Anemia laboratory tests

The nurse assesses the patient for relief of the symptoms of anemia (fatigue, shortness of breath, sore tongue, headache, pallor). Some patients may note a relief of symptoms after a few days of therapy. Periodic laboratory tests are necessary to monitor the results of therapy. 

The nurse obtains a general healtii history and asks about die symptoms of die anemia The primary healdi care provider may order laboratory tests to determine die type, severity, and possible cause of the anemia. At times, it may be easy to identify die cause of the anemia, but diere are also instances where the cause of die anemia is obscure... 

MANAGING HONE MARROW SUPPRESSION. Bone marrow suppression is a potentially dangerous adverse reaction resulting in decreased production of blood cells. Bone marrow suppression is manifested by abnormal laboratory test results and clinical evidence of leukopenia, thrombocytopenia, or anemia For example, there is a decrease in the white blood cells or leukocytes (leukopenia), a decrease in the thrombocytes (thrombocytopenia), and a decrease in the red blood cells, resulting in anemia Fhtients with leukopenia have a decreased resistance to infection, and the nurse must monitor them closely for any signs of infection. 

Table 32-3 summarizes laboratory results obtained on patients with three different causes of jaundice—hemolytic anemia (a prehepatic cause), hepatitis (a hepatic cause), and obstruction of the common bile duct (a posthepatic cause). Laboratory tests on blood (evaluation of the possibihty of a hemolytic anemia and measurement of prothrombin time) and on semm (eg, electrophoresis of proteins activities of the enzymes ALT, AST, and alkahne phosphatase) are also important in helping to distinguish between prehepatic, hepatic, and posthepatic causes of jaundice. 

Several other factors also contribute to the development of anemia in patients with CKD. Uremia, a result of declining renal function, decreases the lifespan of RBCs from a normal of 120 days to as low as 60 days in patients with stage 5 CKD. Iron deficiency and blood loss from regular laboratory testing and hemodialysis also contribute to the development of anemia in patients with CKD. 

Assess the patient for the presence of anemia. Do the laboratory tests suggest the patient requires medical treatment ... 

TABLE 63-1. Pertinent Laboratory Tests in the Evaluation of Anemia... 

There is no specihc laboratory test for Lewisite. Lfrinary arsenic excretion might be helpful. Hemolytic anemia may be seen in Lewisite exposed patients. 

Laboratory testing (e.g., thyroid function, anemia, gonadal hormones)... 

Although the direct medical costs of anemia are unknown, the direct costs of drug treatment must be weighed with the indirect costs associated with anemia. The costs of laboratory tests used to diagnose anemia, the role of screening for anemia, and the prevention of anemia are aU components that necessitate consideration in the phar-macoeconomic analysis. Anemia practice guidelines within medical subspecialties must take pharmacoeconomics into consideration as they are developed. Additionally, the frequency of blood transfusions must be considered, as it impacts cost and therapeutic decision making in patients. 

Micawley Talltwin is a 7-year-oId child star who is brought to his pediatrician by his parents after they noticed that he felt very fatigued. They also noted that his abdomen seemed to be enlarged. Examination reveals an enlarged spleen. Further history reveals that he has been taking vitamins and iron supplements over the last few months. Laboratory tests show a microcytic anemia and elevated iron levels in tissues. 

A characteristic rash (rose sports) may appear during the second week. Fever persists with high temperature, which fluctuates but does not return to normal level. Paradoxically, despite fever, there is bradycardia, which is characteristic of the clinical course. Temperature is usually high 39-40°C for the first 2 weeks. It begins to fall after the third week and gradually returns to normal during the fourth week. Laboratory tests show leucopenia, anemia, thrombocytopenia, elevation transaminases and bilirubin, proteinuria and abnormalities of coagulation. 

A 10-yr-old British boy was diagnosed with Crohn s disease and was treated with an herbal tea containing comfrey leaf. Other medications included sporadic use of prednisolone and sulfasalazine. Three years later, he presented with weight loss, diarrhea, fever, abdominal pain, ascites, tender hepatomegaly, and fatigue. Laboratory tests revealed mild iron deficiency anemia (Hgb 117 g/L), elevated bilirubin (26 mmol/L) and aspartate aminotransferase level (87 IU/L), and low serum albumin. Ascitic fluid protein concentration was 27 g/L. Liver biopsy showed the thrombotic variant of venoocclusive disease. He was treated with salt restriction and spironolactone, with good response. 

Physicians often base their clinical diagnosis on the patient s appearance and behavior. For example, a patient may appear to be pale and complain of fatigue, and the physician may attribute the problem to anemia. The diagnosis of anemia will be confirmed or disconfirmed by laboratory tests the diagnosis cannot be made solely on the basis of the patient s appearance and behavior. 

Laboratory testing is likewise frequently utuevealing imtil advanced disease occnrs. Anemia and positive fecal occult blood testing may be present. Liver tests may be elevated in metastatic liver disease, while the alkahne phosphatase and calcium may be elevated with bony metastases. While certain tnmor markers may be elevated (CEA, CA... 

Although several biomarkers for the effects of zinc have been identified (increased levels of serum amylases and lipase, non-iron responsive anemia, and decreased HDL cholesterol levels), these biomarkers of effect are not specific for zinc (Cotran et al. 1989 Suber 1989). Standard laboratory tests are available that can measure these biomarkers (Henry 1984). These methods are sensitive, accurate, and reliable enough to measure background levels in the population and levels at which biological effects occur. The development of methods for determining biomarkers of effect specific for zinc would be beneficial in assessing whether an individual has been exposed to zinc. 

The correct amounts of certain elements are crucial to the proper growth and health of our bodies. Low levels of iron can lead to anemia, while low levels of iodine can cause hypothyroidism and goiter. Laboratory tests are used to confirm that elements such as iron, copper, zinc, or iodine are within normal ranges in our bodies. 

Groups of Persons Susceptible to Nutritional Anemias Diagnosis of Nutritional Anemias Signs and Symptoms Laboratory Tests... 

Interpretation of Signs, Symptoms, and Laboratory Tests Treatment and Prevention of Iron-Deficiency Anemia... 

Signs and Symptoms. Anemic persons often have pale skin and mucous membranes along with feelings of tiredness. There usually is a low tolerance to strenuous exercise, and the anemic person quickly becomes out-of- breath. Often the heart works harder to deliver more blood to the tissues (shown by rapid pulse). These characteristics may indicate, however, any one of several different anemias (including some with nonnutritional causes). It is, therefore, often necessary to confirm diagnosis of signs and symptoms with laboratory tests. 

Laboratory Tests. Usually, determination of the quantity and quality (size, color, shape) of red blood cells is sufficient to confirm the general diagnosis of anemia and to identify the specific type of anemia. Occasionally, it is necessary to perform tests on other body tissues or fluids, particularly when anemias other than that due to iron deficiency is suspected. 

Interpretation of Signs, Symptoms, and Laboratory Tests. Most cases of anemia are due to iron deficiency, although there are several other causes for anemia. The other types of anemia constitute only a small minority of cases. Nevertheless, they need to be considered when persons with anemia do not respond to iron therapy, or when the symptoms of their anemia differ from those normally found in iron deficiency. One of the problems in the diagnosis of iron-deficiency anemia is the disagreement among both scientists and health practitioners as to the levels of hemoglobin which indicate the presence of the disorder. 

Any potentially important abnormality that is detected by physical examination usually requires confirmation by laboratory tests, X ray, or other means such as (1) measurement of hemoglobin concentration or hematocrit when anemia is suspected, and (2) x rays of bones if signs of rickets are present. 

Laboratory Tests for Mineral Deficiencies. Tests for iron-deficiency anemia are widely used all over the world but most of the tests for other mineral deficiencies are limited mainly to research studies, because there is a lack of information regarding normal values for such groups as infants, children, adults, and pregnant or nursing mothers. Nevertheless, a growing number of commercial laboratories offer analyses of hair and/or urine directly to customers. These laboratories may also sell mineral and vitamin supplements to the people who use their services. 

As an essential factor for the integrity of red blood cells. Evidence has been accumulating that vitamin E functions in the body in maintaining the integrity of the red blood cells. Thus, it is noteworthy that hemolytic anemia. An abnormality of the red blood cells in premature babies, may be corrected with vitamin E. Also, full-term babies with this same abnormality make a more rapid and complete recovery when fed with human milk (rather than cow s milk) and laboratory tests show that human milk contains from 2 to 4 times as much vitamin E as cow s milk. 

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