Unit 5: Decreased Circulating Oxygen / Anemia
Complete interactive study guide with lecture content + web supplementation
LECTURE WEB SUPPLEMENT
LECTURE WEB SUPPLEMENT
Bone marrow cellularity declines with age; marrow fat increases. Hematopoietic reserve is reduced.
Anemia is common with chronic disease and nutritional deficiencies. Symptoms often overlooked or mistaken for normal aging.
New fatigue, dyspnea, pallor, falls, or cognitive/functional decline deserves assessment - do NOT label as "just aging."
Assessment of pallor, cyanosis, inflammation, jaundice, ecchymosis, and petechiae
| Finding | How to Assess | Dark Skin Considerations |
|---|---|---|
| Pallor | Inspect skin, oral mucosa, conjunctiva, nail beds | Brown skin may appear yellow-brown; Black skin may appear ashen gray |
| Cyanosis | Inspect lips, tongue, nail beds, conjunctiva | Color change may appear gray/ashen rather than blue |
| Inflammation | Inspect for swelling/color, palpate warmth/tenderness | Redness may be subtle; warmth, swelling, pain are important |
| Jaundice | Inspect sclera and oral mucosa | Check oral mucosa, hard palate, and sclera |
| Petechiae | Pinpoint, nonblanching hemorrhagic spots | Often easier to see on less-pigmented mucosal surfaces |
| Ecchymosis | Larger nonblanching bruised areas | Assess size, location, tenderness, trauma history |
LECTURE WEB SUPPLEMENT
Oxygen-carrying protein. Low = anemia. Grade severity with Hgb.
Percentage of blood volume made of RBCs. Affected by hydration.
Shows marrow response. High = compensation (blood loss/hemolysis). Low = underproduction.
Iron: often low in deficiency. TIBC: increased in iron deficiency, decreased/normal in inflammation.
Detects hidden blood in stool. Identify chronic GI blood loss.
Rises with heme breakdown. Indirect elevation supports hemolysis.
Low supports B12 deficiency/megaloblastic anemia. Assess neuro symptoms.
WBC: low = infection risk. Platelets: low = bleeding risk.
Evaluates cellularity, morphology, iron stores. Aplastic = hypocellular.
Peripheral blood flow reduced; oxygen prioritized to vital organs (brain, heart). Contributes to pallor/cool skin.
Heart rate and stroke volume increase. Expect tachycardia/palpitations. Severe = cardiopulmonary symptoms.
Tissue hypoxia → renal EPO → bone marrow increases RBCs. Requires adequate iron/B12/folate.
Return to normal ADLs, maintain adequate nutrition, develop no complications related to anemia.
LECTURE WEB SUPPLEMENT
| Feature | Anemia | Thrombocytopenia |
|---|---|---|
| Primary Deficit | RBCs / hemoglobin | Platelets |
| Core Problem | Reduced oxygen-carrying capacity → tissue hypoxia | Impaired hemostasis → bleeding |
| Manifestations | Fatigue, pallor, weakness, dyspnea, tachycardia | Petechiae, ecchymoses, epistaxis, bleeding gums |
| Nursing Focus | Oxygenation, activity tolerance, nutrition | Bleeding precautions, injury prevention |
Heme (better absorbed): Lean red meat, seafood, poultry
Nonheme: Beans/lentils, spinach, nuts, seeds, fortified cereals, dried fruits
💡 Vitamin C improves nonheme iron absorption!
Fish/shellfish, meat, poultry, eggs, milk/dairy
Fortified cereals or nutritional yeast for vegetarians
⚠️ Strict vegetarian/vegan diets increase risk!
Dark green leafy vegetables, spinach, asparagus, Brussels sprouts
Beans/peas, liver, avocado, citrus, enriched grains
🤰 Pregnancy increases folate needs!
WEB SUPPLEMENT
| Product | Why Given | Nursing Implications |
|---|---|---|
| Packed RBCs | Increase O2-carrying capacity | Use blood tubing; monitor for reactions/overload |
| Frozen RBCs | Rare antigen phenotypes | Specialized processing; alert for hemolysis |
| Albumin | Volume expansion (colloid) | Monitor BP, lungs, edema, volume overload |
| Platelets | Treat thrombocytopenia bleeding | Infuse per policy; assess bleeding before/after |
| FFP | Replace clotting factors | ABO compatibility; monitor for TACO |
| Cryoprecipitate | Fibrinogen deficiency/DIC | Monitor fibrinogen/bleeding |
Red flags: Rapid bleeding, hypotension, tachycardia, altered mental status
Action: Activate emergency response; ABCs; control bleeding; IV/blood prep
Red flags: Chest pain, severe dyspnea, syncope, new confusion
Action: Assess O2/perfusion; stop exertion; notify provider; prepare transfusion
Red flags: Fever, chills, hives, dyspnea, chest/back pain during transfusion
Action: STOP transfusion FIRST; assess ABCs; follow protocol
Red flags: Fever with severe neutropenia (even without local signs)
Action: Urgent cultures; empiric broad-spectrum antibiotics
Red flags: Uncontrolled bleeding, sudden severe headache, neuro change
Action: Emergency evaluation; bleeding precautions; blood products
Red flags: Chest pain, focal neuro deficit, unilateral limb swelling, sudden dyspnea
Action: Urgent evaluation for MI/stroke/DVT/PE
Complex anemia, hemolysis, pancytopenia, marrow disorders
Compatibility, special components, reaction investigation
Iron/B12/folate nutrition, malnutrition, dietary constraints
Iron, folate, B12, epoetin, drug interactions
GI blood loss, endoscopy/colonoscopy, malabsorption
CKD-related anemia, dialysis, ESA/iron management
Classification: Iron preparation / hematinic
Action: Supplies elemental iron for hemoglobin synthesis and erythropoiesis
Indications: Treatment/prevention of iron deficiency
Route: Oral (parenteral options exist separately)
Adverse Effects: GI irritation, nausea, abdominal discomfort, constipation/diarrhea, dark/black stools, liquid stains teeth. ⚠️ Serious overdose risk in children!
Teaching: Best absorbed in acidic environment; liquid diluted through straw; expect GI side effects; continue 2-3 months after Hgb normal; empty stomach improves absorption but food okay if upset; keep locked away from children.
Classification: Folate nutritional supplement
Action: Restores folate for DNA synthesis; allows megaloblastic marrow to normalize
Indications: Folate-deficiency megaloblastic anemia, increased folate need
Route: Oral (usual dose = 1 mg PO daily)
Adverse Effects: Usually well tolerated; rare hypersensitivity and GI effects
Teaching: ⚠️ Check B12 deficiency first! Folic acid can improve B12 anemia hematologically without preventing neurologic injury. Encourage folate-rich foods; treat underlying cause.
Classification: Vitamin B12 replacement
Action: Replaces cobalamin for DNA synthesis, RBC formation, neurologic/myelin function
Indications: B12 deficiency including pernicious anemia and malabsorption
Route: Parenteral (IM/subcutaneous) or intranasal; oral products exist
Adverse Effects: Usually well tolerated; rare hypersensitivity/anaphylaxis
Teaching: Assess baseline B12, CBC, neurologic findings, cause. Pernicious anemia = lifelong replacement. Neurologic recovery may be incomplete if prolonged. Protect injectable from light.
Classification: Erythropoiesis-stimulating agent (ESA)
Action: Stimulates erythroid progenitor cells to increase RBC production
Indications: CKD anemia, chemotherapy-related anemia, zidovudine-associated, selected perioperative
Route: IV or subcutaneous
⚠️ Boxed Warning: Increased risk of death, MI, stroke, VTE, vascular-access thrombosis, tumor progression in some cancer settings. Hypertension is important.
Nursing: Monitor Hgb and BP closely; use lowest effective dose; ensure adequate iron; monitor for thrombosis, chest pain, neuro deficits, uncontrolled HTN. Follow indication-specific target (do NOT try to normalize Hgb).
| Condition | Pattern | Hallmark Clue | Key Labs | Focus |
|---|---|---|---|---|
| Iron Deficiency | Micro + Hypo | Pallor, glossitis, cheilitis; chronic blood loss | Low iron/ferritin, high TIBC | Treat source + iron |
| B12/Pernicious | Macro/Megaloblastic | Neuro symptoms + sore tongue | Low B12, normal folate | B12 replacement |
| Folate Deficiency | Macro/Megaloblastic | Similar to B12 but NO neuro | Low folate, normal B12 | Folic acid |
| Chronic Disease | Normocytic/Normochromic | Chronic inflammatory/medical disease | High ferritin, low serum iron | Treat underlying cause |
| Aplastic | Pancytopenia | Anemia + infection + bleeding | Low retic; hypocellular marrow | Infection/bleeding prevention |
| Hemolytic | Normocytic + reticulocytosis | Jaundice, dark urine, splenomegaly | High retic/bili/LDH, low haptoglobin | Treat cause |
| Acute Blood Loss | Normocytic initially | Shock/perfusion signs | Hgb/Hct trend + hemodynamics | Stop bleeding + resuscitate |
| Polycythemia Vera | Too many cells - NOT anemia | Hyperviscosity, HTN, thrombosis, ruddy face | Elevated counts; JAK2 | Phlebotomy/hydration |
Click a card to flip and reveal the answer!
Microcytic + Hypochromic + Chronic Blood Loss?
Iron Deficiency Anemia
Macrocytic + Neurologic Symptoms?
Vitamin B12 Deficiency
Macrocytic + No Neuro Symptoms?
Folate Deficiency
Pancytopenia + Hypocellular Marrow?
Aplastic Anemia
Anemia + Jaundice + High Retic?
Hemolytic Anemia
First Action for Suspected Transfusion Reaction?
STOP THE TRANSFUSION immediately
Fever in Severe Neutropenia?
EMERGENCY - immediate cultures & broad-spectrum antibiotics
Petechiae + Ecchymosis + Mucosal Bleeding?
Thrombocytopenia (NOT anemia)