Introduction
Anemia refers to a condition where an individual has a deficiency in the quality or quantity of red blood cells. The condition has several causes including dietary insufficiencies, inherited disorders, bone marrow diseases, hemorrhage, infections, and chronic diseases. Anemia is normally a sign of underlying pathology.
Sickle Cell Anemia
Sickle cell is a subtype of anemia that is common in people of black descent. The condition results from the inheritance of an unusual sickle cell gene (HbS), which is accountable for the production of hemoglobin S that replaces the normal hemoglobin (HbA). Consequently, the unusual hemoglobin molecule acquires a crystalline structure in low oxygen conditions. Hypoxemia in venous blood triggers this change thereby causing erythrocytes to deform and lose their round and flexible biconcave disk appearance (Bloom, 2009).
The erythrocytes then become long, rigid, and crescent-shaped. They fail to squeeze through small blood vessels leading to clogging of the endothelium. The deformed erythrocytes collect and reduce blood flow to organs. The interruption of blood supply causes severe pain and organ damage. Consequently, the body reacts by destroying the erythrocytes leading to chronic anemia.
The formation of sickle cells, however, does not occur at once as the re-establishment of adequate oxygen supply causes the erythrocytes to revert to their normal shape. Therefore, sickle cell crises are sporadic.
Drugs for Associated Sickle Cell Symptoms
Three treatment modalities namely bone marrow transplant, hydroxyurea, and long-term blood transfusions are available for managing sickle cell anemia (Smeltzer, Bare, Hinkle, & Cheever, 2010). The comprehensive medical intervention of the condition must include the management of the associated signs. Analgesics form the basis of visceral and ischemic pain management in sickle cell crisis. However, actual pain relief must involve halting the sickling process with opioid analgesics (Foster & Prevost, 2012).
Management of cardiac failure in sickle cell crisis requires the use of diuretics and digoxin while hypertension management uses angiotensin-converting enzyme inhibitors and calcium blockers. Preventing life-threatening infections such as influenza and pneumonia is also vital and requires immunization (Smeltzer et al., 2010).
Chelating agents prevent iron overload that causes heart attacks when there is a need for blood transfusion. Hydroxyurea (a chemotherapy agent) is effective in increasing hemoglobin F amounts in patients with this condition thereby decreasing the long-term formation of sickle cells. Anti-platelet agents and anticoagulants reduce sickle cell adhesion to the endothelium especially in veins with a slow rate of blood flow.
Effects of Sickle Cell Anemia Drugs
Hydroxyurea is teratogenic, can cause cancer, and leads to chronic suppression of leukocyte formation (Fishman, Ballantyne, & Rathmell, 2010). The side effects of hydroxyurea are dose-dependent and vary from one individual to another. The drug also increases the risk of opportunistic infections due to its immunosuppressive activity.
The use of narcotics like opioid analgesics produces side effects like lethargy and impaired concentration while the antibiotics cause stomach cramps, diarrhea, and nausea (Arcangelo & Peterson, 2013). These side effects can occur either immediately or after some time. Patients on blood transfusion require close monitoring without which life-threatening blood transfusion reactions can occur.
Behavior and Sickle Cell Anemia
Behavior is one factor that significantly affects the management of sickle cell anemia. A sickle cell anemia patient ought to follow instructions strictly when taking the prescribed medications because the misuse of some of the opioid analgesics such as morphine may cause addiction.
Measures to Reduce Drug Side Effects
The NP advises the patient to adhere to dietary and physical restrictions, which reduce instances of sickle cell crises. Sufficient hydration reduces the attacks and the need for medications that cause unwanted effects. The NP should educate patients on the need to observe high standards of hygiene that subsequently reduce the risk of infections and drug use.
Conclusion
Knowledge of sickle cell anemia management is of clinical significance to NPs. In addition, the condition requires intensive patient education to reduce the frequency of attacks. Therefore, NPs should intervene promptly in cases of sickle cell crises.
References
Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins. Web.
Bloom, M. (2009). Understanding sickle cell disease. Mississippi: University Press of Mississippi. Web.
Fishman, S., Ballantyne, J., & Rathmell J., P., (2010). Bonica’s management of pain. Philadelphia: Lippincott Williams & Wilkins. Web.
Foster, G. J., & Prevost, E. S. (2012). Advanced practice nursing of adults in acute care. Philadelphia: Davis Company. Web.
Smeltzer, C. O., Bare, B. G., Hinkle, J. L., & Cheever K. H. (2010). Brunner and Suddarth textbook of medical surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins. Web.