Aplastic Anemia

  1. General information
    1. Pancytopenia or depression of granulocyte, platelet, and erythrocyte production due to fatty replacement of the bone marrow
    2. Bone marrow destruction may be idiopathic or secondary
    3. Secondary aplastic anemia may be caused by
      1. Chemical toxins (e.g., benzene)
      2. Drugs (e.g., chloramphenicol, cytotoxic drugs)
      3. Radiation
      4. Immunologic injury
  2. Medical management
    1. Blood transfusions (see Laboratory/Diagnostic Tests): key to therapy until client's own marrow begins to produce blood cells
    2. Aggressive treatment of infections
    3. Bone marrow transplantation
    4. Drug therapy
      1. Corticosteroids and/or androgens to stimulate bone marrow function and to increase capillary resistance (effective in children but usually not in adults)
      2. Estrogen and/or progesterone to prevent amenorrhea in female clients
    5. Identification and withdrawal of offending agent or drug
  3. Assessment findings
    1. Fatigue, dyspnea, pallor
    2. Increased susceptibility to infection
    3. Bleeding tendencies and hemorrhage
    4. Laboratory findings: normocytic anemia, granulocytopenia, thrombocytopenia
    5. Bone marrow biopsy: marrow is fatty and contains very few developing cells.
  4. Nursing interventions
    1. Administer blood transfusions as ordered.
    2. Provide nursing care for client with bone marrow transplantation.
    3. Administer medications as ordered.
    4. Monitor for signs of infection and provide care to minimize risk.
      1. Maintain neutropenic precautions.
      2. Encourage high-protein, high-vitamin diet to help reduce incidence of infection.
      3. Provide mouth care before and after meals.
    5. Monitor for signs of bleeding and provide measures to minimize risk.
      1. Use a soft toothbrush and electric razor.
      2. Avoid intramuscular injections.
      3. Hematest urine and stool.
      4. Observe for oozing from gums, petechiae, or ecchymoses.
    6. Provide client teaching and discharge planning concerning
      1. Self-care regimen
      2. Identification of offending agent and importance of avoiding it (if possible) in future


engelhardt@aamds.org said...

If you are interested in learning more about aplastic anemia, myelodysplastic syndromes (MDS), and paroxysmal nocturnal hemoglobinuria (PNH), come to the Bone Marrow Failure Conference: Diagnostic and Treatment Issues for Nurses hosted by the Aplastic Anemia & MDS International Foundation. For more information, visit http://www.aamds.org/aplastic/resources_for_profes/nurses_conference/index.php.
Application has been made for 8.25 contact hours to the ONS Approver Unit. ONS is accredited as an approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.