Chapter 33 Worksheet
N 3561 does not cover everything in this chapter- please look at this worksheet
to see the topics covered.
Anemia is; a condition in which the hemoglobin concentration is lower than normal; it reflects the
presence of fewer than the normal number of erythrocytes (i.e., red blood cells [RBCs]) within the
circulation. As a result, the amount of oxygen delivered to body tissues is also diminished. Anemia is
not a specific disease state but a sign of an underlying disorder. It is by far the most common
hematologic condition.
Table 33-1
TABLE 33-1 Classification of Anemias
Laboratory Findings
Type of Anemia CBC Other
Hypoproliferative (Resulting from Defective RBC Production)
Iron deficiency ↓ MCV, ↓ ↓ Iron, %
reticulocytes saturation,
ferritin
↑ TIBC
Vitamin B12 deficiency ↑ MCV ↓ Vitamin B12
(megaloblastic)
Folate deficiency (megaloblastic) ↑ MCV ↓ Folate
Decreased erythropoietin Normal MCV ↓ Erythropoietin
production (e.g., from renal level
dysfunction) ↑ Creatinine
Cancer/inflammation Normal MCV ↑ Ferritin, %
saturation
↓ Iron, TIBC
↓ Erythropoietin
level (usually)
Bleeding (Resulting from RBC Loss)
Bleeding from gastrointestinal ↓ Hgb and Hct ↓ Iron, %
tract, epistaxis (nosebleed), (Note: Hgb and Hct saturation,
trauma, bleeding from may be normal if ferritin (later)
genitourinary tract (e.g., measured soon
menorrhagia) after bleeding
starts)
↓ MCV
(normal MCV
initially)
,Chapter 33 Worksheet
TABLE 33-1 Classification of Anemias
↑ Reticulocytes
Hemolytic (Resulting from RBC Destruction)
Altered erythropoiesis (sickle cell ↓ MCV
disease, thalassemia, other ↑ Reticulocytes
hemoglobinopathies) Fragmented RBCs
(various shapes)
Hypersplenism (hemolysis) ↑ MCV
Drug-induced anemia ↑ Presence of
spherocytes
Autoimmune anemia ↑ Presence of
spherocytes
Mechanical heart valve–related Fragmented red cells
anemia
CBC, complete blood count; RBC, red blood cell; ↓, decreased; MCV, mean corpuscular volume; %, percent; ↑,
increased; TIBC, total iron-binding capacity; Hgb, hemoglobin; Hct, hematocrit.
Hypoproliferative (Resulting from Defective RBC Production): bone marrow does not produce adequate
numbers of erythrocytes. Decreased erythrocyte production is reflected by a low or inappropriately
normal reticulocyte count. Inadequate production of erythrocytes may result from marrow damage
due to medications (e.g., chloramphenicol [Chloromycetin]), chemicals (e.g., benzene), or from a
lack of factors (e.g., iron, vitamin B12, folic acid, erythropoietin) necessary for erythrocyte
formation.
- Iron deficiency
- Vitamin B12 deficiency (megaloblastic)
- Decreased erythropoietin production (e.g., from renal dysfunction)
Bleeding (Resulting from RBC Loss)
Bleeding from gastrointestinal tract, epistaxis (nosebleed), trauma, bleeding from genitourinary tract
(e.g., menorrhagia)
Hemolytic (Resulting from RBC Destruction): a result from an abnormality within the
erythrocyte itself (e.g., sickle cell disease [SCD], glucose-6-phosphate dehydrogenase [G-6-PD]
deficiency), within the plasma (e.g., immune hemolytic anemias), or from direct injury to the
erythrocyte within the circulation (e.g., hemolysis caused by a mechanical heart valve). identifies
causes of hemolytic anemia.
It is usually possible to determine whether the presence of anemia in a given patient is caused by
destruction or by inadequate production of erythrocytes on the basis of the following factors:
, Chapter 33 Worksheet
The bone marrow’s ability to respond to decreased erythrocytes (as evidenced by an
increased reticulocyte count in the circulating blood)
The degree to which young erythrocytes proliferate in the bone marrow and the manner in
which they mature (as observed on bone marrow aspirate)
The presence or absence of end products of erythrocyte destruction within the circulation
(e.g., increased bilirubin level, decreased haptoglobin level)
Sickle cell:
Clinical Manifestations: Aside from the severity of the anemia itself, several factors influence the
development of anemia-associated symptoms: the rapidity with which the anemia has developed, the
duration of the anemia (i.e., its chronicity), the metabolic requirements of the patient, other
concurrent disorders or disabilities (e.g., cardiac or pulmonary disease), and complications or
concomitant features of the condition that produced the anemia. In general, the more rapidly an
anemia develops, the more severe its symptoms (Bunn, 2017). An otherwise healthy person can often
tolerate as much as a 50% gradual reduction in hemoglobin (e.g., over months) without pronounced
symptoms or significant incapacity, whereas the rapid loss of as little as 30% (e.g., over minutes)
may precipitate profound vascular collapse in the same person. A person who has become gradually
anemic, with hemoglobin levels between 9 and 11 g/dL, usually has fewer or no symptoms other than
slight tachycardia on exertion and possibly fatigue.
Complications of severe anemia include: Complications of severe anemia include heart failure,
paresthesias, and delirium.
Patients with underlying heart disease are far more likely: to have angina or symptoms of heart failure
than those without heart disease.
Medical Management: Management of anemia is directed toward correcting or controlling the cause
of the anemia; if the anemia is severe, the erythrocytes that are lost or destroyed may be replaced
with a transfusion of packed red blood cells (PRBCs). The management of the various types of
anemia is covered in the discussions that follow.
NURSING PROCESS
The Patient with Anemia- this provides a great breakdown
Assessment: The health history and physical examination provide important data about the type of
anemia involved, the extent and type of symptoms it produces, and the impact of those symptoms on
the patient’s life. Weakness, fatigue, and general malaise are common, as are pallor of the skin and
mucous membranes (conjunctivae, oral mucosa) (see Fig. 33-1).
Jaundice; angular cheilosis (ulcerated corners of the mouth); and brittle, ridged, concave nails
may be present in patients with megaloblastic anemia(characterized by the presence of
abnormally large, nucleated RBCs) or hemolytic anemia. The tongue may be beefy red and sore in
megaloblastic anemia, or smooth and red in iron deficiency anemia. Patients with iron deficiency
anemia may infrequently crave ice, starch, or dirt; this craving is known as pica (Broadway-Duren &
Klaassen, 2013). Restless leg syndrome is common in as many as 24% of those with iron deficiency
N 3561 does not cover everything in this chapter- please look at this worksheet
to see the topics covered.
Anemia is; a condition in which the hemoglobin concentration is lower than normal; it reflects the
presence of fewer than the normal number of erythrocytes (i.e., red blood cells [RBCs]) within the
circulation. As a result, the amount of oxygen delivered to body tissues is also diminished. Anemia is
not a specific disease state but a sign of an underlying disorder. It is by far the most common
hematologic condition.
Table 33-1
TABLE 33-1 Classification of Anemias
Laboratory Findings
Type of Anemia CBC Other
Hypoproliferative (Resulting from Defective RBC Production)
Iron deficiency ↓ MCV, ↓ ↓ Iron, %
reticulocytes saturation,
ferritin
↑ TIBC
Vitamin B12 deficiency ↑ MCV ↓ Vitamin B12
(megaloblastic)
Folate deficiency (megaloblastic) ↑ MCV ↓ Folate
Decreased erythropoietin Normal MCV ↓ Erythropoietin
production (e.g., from renal level
dysfunction) ↑ Creatinine
Cancer/inflammation Normal MCV ↑ Ferritin, %
saturation
↓ Iron, TIBC
↓ Erythropoietin
level (usually)
Bleeding (Resulting from RBC Loss)
Bleeding from gastrointestinal ↓ Hgb and Hct ↓ Iron, %
tract, epistaxis (nosebleed), (Note: Hgb and Hct saturation,
trauma, bleeding from may be normal if ferritin (later)
genitourinary tract (e.g., measured soon
menorrhagia) after bleeding
starts)
↓ MCV
(normal MCV
initially)
,Chapter 33 Worksheet
TABLE 33-1 Classification of Anemias
↑ Reticulocytes
Hemolytic (Resulting from RBC Destruction)
Altered erythropoiesis (sickle cell ↓ MCV
disease, thalassemia, other ↑ Reticulocytes
hemoglobinopathies) Fragmented RBCs
(various shapes)
Hypersplenism (hemolysis) ↑ MCV
Drug-induced anemia ↑ Presence of
spherocytes
Autoimmune anemia ↑ Presence of
spherocytes
Mechanical heart valve–related Fragmented red cells
anemia
CBC, complete blood count; RBC, red blood cell; ↓, decreased; MCV, mean corpuscular volume; %, percent; ↑,
increased; TIBC, total iron-binding capacity; Hgb, hemoglobin; Hct, hematocrit.
Hypoproliferative (Resulting from Defective RBC Production): bone marrow does not produce adequate
numbers of erythrocytes. Decreased erythrocyte production is reflected by a low or inappropriately
normal reticulocyte count. Inadequate production of erythrocytes may result from marrow damage
due to medications (e.g., chloramphenicol [Chloromycetin]), chemicals (e.g., benzene), or from a
lack of factors (e.g., iron, vitamin B12, folic acid, erythropoietin) necessary for erythrocyte
formation.
- Iron deficiency
- Vitamin B12 deficiency (megaloblastic)
- Decreased erythropoietin production (e.g., from renal dysfunction)
Bleeding (Resulting from RBC Loss)
Bleeding from gastrointestinal tract, epistaxis (nosebleed), trauma, bleeding from genitourinary tract
(e.g., menorrhagia)
Hemolytic (Resulting from RBC Destruction): a result from an abnormality within the
erythrocyte itself (e.g., sickle cell disease [SCD], glucose-6-phosphate dehydrogenase [G-6-PD]
deficiency), within the plasma (e.g., immune hemolytic anemias), or from direct injury to the
erythrocyte within the circulation (e.g., hemolysis caused by a mechanical heart valve). identifies
causes of hemolytic anemia.
It is usually possible to determine whether the presence of anemia in a given patient is caused by
destruction or by inadequate production of erythrocytes on the basis of the following factors:
, Chapter 33 Worksheet
The bone marrow’s ability to respond to decreased erythrocytes (as evidenced by an
increased reticulocyte count in the circulating blood)
The degree to which young erythrocytes proliferate in the bone marrow and the manner in
which they mature (as observed on bone marrow aspirate)
The presence or absence of end products of erythrocyte destruction within the circulation
(e.g., increased bilirubin level, decreased haptoglobin level)
Sickle cell:
Clinical Manifestations: Aside from the severity of the anemia itself, several factors influence the
development of anemia-associated symptoms: the rapidity with which the anemia has developed, the
duration of the anemia (i.e., its chronicity), the metabolic requirements of the patient, other
concurrent disorders or disabilities (e.g., cardiac or pulmonary disease), and complications or
concomitant features of the condition that produced the anemia. In general, the more rapidly an
anemia develops, the more severe its symptoms (Bunn, 2017). An otherwise healthy person can often
tolerate as much as a 50% gradual reduction in hemoglobin (e.g., over months) without pronounced
symptoms or significant incapacity, whereas the rapid loss of as little as 30% (e.g., over minutes)
may precipitate profound vascular collapse in the same person. A person who has become gradually
anemic, with hemoglobin levels between 9 and 11 g/dL, usually has fewer or no symptoms other than
slight tachycardia on exertion and possibly fatigue.
Complications of severe anemia include: Complications of severe anemia include heart failure,
paresthesias, and delirium.
Patients with underlying heart disease are far more likely: to have angina or symptoms of heart failure
than those without heart disease.
Medical Management: Management of anemia is directed toward correcting or controlling the cause
of the anemia; if the anemia is severe, the erythrocytes that are lost or destroyed may be replaced
with a transfusion of packed red blood cells (PRBCs). The management of the various types of
anemia is covered in the discussions that follow.
NURSING PROCESS
The Patient with Anemia- this provides a great breakdown
Assessment: The health history and physical examination provide important data about the type of
anemia involved, the extent and type of symptoms it produces, and the impact of those symptoms on
the patient’s life. Weakness, fatigue, and general malaise are common, as are pallor of the skin and
mucous membranes (conjunctivae, oral mucosa) (see Fig. 33-1).
Jaundice; angular cheilosis (ulcerated corners of the mouth); and brittle, ridged, concave nails
may be present in patients with megaloblastic anemia(characterized by the presence of
abnormally large, nucleated RBCs) or hemolytic anemia. The tongue may be beefy red and sore in
megaloblastic anemia, or smooth and red in iron deficiency anemia. Patients with iron deficiency
anemia may infrequently crave ice, starch, or dirt; this craving is known as pica (Broadway-Duren &
Klaassen, 2013). Restless leg syndrome is common in as many as 24% of those with iron deficiency
