Naga College Foundation, Inc.

College of Health Sciences

2nd Semester AY 2022-2023

CASE STUDY
on
ANEMIA

Presented by:

Abraham, Annie Lou Aquino, Princess Lie R.

Almero, Kimberly L. Armea, Ma Caitlin D.S.
Alpano, Abegail Atienza, Andrea Nicole A.
Amican, Eloiza Mae Baeta, Anabelle D.
Andes, Jerard Banadera, Abegail

March 01, 2023

 CASE SCENARIO

Patient J.G is a 25 yr-old, 32 weeks pregnant admitted to a hospital on Feb. 17 complaining

severe labor pain and vaginal bleeding. She gave birth on the same day with G4T3P1A0L4 with
principal diagnosis of pregnancy uterine delivered to live preterm, cephalic baby girl with
AGPAR score of 8 and 9, birthweight of 1570 grams and small for gestational age via normal
spontaneous delivery.

After delivery she experienced DOB and productive cough. She also experiencing severe
decreased in hemoglobin count that leads her for blood transfusion.
BIOGRAPHIC DATA
Patient’s Initial : Ms. J.G
Address : Bagumbayan Grande ( Pob.) Goa, Cam Sur
Age : 24 yr-old
Sex : Female
Marital Status : Single
Occupation : None
Religion : Catholic
Health care financing : None
Date of Admission : Feb. 17, 2023
VITAL SIGNS
BLOOD PRESSURE 140/90 mmHg

CARDIAC RATE 96 beats per min.

RESPIRATORY RATE 21 breaths per min.

TEMPERATURE 36.5 °C

OXYGEN SATURATION 100%

GENERAL SURVEY
HEENT Essentially Normal

CHEST / LUNGS Essentially Normal

CARDIOVASCULAR Essentially Normal

SKIN / EXTREMITIES Essentially Normal

NEURO Essentially Normal

ABDOMEN Globular, FH-25cm, FTH-130

IE fully 100% effaced, cephalic, (-) BOW, station +4

History of Present Illness
Few hours prior to consultation, Mrs. J.G noted
uterine contractions associated with (+) vaginal
bleeding, (-) watery discharge, and good fetal
movement sought consultation with OB– ER and was
subsequently admitted.
Past Medical History
Patient G.J doesn't complete her vaccination .She is not completely
immunized. She claimed that before getting pregnant, she had never
experienced a cold. She does not have any food or drug allergies. She
also didn't complete all of her prenatal checkups. The patient's
menarche started when she was 14 years old. She has a regular
menstruation, and she also experienced dysmenorrhea, dyspareunia ,
menorrhagia and postcoital bleeding. She is unable to recall the date
of her last menstrual period.
Patient J.G previously diagnosed with hypertension and Diabetes
mellitus. She is also exposed to secondhand smoke.
Family History of Illness
Patient J.G has four children with no chronic or infectious
diseases as of the present time. They are currently alive
and healthy. His wife has a history of IV drug user. She
also stated that his wife smoke and drink alcohol. The
illnesses within the family are CAD, hypertension, cancer
and DM. But as stated by the client, there has no any
history of illnesses or diseases within the family.
 GORDON'S
FUNCTIONAL
PATTERN
Health Perception and Health Management Pattern

The client's general health is altered after she gives birth to

her 4th child. She has not experienced colds and flu for the
past 6 months. The client verbalizes that after giving birth
she is having difficulty breathing and experiencing coughs
that affect her daily life. The client stated that she doesn’t
smoke nor drink alcohol and has never done illicit drugs but
she exposed on this kind of environment.
Nutritional and Metabolic Pattern

The client usually ate 3x a day consisting of rice, bread,

vegetables, instant food like lucky me and canned goods, fish
and occasionally they ate meat.
The client has no allergies in food and no eating discomfort.

During hospitalization the client usually follow soft diet as

prescribed.
Elimination Pattern
Activity - Exercise Pattern

Before Hospitalization, The client states that she

does not perform any exercises, just casual walking
and doing household chores serves as her excersice.
During Hospitalization, Since the client experienced
DOB and she does not have sufficient energy to do
a task or simple exercises.
Sleep - Rest Pattern
Cognitive - Perceptual Pattern

The client stated that she doesn’t have any

sensory problems such as impaired hearing and
visual problems. Upon interviewing the clients
vocabulary is slightly altered. She has difficulty on
remembering and answering some of my basing
questions like her last menstrual period.
Sexual Reproductive Pattern

The client is sexually active and denies of using

any contraceptives and family planning method.
She had four children and her first menstrual
period begun when she was 14 yrs old. The client
experienced dysmenorrhea and menorrhagia
during menstruation. She also experienced
dyspareunia and post coital bleeding.
 ANATOMY
AND
PHYSIOLOGY
BLOOD
Functions of Blood
1.Transport of gases, nutrients and waste products
2.Transport of processed molecules
3.Transport of regulatory molecules
4.Regulation of pH and osmosis
5.Maintenance of body temperature
6.Protection against foreign substances
7.Clot formation
Composition of Blood 1
Plasma:
55% of total blood
pale, yellow liquid that surrounds cells
91% water, 7% proteins, and 2% other
Formed Elements:
45% of total blood
cells and cell fragments
erythrocytes, leukocytes,
thrombocytes
Plasma Proteins
Albumin:
58% of plasma proteins
helps maintain water balance
Globulins:
38% of plasma proteins
helps immune system
Fibrinogen:
4% of plasma proteins
aids in clot formation
Platelets
Platelets are minute fragments of cells, each consisting of a small
amount of cytoplasm surrounded by a cell membrane.
They are produced in the red bone marrow from large cells called
megakaryocytes. Small fragments break off from the
megakaryocytes and enter the blood as platelets.
Platelets play an important role in preventing blood loss.

Blood Loss
When blood vessels are damaged, blood can leak into other tissues and
disrupt normal function.
Blood that is lost must be replaced by production of new blood or by a
transfusion.
Preventing Blood Loss
1.Vascular spasm:
temporary constriction of blood vessel
2.Platelet plugs:
can seal up small breaks in blood vessels
3.Blood clotting (coagulation)
Vascular Spasm
Vascular spasm is an immediate but
temporary constriction of a blood vessel
that results when smooth muscle within the
wall of the vessel contracts.
This constriction can close small vessels
completely and stop the flow of blood
through them.
Vascular spasm is stimulated by chemicals
released by cells of the damaged blood
vessel wall and by platelets.
A platelet plug is very important in maintaining the integrity of
the damaged blood vessels. The formation of a platelet plug can
be described as a series of steps, but in actuality many of these
steps occur at the same time. Platelet adhesion occurs first,
when platelets stick to the exposed collagen in the damaged
blood vessel wall.
After platelets adhere to collagen, they become activated,
change shape, and release chemicals.
In platelet aggregation, fibrinogen forms bridges between the
fibrinogen receptors of numerous platelets, resulting in a
platelet plug. 
Blood Clotting
Blood can be transformed from a liquid to a gel Clot:
network of thread-like proteins called fibrin that trap blood
cells and fluid
depends on clotting factors
Clotting factors:
proteins in plasma
only activated following injury
made in liver
require vitamin K
 
RISK
In pregnancy having anemia would lead to;
Risk for pre-mature labor

Risk for Low birth weight of the baby

neural tube defect
congenital anomaly

Assessment
extreme fatigue
headache
pallor
tachycardia
hemoglobin value is usuallu less than 12g/dl
For patient J.G case;
Based on the findings and results of the laboratory tests;
She had profuse vaginal bleeding that resulted in low cardiac
output and hemoglobin count. She was given an O2 as treatment
and a blood transfusion.

Here are the risk she can probably get;

risk for deficient fluid and electrolyte volume
risk for impaired oral mucous membrane
Risk for infection
risk for disproportionate growth and delayed development
risk for nutrition imbalance related to low body weight
 RISK
FACTORS
Risk factors of anemia

Diet low in iron

Heavy menstrual period
Unwise weight-reducing program
Pregnancy less than 2yrs before current program
Low socioeconomic status
PATHOPYSIOLOGY
 Anemia is strictly defined as a decrease in red blood cell (RBC)
mass. The function of the RBC is to deliver oxygen from the lungs to
the tissues and carbon dioxide from the tissues to the lungs. This is
accomplished by using hemoglobin (Hb), a tetramer protein
composed of heme and globin. Usually discovered and quantified by
measurement of the RBC count, Hb concentration, and hematocrit
(Hct).

Basically, only three causes of anemia exist:

decreased
blood loss increased
destruction of RBCs production of RBCs.
(hemolysis)
Genetic etiologies include the following:
Hemoglobinopathies
Thalassemias
Enzyme abnormalities of the glycolytic pathways
Defects of the RBC cytoskeleton
Congenital dyserythropoietic anemia
Rh null disease
Hereditary xerocytosis
Abetalipoproteinemia
Fanconi anemia
Nutritional etiologies include the following:

Iron deficiency
Vitamin B12 deficiency
Starvation and generalized malnutrition
Folate deficiency

Physical etiologies include the following:

Trauma
Burns
Frostbite
Prosthetic valves and surfaces
Infectious etiologies include the following:
Viral - Hepatitis, infectious mononucleosis, cytomegalovirus
Bacterial - Clostridia, gram-negative sepsis
Protozoal - Malaria, leishmaniasis, toxoplasmosis

Chronic disease and malignant etiologies include the

following:
Kidney disease
Liver disease
Chronic infections
Neoplasia
Collagen vascular diseases
Response to Anemia

A reduction in oxygen-carrying capacity occurs along

with a decrease in intravascular volume, with resultant
hypoxia and hypovolemia. Hypovolemia leads to
hypotension. stroke volume, heart rate, and SVR all
are maximized by the sympathetic nervous system.
Oxygen delivery is enhanced by the increased blood
flow.
 Anemia during Pregnancy
More common types of anemia during pregnancy, including:
Iron-deficiency anemia, from a lack of iron.
Folate-deficiency anemia, from a lack of folic acid.
Vitamin B12 deficiency anemia, from a lack of vitamin B12.

Throughout pregnancy, the amount of blood in the body increases by 20% to

30%. People who at higher risk for anemia during pregnancy are:

Pregnant with multiples.

Not consuming enough iron.
Having back-to-back pregnancies with minimal time between.
Experiencing a heavy menstrual flow before pregnancy.
Vomiting often because of morning sickness.
 DIETARY
Preventing anemia
Eat iron-rich foods such as meat, chicken, fish, eggs, dried
beans and fortified grains. The form of iron in meat
products, called heme, is more easily absorbed than the iron
in vegetables.
Eat foods high in folic acid, such as dried beans, dark green
leafy vegetables, wheat germ and orange juice.
Take your prenatal multivitamin and mineral pill which
contains extra folate.
DIETARY
Foods should be avoided
Don't eat iron-rich foods with foods or beverages that block iron absorption. These include
coffee or tea, eggs, foods high in oxalates, and foods high in calcium. Eat iron-rich foods with
vitamin C-rich foods, such as oranges, tomatoes, or strawberries, to improve absorption.
DIAGNOSTIC
TEST
HEMATOLOGY
DIFFERENTIAL COUNT
CHEMISTRY
SEROLOGY RESULT
DRUG STUDY
 DRUG STUDY
INDICATION AND
MECHANISM OF ADVERSE OR SIDE DESIRE ACTION TO
DRUG NAME CONTRAINDICATIO
ACTION EFFECT CLIENT
N

Indication: Iron
deficiency anemia
due to: Nutritional
iron deficiency
Pregnancy helps relieve
Metallic taste
Breastfeeding symptoms of
Temporary staining
Bleeding Chronic anemia by
Replenish iron of teeth enamel
kidney disease providing iron to
Ferrous SulfateTab stores and promote Nausea Vomiting
Contraindication make hemoglobin
BID hemoglobin Abdominal pain
Hemochromatosis for red blood cells,
synthesis Flatulence
Thalassemia increase the
Constipation Dark,
Hemolytic anemia oxygen-carrying
tarry stool
Peptic ulcer disease capacity of blood
Gastritis
Inflammatory bowel
disease
Regional enteritis
 DRUG STUDY
INDICATION AND
MECHANISM OF ADVERSE OR SIDE DESIRE ACTION TO
DRUG NAME CONTRAINDICATIO
ACTION EFFECT CLIENT
N

Monitor
Evidence of
increased
oxygen-carrying
capacity of
RBCs
Increased
hemoglobin and
hematocrit

Side effects
Toxicity
Anaphylaxis
Take medication
between meals
with orange
juice or vitamin
C supplement
 DRUG STUDY
INDICATION AND
MECHANISM OF ADVERSE OR SIDE DESIRE ACTION TO
DRUG NAME CONTRAINDICATIO
ACTION EFFECT CLIENT
N

Increases iron
absorption;
decreases
metallic taste
May take
medication with
food to
decrease

gastrointestinal
side effects
Avoid taking
medication with
dietary fiber,
eggs, milk,
coffee, or tea
 DRUG STUDY
INDICATION AND
MECHANISM OF ADVERSE OR SIDE DESIRE ACTION TO
DRUG NAME CONTRAINDICATIO
ACTION EFFECT CLIENT
N

Remain upright
for at least 30
minutes after
administration

Decreases
irritation to
esophagu
DRUG STUDY
DRUG STUDY
DRUG STUDY
DRUG STUDY
DRUG STUDY
DRUG STUDY
DRUG STUDY
DRUG STUDY
DRUG STUDY
DISCHARGE
PLANNING
THANKYOU!!!