RBC Count: Polycythemia vs. Anemia (Nursing)

00:01 Okay, let's look at the reason that the red blood cells are elevated.

00:05 Now, I'm going to give you a pretty long list here.

00:08 What's most important is you listen for the concepts, rather than just try to memorize this list of things.

00:13 So we're talking about what are the reasons, if you look at your patient's lab work and the red blood cells are elevated.

00:19 These are the things I'd like you to think through.

00:22 Think through what you know about the patient, what medications they're on, what their history is, and what your assessment has already shown you.

00:29 Now you compare it to the lab values.

00:31 We know we have a patient with red blood cells, so the things we would consider would be like polycythemia vera.

00:37 That's because the bone marrow is going crazy.

00:39 Poly means multiple, cythemia means from the blood.

00:43 Now we know the bone marrow is putting out extra red blood cells.

00:47 High altitude.

00:49 Extra red blood cells is an adaptation to being in high altitude.

00:53 Have you ever gone up to the mountains when you're not used to being in the mountains? You -- find your -- self -- very -- short -- of breath just walking from your car to the look out site.

01:05 That's because we're not used to that type of high altitude.

01:08 There's not as much oxygen available as there is down below.

01:13 So if your body is in high altitude long enough, it compensates.

01:17 I mean, stop and think about that. That is super cool what your body can do.

01:22 So if I'm in an area of high altitude, there's less oxygen available, you've got extra red blood cells.

01:28 If you're there long enough, your body will start cranking them out.

01:31 That's a means of adaptation.

01:33 There's even some elite athletes that will go and train at high altitudes to beef up their red blood cells, and then they'll come back down to a normal altitude.

01:42 So keep in mind, this isn't a super quick process.

01:45 Remember, white blood cells can multiply very, very quickly.

01:49 It takes longer for red blood cells to adapt.

01:53 Now congenital heart disease is another thing we may think through, and you would be pretty aware that your patient has congenital heart disease.

01:59 That should be in their history.

02:01 Pulmonary disease is another problem.

02:04 Pulmonary disease or even specifically, COPD.

02:07 If these are chronic diseases and your patient has had them over a period of time, their body will learn to respond by making these extra red blood cells so they can carry more oxygen around.

02:18 Now, dehydration and renal problems can also cause an elevated red blood cell.

02:25 Let's look at low red blood cells or anemia.

02:29 Aplastic anemia can be a problem, or chronic renal failure.

02:33 Now, here's the deal with chronic renal failure.

02:37 Kidneys no longer can make enough erythropoietin.

02:40 Erythropoietin is what stimulates your bone marrow to put out red blood cells.

02:44 Now, this was the problem my father had.

02:47 He went through chronic renal failure, and was always low on red blood cells.

02:52 So fairly regularly, every couple of weeks, he would have to go into an outpatient clinic.

02:57 They would do a CBC.

02:59 They would look at his red blood cell level, and if it was too low, which it always was, he'd had to have erythropoietin administered.

03:06 That's an IV medication.

03:08 It's very, very expensive.

03:10 But it's what will help the patient develop those red blood cells that they need to carry oxygen, because their kidneys that are in renal failure chronically, no longer can make enough erythropoietin.

03:21 That's why they have to be given extra erythropoietin.

03:24 But remember, it's a very expensive drug.

03:28 Now if a patient has an iron deficiency, they'll also be low in red blood cells.

03:32 It matters that you understand what causes the patient's low red blood cells because we treat them differently.

03:38 If a patient's in chronic renal failure and we just try and give them iron, that's not going to fix the problem.

03:43 If they're just iron deficient, we don't need to give them erythropoietin.

03:47 So that's why it matters that you dig down deeper to find out what's the cause of the anemia.

03:53 Now, there's pernicious anemia. Wow, who knows what happens from there, right? Bone marrow damage. Anytime the bone marrow is damaged -- that's the source of making red blood cells, we're going to have a lower red cell count.

04:05 Of course, leukemia or lymphoma is going to be problematic, or if somebody has blood loss.

04:10 Now it can be acute, meaning blood is exiting my body, or it can be chronic -- small amounts of blood.

04:19 You see this a lot with patients who have GI bleeding somewhere.

04:22 They just have this oozing that kind of goes on all the time, but it's not large and graphic amounts of blood.

04:29 So you're going to see different types of anemia, whether it's an acute loss, or if it's a chronic loss over a period of time.

04:35 Now we got some deficiencies in nutrition: low in iron, vitamin B12, or folate deficiencies will also show you anemia. So again, that's back to if we know that's the problem, you need more folate or B12, we would address that differently than somebody who has a chronic blood loss.

04:52 Now, the last point is a red blood cell hemolysis.

04:55 If you've got something going on, hemo, lysis, hemolysis, that means the destruction of red blood cells, you're going to have a low red blood cell count.