CHAPTER 4 Hematologic System^179
- Plan nursing care based on patient tolerance of activity.
- Monitor for angina.
Aplastic Anemia (Pancytopenia)
WHAT WENT WRONG?
The bone marrow stops producing a sufficient amount of RBC, WBC, and platelets,
thereby increasing the risk of infection and hemorrhage. The red cells remaining in
circulation are normal in size and color. This may be due to chemical exposure, high-
dose radiation exposure, or exposure to toxins. Cancer treatments such as radiation
therapy and chemotherapeutic agents may suppress bone marrow function, which
will result in anemia (low RBC), thrombocytopenia (low platelets), and leukopenia
(low WBC). The cause may also be unknown or idiopathic.
PROGNOSIS
The bone marrow dysfunction may be slow-onset or sudden. The lifespan of the
RBC is longer than the platelets and WBC, so the anemia may show up later than
the effects of losing the other cells. Some exposures to toxic agents or medications
are severe and potentially fatal in susceptible individuals.
HALLMARK SIGNS AND SYMPTOMS
- Fatigue due to hypoxemia
- Weakness due to tissue hypoxia
- Pallor due to lack of oxygen reaching superficial tissues due to anemia
- Infections due to low white blood cell production, causing decreased ability
to fight infection - Bruising (ecchymosis), and tiny subcutaneous (SC) hemorrhages (petechiae)
due to decrease in platelets, altering clotting ability - Bleeding from mucous membranes (GI tract, mouth, nose, vagina)
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