Question

The nurse is caring for a patient with exacerbation of sickle cell disease and in pain crisis due to an infection. When reviewing the lab values, the nurse would anticipate which of the following lab values? Select all that apply.

1. Reticulocyte 12%

2.Hgb 9.2 mg/dL.

3.WBC 14.3x 103\microL

4. Ca 4.9 mg/dL

Answer 1

ANSWER

.1. Reticulocyte 12%

2. Hb- 9.2 mg/dL.

3.WBC- 14.3x 103\microL

there is increased reticulocyte count due to immature RBCs, decreased Hb, and increased infection which increases WBC levels.

Baseline Blood Study Abnormalities

• Typical baseline abnormalities in the patient with SCD are as follows:
• Hemoglobin level is 5-9 g/dL.
• Hematocrit is decreased to 17-29%
• Total leukocyte count is elevated to 12,000-20,000 cells/mm3 (12-20 X 109/L), with a predominance of neutrophils.

• retic count in sickle cell crisis: The normal fraction of reticulocytes in the blood depends on the clinical situation but is usually 0.5% to 2.5% in adults and 2% to 6% in infants

  The reticulocyte count is a measure of immature red blood cells (RBC) and should be elevated with acute RBC destruction that occurs during a vaso-occlusive crisis (VOC). When the bone marrow fails to respond to the acute anemia due to RBC destruction, an aplastic crisis may be present

Causes of low hematocrit, or anemia, include: Bleeding (ulcers, trauma, colon cancer, internal bleeding) Destruction of red blood cells (sickle cell anemia, enlarged spleen) Decreased production of red blood cells (bone marrow supression, cancer, drugs)

Sickle cell disease is a group of disorders that affects hemoglobin, the molecule in red blood cells that delivers oxygen to cells throughout the body.

People with this disorder have atypical hemoglobin molecules called hemoglobin S, which can distort red blood cells into a sickle, or crescent, shape.

Signs and symptoms of sickle cell anemia

• Anemia.  Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 days, leaving a shortage of red blood cells (anemia).

  Without enough red blood cells, your body can't get enough oxygen, causing fatigue.

• Episodes of pain. Periodic episodes of pain, called pain crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints. Pain can also occur in your bones.

• Swelling of hands and feet. The swelling is caused by sickle-shaped red blood cells blocking blood flow to the hands and feet.
• Frequent infections. Sickle cells can damage your spleen, leaving you more vulnerable to infections.
• Delayed growth or puberty. Red blood cells provide your body with the oxygen and nutrients needed for growth. A shortage of healthy red blood cells can slow growth in infants and children and delay puberty in teenagers.
• Vision problems. Tiny blood vessels that supply your eyes can become plugged with sickle cells. This can damage the retina — the portion of the eye that processes visual images — and lead to vision problems