Introduction

Anemia is a major killer in India.Statistics reveal that every second Indian

woman is anemic. Anemia affects both adults and children of both sexes,
although pregnant women and adolescent girls are most susceptible and most
affected by this disease.
According to WHO estimates, India is one of the countries in theworld that has
highest prevalence of anemia. The bliss of motherhood thrives under the looming
presence of anemia in India.

DEFINITION
Abnormal reduction in the number of circulating red blood cells, the quantity
of hemoglobin and the volume of packed red cells in a given unit of blood.

WHO definition: “ A condition in which the haemoglobin content of blood is

lower than normal as a result of a deficiency of one or more essential nutrients,
regardless of the cause of such deficiency.

RISK FACTORS
 Poor socio economic class
 Multiparity
 Teenage pregnancy
 Menstural problem

SYMPTOMS
Common symptoms of anemia
 Easy fatigue and loss of energy
 Unusually rapid heart beat, particularly with exercise
 Shortness of breath and headache, particularly with exercise
 Difficulty concentrating
 Dizziness
 Pale skin
 Leg cramps
 Insomnia

1. Classification of Anemia 2. On the basis of morphology • Microcytic – If the

cells are smaller than normal, e.g. iron deficiency anemia, anemia of chronic
disease, thalassemia. • Normocytic – if cells are in normal size, e.g.- acute blood
loss, anemia of chronic disease, hemolytic anemia, Aplastic anemia. • Macrocytic
- if they are larger than normal, e.g.-Megaloblastic anemia
2. 13. Types of Anemia 1. Iron deficiency anemia – it is caused by a lack of iron. It
develop when body store of iron drops too low to support normal RBCs
production. women are at risk, for menstrual blood flow and growing fetus. 2.
Anemia of chronic disease – it is a chronic disease of inflammation, infection and
malignancy cause this type of anemia. 3. Thalassemia – it is a genetic disorder
that is characterized by abnormal formation of hemoglobin it results in inadequate
oxygen transport and destruction of RBCs which leads to anemia.
3. 14. Types of Anemia 4. Aplastic anemia – it is a rare disease in which the bone
marrow and hematopoietic stem cells that are damaged leads to pancytopenia
(deficiency of all three cellular components of the blood such as red cells, white
cells, and platelets). 5. Megaloblastic or folic acid deficiency anemia - in this
condition the bone marrow usually produce large, abnormal and immature RBCs.
It results from inhibition of DNA synthesis during RBCs production so it leads to
continuing cell growth without division.
4. 15. Types of Anemia 6. Pernicious anemia - it occurs when the intestine can’t
properly absorb vitamin B12. 7. Sickle cell anemia – it is characterized by RBC
that assume the abnormal, rigid, sickle shape. It results from the presence of
mutated form of a Hb.
5. 16. Thalasemia
6. 17. P/P of pernicious anemia Normal gastric mucosa secrete a substance called
intrinsic factor necessary for absorption of vit.B12 in ilieum. If defect exists in
mucosa intrinsic factor may not be secreted Orally ingested vitamin B12 is not
absorbed. Vitamin B12 is necessary for the normal DNA synthesis in maturing
RBCs. Pernicious anemia
7. 18. Clinical manifestations • Easy fatigue and loss of energy • Hypotension,
rapid heart rate when exercise • Shortness of breath and headache in exercise. •
Difficulty in concentration. • Dizziness, insomnia, leg cramps • Pale skin, changes
in stool color. • Spleenomegaly
8. 19. Diagnostic evaluation of anemia • History • Physical examination •
Complete blood count • Others –  Stool Hb test
9. 20. Diagnostic evaluation of anemia  Iron,, Folate, Vitamin b12, bilirubin. 
Hb electrophoresis  Reticulocyte count  Bone marrow biopsy
10. 21. Management Of anemia 1. Blood transfusion – specially RBCs transfusion.
2. Iron supplements – oral ferrous sulphate, parenteral iron therapy. 3. Nutritional
therapy and dietary consideration – vitamin b12 rich diet, iron rich diet, and folic
acid rich diet to be provided to the patient. 4. Spleenectomy – removal of spleen.
5. Bone marrow and stem cell transplantation – to enhance the production of
RBCs, WBC, platelets.
11. 22. Management Of anemia 6. Activity restriction – minimizes the activity,
curtailing the exercise ( running on the grass rather then the concrete). Running
on the hard surface develop the hemoglobinuria.
12. 23. Management Of iron deficiency anemia • Correction of chronic blood loss •
Oral or parenteral iron therapy  Oral ferrous sulfate  Iron dextran or iron
sorbitex parenteral therapy
13. 24. Management Of pernicious anemia • Parenteral replacement with
hydroxycobalamine or cyanocobalamine is necessary by IM injection every
month.
14. 25. Management Of folic acid deficiency anemia The goal is to identify and treat
the cause of the folate deficiency. • You may receive folic acid supplements by
mouth or through a vein. If you have low folate levels because of a problem with
your intestines, you may need treatment for the rest of your life. • Diet changes
can help boost your folate level. Eat more green, leafy vegetables and citrus
fruits.
15. 26. Management Of aplastic anemia • Bone marrow transplantation •
Immunosuppressive treatment • Androgens to stimulate bone marrow
regeneration • Platelet and RBCS transfusion
16. 27. Management Of thalasemia • Blood transfusion • iron chelation therapy • Folic
acid supplements • BMT • Spleenectomy
17. 28. Management Of sickle cell anemia • Promote adequate oxygenation • Blood
transfusion • Spleenectomy • Butyrate and hydroxyurea
18. 29. Complication of Anemia • Hypoxia • Severe fatigue • Physical & mental
growth retardation • Neurologic damage • Heart problem – irregular heart rate,
heart enlargement, heart failure • Pregnancy complication – premature birth •
Death
19. 30. Nursing Management
20. 31. 1. Nursing diagnosis - Imbalanced nutrition less then body requirement
related to inadequate intake of essential nutrients as evidenced by skin integrity,
color and body weight. • Goals: Improve nutrition level • Intervention: • A healthy
diet should be encouraged. • Avoid alcoholic beverages. • Dietary teaching
session should be individualized including culture aspect related to food
preference and food preparation.
21. 32. 2. Nursing diagnosis – activity intolerance related to low level of Hb in body
as evidenced by the weakness, fatigue and malaise. • Goal: Improve the activity
intolerance • Intervention: • assist the patient to prioritize the Activities and a
establish balance between the activity and rest that is realistic and feasible from
the patient perspectives. • Patient with chronic anemia need to maintain some
physical activity and exercise to prevent the deconditioning that results from the
inactivity.
22. 33. 3. Nursing diagnosis – ineffective tissue perfusion related to less blood
volume as evidenced by skin color (pallor). • Goal: Improve tissue perfusion. •
Intervention: • The nurse monitor the vital sign closely. • lost volume replaced with
blood transfusion or IV fluids. • Supplemental oxygen may be necessary but it is
rarely needed on a long term basis. • Other medication such as antihypertensive
agent may be needed to be adjusted.
23. 34. 3. Nursing diagnosis – ineffective tissue perfusion related to less blood
volume as evidenced by skin color (pallor). • Goal: Improve tissue perfusion. •
Intervention: • The nurse monitor the vital sign closely. • lost volume replaced with
blood transfusion or IV fluids. • Supplemental oxygen may be necessary but it is
 rarely needed on a long term basis. • Other medication such as antihypertensive
agent may be needed to be adjusted.
24. 35. Research related to Anemia Sanjeev M Chaudhary conducted a cross
sectional study of anemia among adolescent Females in the Urban Area of
Nagpur. Sample consisted of 296 adolescent females (10–19 years old). Major
finding of the study reveals that the prevalence of anemia was found to be 35.1%.
This study concluded that a high prevalence of anemia among adolescent
females was found, which was higher in the lower socio-economic strata and
among those whose parents were less educated. Mean height and weight of
subjects with anemia was significantly less than subjects without anemia.
25. 36. Summary

CONCLUSION
Anaemia although preventable is a global problem. Anaemia still is the
commonest cause of maternal mortality and morbidity in spite of easy diagnosis
and treatment. Anaemia can be due to a number of causes, including certain
diseases or a shortage of iron, folic acid or Vitamin B12. The most common cause
of anemia in pregnancy is iron deficiency. The youth needs to be educated about
diet, sanitation and personal hygiene