TIME CONTENT TEACHING AV EVALUATION

OBJECTIVE LEARNING AIDS

ACTIVITY

INTRODUCTION
The majority of Hematologic disorders are considered Explanation
benign( ie., non malignant )where as mny are relatively
indolent others have severe consequences and can be life
3min threatening. Most hematological disorders are quite complex ;
a throughout understanding of the underlying processes
associated with the disorders can assist nurse so that they may
appropriately assess , monitor , educate and intervene with
patients with hematologic disorder than 12.

Explaining What do
What is 2min ANEMIA mean by
anemia? Explanation anemia?
Anemia is a condition in which the hemoglobin concentration
is lower than normal
The normal range of hemoglobin is generally different in
male and female
For men –hemoglobin less than 13.5gram
For female- hemoglobin less 0gram
 SEVERITY OF ANEMIA
Enumerate 5min
the severity SEVERITY Hb RANGE SYMPTOM MEDICAL Lecture cum
of anemia g/dl S ATTENTIO discussion
N Chart
MILD 9.5-13.0 Often no Commonly
signs or remains What are the
symptoms untreated severity of
anemia?
MODERAT 8.0 – 9.5 May present Requires
E with managemen
symptoms t to prevent
complicatio
< 8.0 Symptoms ns
SEVERE usually
present May be life
threatening
and requires
prompt
managemen
t

CAUSES OF ANEMIA:-

Any process that can disrupt the normal life span of RBC may cause What are the
anemia Discussion causes of
Enlisting Normal life span of a RBC is typically around 120 days. anemia?
the causes Red blood cells are made in bone marrow.
of anemia
 CLASSIFICATION OF ANEMIA:-
Enumeratin
g the What are tha
classificatio ANEMIA IS CLASSIFIED INTO THREE BROAD CATEGORIES :- classification
n of 1omi  Anemia caused by blood loss of anemia?
anemia n  Decreased or faulty production of RBC
 Increased destruction of RBC
Explanation
ANEMIA CAUSED BY BLOOD LOSS:- Blood loss is most common
cause of anemia ; especially iron deficiency anemia .
Red blood cells can be lost through bleeding , which can occur slowly
over a long period of time ; and can often go undetected . this kind of
chronic bleeding commonly results from the following :
 Gastrointestinal conditions such as ulcers ; hemorrhoids ;gastritis
;and cancer
 Menstruation and child birth in women , especially if menstrual
bleeding is excessive and if there are multiple pregnencies
 Use of non steroidal anti-inflamatory drugs (NSAIDS)

DECREASED OR FAULTY PRODUCTIONOF RBC:

Both acquired and inherited conditions and factors can prevent
body from making enough RBCs.
The body may provide too few blood cells or blood cells or the blood
cells may not function correctly
RBCs may be faulty or decreased due to abnormal RBCs or a lack of
minerals and vitamins need for RBCs to work properly.

EXAMLES of acquired conditions and factors that can prevent

body from making enough RBCs includes
 Diet
 Hormones
 Some chronic diseases
 Pregnancy
 Aplastic anemia also can prevent body from making enough
 RBCs
INCREASED DESTRUCTION OF RBCs:-
Both acquired and inherited conditions and factors can cause body to
destroy too many RBCs
EXAMPLES of inherited conditions that can cause body to destroy
too many RBCs include
 SICKLE CELL ANEMIA
 THALASSEMIAS
 LACK OF CERTAIN ENZYMES
These conditions create defects in RBCs that cause them to die
faster than healthy RBCs.

RISK FACTORS:-

Factor that raise your risk of anemia include:- What are the
Enlisting risk factors of
A diet in low in iron vitamins or minerals
the risk anemia?
Blood loss from surgery or injury
factors of
Menstruation
anemia?
Pregnancy
Long term infections
Family history of inherited anemia such as sickle cell anemia or
thalassemia
Long or derious illnesses such as kidney disease cancer diabetes liver
disease heart disease and thyroid disease
5min
Frame the
PATH PHYSIOLOGY:- path
A decrease in the number of functional red blood cells due to one or physiology of
more following anemia?
 Insufficient production of RBCs by the bone marrow
Explaining  Defective synthesisis of the RBCs due to absence of essential
the path factors
physiology  Increased loss of the RBCs caused by bleeding
of anemia? Transport of oxygen is impaired. Hemoglobin is lacking or the number
of the red blood cells is too low to carry adequate oxygen to tissues and
hypoxia develops.
ANEMIA CLINICAL MANIFESTATIONS:-
What are the
Symptoms of anemia may include the following:-
Enliating clinical
 Fatigue
the clinical 5min manifestation
 Decreased energy
manifestati of anemia?
ons of
 Weakness
anemia?
 Shortness of breath
 Light headedness
 Palpitations feeling of the heart racing or beating irregularly
 Looking pale
Symptoms of severe anemia include:-
 Chest pain
 Pale and always feel exhausted
 Dizziness and headache
 Fainting or passing out
 Loss of appetite
 Rapid heart rate
 Profound weakness
5min Other manifestations of anemia associated with specific body
systems include :-
 Integumentary system :-pallor delyed wond healing ; sore mouth
and toungue jaundice spider angiomas and sensitivity of cold.
 Respiratory systems:-shortness of breath ; dyspnea , on excretion
and orthopnea.
 Cardio vascular system:-palpitations , angina, tachycardia
tachypnea , cardiomegaly ,dependent anemia fatigue andwellness.
 GI System:-beefy red colour toungue, anorexia nausea black stools ,
constipation; diarrhea, hemorrhoids, weght loss dietary changes due
to clay eating and pica
 Reproductive system:- hematuria , loss of libido, menstrual
irregularity and importance
  Neurological system:-headache , dizziness, numbness,tingling of
extremities, irritability and paralysis.
CLASSIFICATION OF ANEMIA:-
1.HYPOPROLIFERATIVE ANEMIA
2.HEMORRHAGIC ANEMIA
3. HEMOLYTIC ANEMIA
(A) INHERITED HEMOLYTIC ANEMIAS
Enumeratin (B)AQUIRED HEMOLYTIC ANEMIAS
g the risk 1.HYPOPROLIFERATIVE ANEMIA: Anemias resulting from
factors of defective or reduced red blood cells production. Hypoproliferative
anemia anemias result from deficient erythropoietin(EPO) or a diminished
response to it ; they tent to be normocytic and non normochromic.
Renal, metabolic and endocrine disorders are common causes.
Treatment includes measures to correct the underlying disorders and
EPO.
 Iron deficiency anemia
 Vitamin B12 DEFICIENCY ANEMIA
 FOLIC ACID DEFICIENCY ANEMIA
Explaining
 APLASTIC ANEMIA
the path 2.HEMORRHAGIC ANEMIA:- Anemias resulting from loss of
physiology RBCs or blood loss
of anemia blood loss can cause anemia—whether it is due to excessive bleeding
or due to heavy loss of blood due to injury
(A) Acute hemorrhagic anemia
(B) Chronic hemorrhagic anemia
3.HEMOLYTIC ANEMIA:-Anemia resulting from excessive RBCs
destruction
 Rarely anemia is due to problems that cause due to death of RBCs or
be destroyed prematurely.
Normally cells leave in blood for about 4 months
Enumeratin In hemolytic anemia this time is shortened sometimes to only few
g the
days. The bone marrow is not able to provide new RBCs quickly
clinical
enough to replace those that have been destroyed leading to
manifestati
ons of decreased number of RBCs in the blood which inturn leads to a
anemia diminished capacity to supply oxygen to tissues throughout the body
INHERITED HEMOLYTIC ANEMIAS
 SICKLE CELL ANEMIA
 THALASSEMIAS
 HEREDITARY SPHEROCYTOSIS
 HEREDITARY ELLIPTOCYTOSIS (OVALOCYTOSIS)
 GLUCOS-6-PHOSPHATE DEHYDROGENASE DEFICIENCY
 PYRUVATIVE KINASE DEFICIENCY
AQUIRED HEMOLYTIC ANEMIAS
 IMMUNE HEMOLYTIC ANEMIA
 AUTO IMMUNE HEMOLYTIC ANEMIA
 ALLOIMMUNE HEMOLYTIC ANEMIA
 DRUG INDUCED HEMOLYTIC ANEMIA
 MECHANICAL HEMOLYTIC ANEMIAS
 PAROXYSMAL NOCTURNAL HEMOGLOBINURIA
 NON IMMUNE HEMOLYTIC ANEMIA CAUSED BY CHEMICHAS
OR TOXINS

IRON DEFICIENCY ANEMIA:-

Iron deficiency is defined as anemia associated with either inadequate
absorption or excessive loss of iron ; it is chronic ; microcytic ;
hypochromic anemia.
 Iron deficiency anemia is most common in anemia
Mostly it is seen 20% of women ; 50% of pregnant women and 3% in
men do not have enough iron in their body
CAUSES OF IRON DEFICIENCY ANEMIA:-
 CHRONIC BLOOD LOSS 2-4ML PER DAY
 INSUFFICIENT IRON IN DIET
 POOR OR IMPAIRED ABSORPTION OF IRONBY THE BODY
 PERIODS OF RAPID GROWTH

Enlisting CLINICAL MANIFESTATIONS:-

the Signs and symptoms
classificatio  Decreased serum in iron
n of  Decreased Hb level 6-9g/Dl
anemia  Feeling of fatigue tiered ness
 Cold hands and feets
 Lack of energy
 Shortness of breath sore throat
 Unusual food craving pica decreased appetite
Explaining  Weakness
what is  Dizziness or light headedness
hypoprolife  Blue colour of eyes
rative  Rapid heart beat
anemia  Irritability
 Pale skin colour
DIAGNOSTIC EVALUAIONS:-
 Stool for blood occult
 Serum iron levels
 Fecal immune chemical test
 Serum ferratin
 Hb level or CBP
 MANAGEMENT:- the cause of iron deficiciency must be found
especially in older patients who face the greatest risk for
gastrointestinal cancers.
Patients who cannot tolerate iron by mouth can take it through
Explaining
intravenous or intra muscular
what is
Milk and antacids may interfere with the obsorption of iron and should
hemorrhagi
c anemia not be taken at same time as iron suppliments
Vitamin c can increase absorption and it is essential for production of
hemoglobin
Hematocrit should return to normal after 2 months of iron therapy
How ever iron therapy should continue till 6 months to 12 months
Iron rich food :- egg yolk fish legumes peas and beans meat liver is the
highest source whole grain bread.
MEGABLOBLASTIC ANEMIA:- it is a type of anemia
characterized by very large RBCs . in additions to the cells being large
the inner contents of each cells are not completely developed. This mal
formations causes the bone marrow to produce fewer cells and
sometimes cells die earlier than the 120 days life expectancy . instead
of being round or disc shape it can be oval.
1.PERNICIOUS ANEMIA:- It is decreased in RBCs that occur
when the body cannot properly absorb vitamin B12 from the gastro
intestinal tract vitamin B12 is necessary for the proper developmentof
red blood cells.
CAUSES:-
 Weakened stomach lining
 Lack of vitamin B12
 Macrocytes (abnormal production of RBCs)
 Long term use of certain medications and antibiotics
 Chronic obstructive pulmonary disease
 Folate( vit B-9 deficiency)
CLINICAL MANIFESTATIONS:-
The signs and symptoms of pernicious anemia are due to lack of
enough vitamin B12 deficiency body cant make enough healthy RBCs
this causes anemia.

SIGNS AND SYMPTOMS OF PERINIOUS ANEMIA:-

Common overlook symptoms:-
 Weakness
 Headache
 Chest pain
 Weight loss
Neurological symptoms:-
 Stiffness and tightness in the muscles
 (peripheral neuropathy) Numbness in arms and legs
 Memory loss
SIGNS AND SYMPTOMS OF VIT B12 DEFICIENCY:-
 Nausea and vomiting
 Confusion
 Depression
 Constipation
 Loss of appetite
 Heart burn
DIAGNOSTIC EVALUATIONS:-
 CBP
 Vitamin B12 deficiency test
 Instrinsic factor deficiency test
MANAGEMENT:- vitamin B12 injections that are slowly
decreased over time
 Complete blood count to measure vitamin B12 and iron levels in
blood serum
High dosage of vitamin B12 tablets by mouth in a very effective
Folic acid vitamin C and iron rich diet are meat liver green leafy
vegetables citrus fruits and berrys.
2. FOLIC ACID DEFICIENCY:-
Folic acid deficiency anemia is decreased in red blood cells due to lack
of folate or lower than normal amount of folic acid a type of vitamin B ,
in blood . Red blood cells provide oxygen to body tissues.
CAUSES:-
 Certain medications such as phenytoin
 Alcohol abuse
 Eating over cooked food
 Poor diet
 Excess folic acid diet is needed in third trimester of pregnancy
 Impaired absorption because of intestinal dysfunction from such
disorders as celiac diseases and bowel distruction.
Clinical manifestations:-
 Fatigue
 Dyspnea
 Palpitations
 Weakness
 Glossitis
 Nausea
 Anorexia
 Headache
 Forgetfulness
 Irritability
DIAGNOSTIC EVALUATION:-
Decreased reticulocyte count
Serum folate level less than 4mg/ml
Low platelet count
MANAGEMENT:- The goal is to identify and treat the folic acid
deficiency
Folic acid suppliments can be given by mouth.
Or through intravenous on short term basis until the anemia has been
treated or corrected
In case of poor absorption by the intestine replacement will be life long
DIETARY TREATMENT:- Intake of green leafy vegetables and citrus
fruits.
PREVENTION:- Eating raw or lightly cooked vegetables every day heps
maintain normal folic acid levels
Folic acid deficiency can cause child birth defect all women
Of child bearing age who can become pregnant should consume atleast
400 mcg of folic acid daily .
A women who is pregnant should have regular medical check ups and
take good prenatal vitamins.

APLASTIC ANEMIA:-Aplastic anemia is a rare and serious blood

disordersin which bone marrow stops making enough new red blood
cells . this is because the bone marrow’s steam cells are damaged
It can develop slowly or suddenly.
The disorder tend to get worse over time , unless its cause is found and
treated.
CAUSES:-
 Exposure to toxic substances such as pesticides or benzymes
 Cancer therapy (radiation therapy or chemo therapy)
 Use of certain drugs
  Pregnancy
 Auto immune diseases such as rheumatoid arthritis
 Viral infections such as HIV , HEPATITIS
CLINICAL MANIFESTATIONS:-
Lower than normal numbers of RBCs WBCs and platelets are most
of the signs and symptoms of aplastic anemia
SIGNS AND SYMPTOMS OF LOW BLOOD CELL
COUNT
 Too few red blood cells
 Too few white blood cells
 Too few platelets
 Other signs and symptoms:-
 Head ache
 Tender sinuses
 White patches in mouth or oral thrush
 Nausea
 Enlarged spleen or liver
DIAGNOSTIC EVALUATION:-
 Low red blood cells count
 Low white blood cells count
 Low reticulocyte count or immature red blood cells
 Low platelet counts
 Bone marrow biopsy shows over all decrease in number of
blood cells
 X-Ray
 CT-Scan
 Ultrasound
 Vit B12
 studies and viral studies
MANAGEMENT:
 1. BLOOD TRANSFUIONS:-
Mild cases of aplastic anemia may be treated with supportive care
or may require no treatment.
In moderate cases blood transfusions will help to correct the
anemia and risk of bleeding
2.BONE MARROW OR STEAM CELL TRANSPLANT:-
Bone marrow transplant or steam cell transplant is recommended
for severe disease in youngr patients
A bone marrow tansplant replaces damaged steam cells in bone
marrow with healthy steam cells from donars bone marrow
3.MEDICINES:- if patients have aplastic anemia , doctor may
prescribe
medicines to stimulate bone marrow ,
suppress immune system and prevent and treat infections.
LIFE STYLE HOME REMEDIES:-
 Avoid excessive excersise :- anemia can cause fatigue and
shortness of breath with even mild exertion. It may be best
to conserve energy.
 Avoid contract sports:-because of risk of bleeding associated
with low platelet count avoid activities that may result in
major cut or fall.
 Avoid infections:-protect from infections by frequent hand
washing and by avoiding sick people . if develop a fever or
other indicators of an infection, see doctor for treatment.
HEMOLYTIC ANEMIA:-It is a condition in which red blood cells
are destroyed and removed from blood stream before their normal life
span is up.
Red blood cells are made in bone marrow a sponge like tissue inside
the bone
They live for about 120 days in the blood stream and then die.
TYPES OF HEMOLYTIC ANEMIA:-
A. INHERITED HEMOLYTIC ANEMIAS:-
1.SICKLE CELL ANEMIA
2.THALASSEMIAS
3.