting
- assess for possible need of diuretics in the case of fluid retention
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