Hematological Disorder-Anaemia

Anaemia is described as decreased levels of red blood cell (RBC) mass, hematocrit values, and haemoglobin (Lanzkowsky, 2016). These red blood cells transport oxygen from the lungs to the body tissues. In the case of anaemia, where its number is reduced, there is decreased oxygen reaching the body tissues from the lungs. With these, the likely complications that arise include shock and hypoxia. Anaemia can be classified according to morphology, which provides for microcytic, normocytic, and macrocytic. It can also be classified according to the aetiology, such as excessive RBC destruction, bleeding, and inadequate production of these cells. Some types of anaemia include hemolytic anaemia, sickle-cell anaemia, pernicious anaemia, and aplastic and iron-deficiency anaemia. Pernicious anaemia is caused by the inability of one’s small intestines to absorb vitamin B12. In contrast, megaloblastic anaemia, on the other hand, is caused by factors such as cancer drugs and reduced intake of folic acid and vitamin B12. Normal haemoglobin levels to rule out anaemia in men are>13.7g/dl, and in women, it is >12.2g/dl (Lanier et al., 2018).

Treatment strategies differ depending on the type of anaemia a patient has. The treatment strategies include blood transfusion, a splenectomy can be done for those with acute hemolytic anaemia, and the use of medication for immunotherapy purposes. Blood transfusion of packed RBCs helps those patients with acute severe anaemia presenting with hypoxia. However, one may develop a hemolytic transfusion reaction because of the inability to cross-match the blood (Ipe et al., 2015). For those with an autoimmune hemolytic type, a splenectomy is done (Englum et al., 2016). This type of surgery puts one at risk of infections because of an open wound site. Therefore, nurses need to exercise high standards of hygiene care. Another challenge is low wound healing because of the primary anaemia problem. Medications given in all these types of anaemia may also cause systemic toxicity and finally lead to systemic failure.

References

Englum, B. R., Rothman, J., Leonard, S., Reiter, A., Thornburg, C., Brindle, M., … & Rice, H. E. (2016). Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anaemia. Journal of pediatric surgery, 51(1), 122-127. https://doi.org/10.1016/j.jpedsurg.2015.10.028

Ipe, T. S., Wilkes, J. J., Hartung, H. D., Westhoff, C. M., Chou, S. T., & Friedman, D. F. (2015). Severe hemolytic transfusion reaction due to anti-D in a D+ patient with sickle cell disease. Journal of pediatric haematology/oncology, 37(2), e135. https://dx.doi.org/10.1097%2FMPH.0000000000000241

Lanier, J. B., Park, J. J., & Callahan, R. C. (2018). Anaemia in older adults. American Family Physician, 98(7), 437-442. https://www.aafp.org/afp/2018/1001/p437.html

Lanzkowsky, P. (2016). Classification and diagnosis of anaemia in children. In Lanzkowsky’s Manual of Pediatric Hematology and Oncology (pp. 32-41). Academic Press. https://doi.org/10.1016/B978-0-12-801368-7.00003-X

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Hematological Disorder-Anaemia

Pick one haematological disorder covered in this module. For this disorder, identify and describe three treatment strategies for the disease.

What challenges could arise in carrying out these strategies and providing care to the patient?