Aplastic and hypoplastic anemia nursing care is a common. Perhaps, it is becaue this type of anemia could affect all. So aplastic and hypoplastic anemia are a condition that is caused by bone marrow cells matrix injury or obstruction.

It causes pancytopenia (anemia, granulocytopenia, and thrombocytopenia) and bone marrow hypoplasia. Aplastic anemia refers to pancytopenia which is caused by functional decrease from bone marrow and hypoplastic. This condition triggers bleeding and infection, especially if it is an idiopathic anemia or chloramphenicol use of hepatitis therapy. Mortality of Aplastic and hypoplastic anemia with acute pancytopenia is about 80-90%.

Etiology

The cause of aplastic and hypoplastic anemia  are as follows;

  • Congenital (congenital hypoplastic anemia or Blackfan-Diamond anemia that develop while the patient is 2-3 months old and Fanconi syndrome that develops in newborn to 10 years old patient)
  • Family history with Aplastic and hypoplastic anemia
  • Bone marrow microvascular damage that makes disturbances in cells growth and maturation
  • Main cell damage inhibits red blood cell production
  • Pharmacology (antibiotic and anticonvulsant use)
  • Immunology factors
  • Radiation
  • Hepatitis
  • Toxic agent like benzene and chloramphenicol

Sign and Symptoms

Before implementing the aplastic and hypoplastic anemia nursing care, you have to assess the sign and symptoms of patients though. the symptoms and sign of this type of anemia are similar with a common anemia. So some of those sign and symptoms for aplastic and hypoplastic anemia are as follows;

  • Ecchymosis and petechial if there is a thrombocytopenia
  • Headache
  • Heart failure
  • Neutropenia, probably it cause infection with fever, oral ulcer, rectal ulcer and sore throat sign and symptoms
  • Pale
  • Fatigue and weakness
  • Dyspnea
  • Tachycardia
  • Thrombocytopenia (easy to bleed and bruise, especially in mucosa membrane like nose, gingiva, rectum, and reproduction system)
  • Bleeding inside the eye or central nervous system.

Diagnostic examination

For aplastic anemia and hypoplastic anemia nursing care, the doctors usually diagnose it with certain labolatory diagnosis. Laboratory result is needed to diagnose Aplastic and hypoplastic anemia are as follows;

  • Normochromic and normocytic red blood cells. It is usually like macrocytosis (bigger red blood cells form) and anisocytosis (white blood cells variation). Those cells count are about less than 1 million/µl. Absolute reticulocyte in small amount
  • Ferron serum is increase, except if there is bleeding. But, Ferron-binding capacity is normal or decrease.
  • Hemosiderin present and Ferron storage tissue can be analyzed through microscope
  • Thrombocyte , neutrophil, and white blood cells decrease
  • Coagulation test shows abnormal amount of thrombocyte
  • Certain location of bone marrow aspiration shows dry tap and biopsy will shows hypo cellular or aplastic bone marrow clearly with fat, fibrous tissue, or gelatin in amount variation; there are no Ferron binding (because
  • Ferron settles in liver not in bone marrow), megakaryocyte, and erythroid element depress

Treatment

Nurses must colaborate with doctors in aplastic and hypoplastic anemia nursing care. The colaboration are helping for the best result of nursing implementation. Some of those colaboration are like;

  1. The etiology must be identified
  2. Red blood and thrombocyte tranfusion
  3. Human leucocyte which match with leucocyte antigen or anti-timocyte globulin are used with or without cyclosporine combination (for children and severe neutropenia patient)
  4. Bone marrow transplantation for severe aplasia and for patient who needs constant red blood cell transfusion
  5. Antibiotic for infection etiology
  6. Oxygenation
  7. Corticosteroid to stimulate erythrocyte (effective for children)
  8. Bone marrow stimulating agent like androgen
  9. Immunosuppressant for patient who does not respond with other therapies
  10. Anti-lymphocyte globulin can be prescribed
  11. Colony stimulating factors are used to force certain cellular maturation.

Aplastic and Hypoplastic Anemia Nursing care

  1. If the thrombocyte in small number (less than 20.000/µl, prevent hemorrhage with intramuscular injection, do not a razor for a period of time, use soft tooth brush, oxygen humidified, and a laxative to decrease constipation that can irritate rectum.
  2. Give a pressure in venifunction till the bleeding stop. Detect bleeding early and check blood in urine and feces, check skin if there is petechial
  3. Help prevent infection with washing hand before entering patient’s room. Make sure the patient consume enough nutrition to increase his/her resistance and suggest patient to do mouth care and perianal carefully
  4. Look hemorrhage signs, infection, negative effects of medicine, and blood transfusion reaction
  5. Make sure to check the thoat, urine, nasal, rectal, and blood culture routinely. Recheck for the infection presents. Ask the patient to report infection signs
  6. Schedule rest period correctly if patient has low hemoglobin level. This condition will make patient easy to be fatigue
  7. Blood tranfusion is needed. Pay attention to tranfusion reaction by checking patient’s temperature and other signs like hives, itchy, back pain, tremor, and cold
  8. Support patient and family with disease and treatment infromation, especially if patient experience acute episode. Explain about medication purpose and discuss about side effects that should be reported.
  9. If patient is prescribe a medicine that make anemia, monitor chemical study toward his/her blood to prevent aplastic anemia
  10. Suggest the patient that has radiation occupation to wear anti-radiation clothes or radiation detector to secure the recurrence
  11. People with benzene contact occupation should know about 10 part per million environment is the safest environment and benzene pending reaction can be occur.