Chapter 31 Nursing Management: Aplastic Anemia

Aplastic anemia is a disease in which
a disease in which the patient has peripheral blood pancytopenia and hypocellular bone marrow.

decrease of all blood cell types—RBCs, white blood cells [WBCs], and platelets)

The signs and symptoms Aplastic anemia
can range from a chronic condition managed with erythropoietin or blood transfusions to a critical condition with hemorrhage and sepsis.

The incidence of aplastic anemia is low affecting approximately
4 of every 1 million persons.

aplastic anemia, can be divided two major groups:
congenital or acquired

Congenital origin is caused by
chromosomal alterations.

Approximately 30% of the aplastic anemias that appear in childhood
are inherited.

Acquired aplastic anemia results from
exposure to ionizing radiation, chemical agents (e.g., benzene, insecticides, arsenic, alcohol), viral and bacterial infections (e.g., hepatitis, parvovirus, biliary tuberculosis), and prescribed medications (e.g., alkylating agents, antiseizure agents, antimetabolites, antimicrobials, gold).

the patient may have symptoms caused by
suppression of any or all bone marrow elements.

The patient with neutropenia (low neutrophil count) is susceptible to
infection and may be febrile.

Thrombocytopenia is manifested by
a predisposition to bleeding (e.g., petechiae, ecchymosis, epistaxis).

Causes of Aplastic Anemia Congenital
Fanconi syndrome

•Congenital dyskeratosis

•Amegakaryocytic thrombocytopenia

•Schwachman-Diamond syndrome

Causes of Aplastic Anemia Acquired
• Chemical agents and toxins

• Drugs

• Idiopathic

• Pregnancy

• Radiation

• Viral and bacterial infections

Because all marrow elements are affected, what lab values are often decreased in aplastic anemia.
hemoglobin, WBC, and platelet

Other RBC indices are generally normal. The condition is therefore classified as
a normocytic, normochromic anemia.

The reticulocyte count is

Bleeding time is

Aplastic anemia can be further evaluated by
assessing various iron studies

The serum iron and total iron-binding capacity (TIBC) may be
elevated as initial signs of erythropoiesis suppression.

findings are especially important in aplastic anemia because
the marrow is hypocellular with increased yellow marrow (fat content).

Management of aplastic anemia is based on
identifying and removing the causative agent (when possible) and providing supportive care until the pancytopenia reverses.

Nursing actions are directed at
preventing complications from infection and hemorrhage.

The prognosis of severe untreated aplastic anemia is

evere untreated aplastic anemia have improved outcomes significantly.
hematopoietic stem cell transplant (HSCT) and immunosuppressive therapy with antithymocyte globulin (ATG) and cyclosporine or high-dose cyclophosphamide (Cytoxan),

antithymocyte globulin (ATG) is
a horse serum that contains polyclonal antibodies against human T cells.

antithymocyte globulin (ATG) can cause
It can cause anaphylaxis and a serum sickness.

he rationale for ATG therapy
is that aplastic anemia is an immune-mediated diseas

The treatment of choice for adults less than 45 years of age who do not respond to the immunosuppressive therapy and who have a human leukocyte antigen (HLA)-matched donor
hematopoietic stem cell transplant (HSCT)

Prior transfusions increase the risk of
graft rejection

For the older adult or the patient without an HLA-matched donor, the treatment of choice is
immunosuppression with ATG or cyclosporine or high-dose cyclophosphamide.

Anemia resulting from blood loss may be caused by either ? acute or chronic problems. Acute blood loss occurs as a result of ? sudden hemorrhage. WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR …

Physiologic mechanism Anemia Altered hemoglobin synthesis………Acute or chroni bld loss Altered DNA synthesis……….Increased Hemolysis Bone Marrow Failure……….Infection Causes of anemia reduces oxygen carrying capacity….gradual blood loss….rapid bld loss…iron deficiency anemia..poor diet, child bearing years WE WILL WRITE A CUSTOM ESSAY …

Acute Lymphocytic Leukemia (ALL) Most common form of leukemia in adults over 70 yeas of age; characterized by overproduction of lymphocytes. Acute Myeloid Leukemia (AML) Most common form of leukemia in adults; develops when bone marrow produces too many myeloblasts. …

A child is suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the laboratory results, knowing that which of the following would be increased in this disease? 1. platelet count …

Anemia is a condition in which there is lower than normal number of red blood cells or hemoglobin within a person, consequently decreasing the amount of oxygen being carried to the rest of the body. Causes of such a condition …

The International Nutritional Anemia Consultative Group (INACG) has recommended routine iron supplementation in all pregnant women. This is because; the high physiological requirement for iron in pregnancy is difficult to meet with most diets. The recommended dose in those living …

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