Anemias of chronic disease

62 Anemias of chronic disease




Overview/pathophysiology


Erythropoietin (EPO) is a naturally occurring protein hormone produced and released by the kidneys (90%) and liver (10%). The kidneys are stimulated to release EPO in response to low blood oxygenation. EPO then stimulates stem cells in the bone marrow to develop and produce red blood cells (RBCs). Individuals with decreased renal function (e.g., chronic kidney disease [CKD]) often become anemic because their kidneys cannot produce EPO. In other chronic conditions, bone marrow fails to compensate (because of a blunted response to EPO) for decreased red cell survival adequately by increasing RBC production. In these cases, erythropoietin rarely is an important cause of underproduction of red cells except in renal failure. However, development of recombinant human erythropoietin (epoetin alpha) has provided dramatic benefits for patients with CKD, some patients receiving chemotherapy for cancer, and patients undergoing treatment for infection with human immunodeficiency virus (HIV). Because anemia may be caused by other acute or chronic conditions, these conditions must be ruled out. Examples include anemia from blood loss, hemolysis, and inadequate dietary intake of iron, vitamin B12 (cobalamine), or folate.



Health care setting


Primary care; acute care for blood transfusion or treatment for sequelae of CKD



Assessment




Chronic indicators:


Patient may be asymptomatic or have brittle hair and nails and pallor. In the presence of severe and chronic disease, shortness of breath, dizziness, and fatigue may be present even at rest. History of CKD, dialysis therapy, cancer within the bone marrow (e.g., leukemia), cancer chemotherapy, or therapy for HIV infection also may be factors.



Acute indicators:


Fatigue, decreased ability to concentrate, cold sensitivity, menstrual irregularities, and loss of libido.



Physical assessment:


Tachycardia, palpitations, tachypnea, exertional dyspnea, pale mucous membranes, pale nail beds, vertigo.



Diagnostic tests




Blood count:


Usually RBCs and hemoglobin (Hb) are decreased, and hematocrit (Hct) is low because the percentage of RBCs in the total blood volume is decreased. The mean corpuscular volume (MCV) may be normal or slightly decreased. In iron-deficiency anemia, the MCV will be decreased; in cobalamine and folic acid deficiencies, the MCV will be increased.



Ferritin:


Normal or increased. However, if it is less than 30 mcg/L, there is a coexisting iron deficiency.



Peripheral blood smear to examine RBC indices:


Morphology reveals normocytic and normochromic erythrocytes (normal or slightly low mean corpuscular volume [MCV]).



Total iron-binding capacity:


Decreased.

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Jul 18, 2016 | Posted by in NURSING | Comments Off on Anemias of chronic disease

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