Description

Overview

1. Hemoglobin
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Elevated hemoglobin
   5. Decreased hemoglobin

Nursing Points

General

1. Normal value range
   1. Males – 13.5-16.5 g/dL
   2. Females – 12.0 – 15.0 g/dL
2. Pathophysiology
   1. Protein attached to red blood cell
   2. Iron based protein
   3. 4 groups
      1. 2 alpha
      2. 2 beta
   4. Has a high affinity (attraction) for oxygen
      1. Oxyhemoglobin
         1. Has oxygen attached
      2. Deoxyhemoglobin
         1. Oxygen has been released
   5. Oxyhemoglobin Dissociation Curve
      1. Oxygen saturation
      2. Shift to the right
         1. Partial pressure is higher
         2. HGB attraction to oxygen is lower
         3. Oxygen becomes less "sticky" and wants to be released
         4. Causes
            1. ↓pH
            2. ↑pCO2
            3. ↑Temperature
      3. Shift to the left
         1. Partial pressure is lower
         2. HGB attraction is higher
         3. Oxygen wants to stay "stuck" to HGB
         4. Causes
            1. ↑pH
            2. ↓pCO2
            3. ↓Temperature
3. Special considerations
   1. Submit in lavender top tube
   2. Be cautious with phlebotomy technique
      1. Reduce hemolysis with proper tubing and syringes
4. Elevated HGB values
   1. Polycythemia vera
      1. Treatments
         1. Blood letting
         2. Increased water intake
         3. Some medications
   2. Dehydration
   3. Lung disease
      1. Pulmonary fibrosis
      2. COPD
   4. Certain medical therapies
      1. EPO supplementation
5. Decreased HGB values
   1. Thalassemia
   2. Blood loss
   3. Sickle Cell anemia
   4. Aplastic anemia
   5. Cancers

Assessment

1. Assess for signs of anemia
   1. Tachycardia
   2. Fatigue
   3. Shortness of breath
   4. Decreased SaO2
   5. Pallor

Therapeutic Management

1. Blood transfusions as necessary
2. Treat primary cause of anemia

Nursing Concepts

1. Lab Values
2. Oxygenation