Assessment

HISTORY. Determine if the patient has recently been exposed to known risk factors, such as recent treatment with chemotherapeutic drugs or antibiotics known to cause bone marrow suppression, radiation therapy, or accidental exposure to organic solvents. Establish a history of dyspnea, headache, intolerance for activity, progressive fatigue, malaise, chills and possibly fever, easy bruising, or frank bleeding.

PHYSICAL EXAMINATION. Examine the patient's skin for pallor or a jaundiced appearance. Inspect the patient's mucous membranes for bleeding. Inspect the patient's mouth and throat for lesions. Palpate the patient's lymph nodes to see if they are enlarged. Palpate the patient's liver and spleen, and note any enlargement. Auscultate the patient's chest for tachycardia and adventitious lung sounds.

PSYCHOSOCIAL. Assess the patient's mental status as an indicator of cerebral perfusion; assess the sensorimotor status to evaluate nervous system oxygenation. Patients may be anxious or fearful because of their low level of energy. Discomfort caused by mouth pain may cause the

96 Aplastic Anemia patient to feel irritable. The parents of an infant with a congenital form of aplastic anemia may be quite agitated over the child's illness.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Complete blood count

Red blood cells (RBCs) 4.0-5.5 million/pL

White blood cells 4500-11,000/pL

Reticulocyte count 0.5-2.5% of total RBCs; platelets 150,000-400,000/pL

Decreased to < 1.0 million/pL; usually normochromic and normo-cytic, but may be macrocytic (enlarged) and anisocytotic (excessive variation in erythrocyte size) Decreased

Decreased

Injury to the stem cells decreases production of blood cells

Other Tests: Serum iron; coagulation tests; bone marrow biopsy; hemoglobin electrophoresis; transaminase; bilirubin; lactic dehydrogenase; blood urea nitrogen; creatinine; hepatitis testing; peripheral smear.

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