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Anemia

Anemia. Objective. The learner will be able to define anemia and identify its cancer-related causes. Red Blood Cells. Main purpose of red blood cells (RBCs) is to carry oxygen to the tissues. Hemoglobin is an iron molecule surrounded by proteins (alpha and beta) that carries oxygen.

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Anemia

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  1. Anemia

  2. Objective The learner will be able to define anemia and identify its cancer-related causes.

  3. Red Blood Cells • Main purpose of red blood cells (RBCs) is to carry oxygen to the tissues. • Hemoglobin is an iron molecule surrounded by proteins (alpha and beta) that carries oxygen. • Cells lose their nucleus before entering the circulation from the bone marrow. • Cells become pliable and can travel through the microcirculation without damage.

  4. Red Blood Cells • RBCs live approximately 120 days. • RBC production is stimulated by tissue hypoxia, especially in the kidney. • Kidney secretes erythropoietin, which stimulates RBC production. • Several nutrients are required to make RBCs: • Protein • Iron • Vitamin B12, folate

  5. Anemia • Anemia  Reduced circulating RBCs that reduces circulating oxygen levels • Definition  A hemoglobin (Hgb) level of less than 12 g/dl (grams per deciliter) • Severity of symptoms  Determined by the rate at which anemia occurs, cause, and comorbidities • Most anemia happens slowly, but symptoms worsen as the Hgb level drops. • Rapid blood loss (hemorrhage) can result in acute symptoms in a very short period of time.

  6. Defining Anemia by Grade/Severity

  7. Causes of Anemia • Destruction/loss • Autoimmune hemolytic anemia – Antibody, transfusion • Hemolysis – Breakdown of cells (trauma, DIC, infection) • Bleeding – Blood loss (rapid or slow) (GI tract) • Inherited disorders – Sickle cell anemia, thalassemia • Production • Lack of nutrients – Iron, vitamins, proteins • Kidney failure – Lack of erythropoietin production • Chemicals – Drugs, chemotherapy, radiation • Cancer – Infiltration into the bone marrow • Chronic disease, organ dysfunction, aging

  8. Signs and Symptoms of Anemia • Fast heartbeat (tachycardia) • Shortness of breath (SOB) when doing things like walking, climbing stairs, or even talking • Dizziness, light-headedness • Chest pain, angina • Swelling in the hands or feet • Pale skin, nail beds, mouth, and gums • Extreme tiredness (fatigue)

  9. Diagnostic Testing for Anemia • Reticulocyte count – Immature RBCs • High: Normal or increased RBC production indicating blood loss or hemolysis • Low: Decreased RBC production indicating iron deficiency, B12/folate deficiency, aplastic anemia, kidney disease, or bone marrow dysfunction due to cancer or cancer treatment • Mean corpuscular volume (MCV) • If low, RBCs are small; can indicate iron deficiency. • If high, RBCs are large; can indicate B12/folate deficiency. • Hemoglobin electrophoresis – If hereditary abnormalities are suspected

  10. Evidence-Based Interventions: Treatment Dependent on Cause • Blood loss • Iron (oral, intramuscular injection, intravenous) • Locate source and intervene (GI tract ulcer, heavy menstrual bleeding, etc.). • Destruction (hemolysis) • Autoimmune – Steroids; treat underlying cause. • Infection – Treat with appropriate antibiotics. • Cancer – Treat underlying malignancy.

  11. Evidence-Based Interventions: Treatment Dependent on Cause • RBC production problems • Chronic renal disease – Erythropoiesis-stimulating agents (ESAs) (epoetinalfa, darbepoetinalfa) • Bone marrow dysfunction – Treat cancer, bone marrow transplant for aplastic anemia, ESAs • Hereditary anemias – Treat cause, transfuse • Bone marrow suppression: • Cancer treatments – Transfusion, ESAs (may cause early recurrence of cancer) • Lack of nutrients – Give iron, B12/folate, protein. • Improve organ dysfunction – Liver, kidneys, cardiovascular perfusion, lungs (improve oxygenation)

  12. References National Comprehensive Cancer Network. (2012). NCCN Clinical Practice Guidelines in Oncology: Cancer- and chemotherapy-induced anemia [v.2.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/anemia.pdf Polovich, M., Whitford, J.M., & Olsen, M. (Eds.). (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed.).Pittsburgh, PA: Oncology Nursing Society.

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