ANAEMIA

I. Background of the condition

Anaemia is a condition in which the number of red blood cells or the haemoglobin

concentration within them is lower than normal. Haemoglobin is needed to carry oxygen and if

you have too few or abnormal red blood cells, or not enough haemoglobin, there will be a

decreased capacity of the blood to carry oxygen to the body’s tissues. 

Because of hemodilution and increasing needs of iron and other nutrients for both the

mother and the fetus, hemoglobin (Hb) levels decrease progressively in pregnancy,

whereas in the third trimester, hemoconcentration results in higher Hb levels.

Anaemia is an indicator of both poor nutrition and poor health. It is problematic on its own,

but it can also impact other global nutritional concerns such as stunting and wasting, low birth

weight and childhood overweight and obesity due to lack of energy to exercise. 

Anaemia is a serious global public health problem that particularly affects young children

and pregnant women. WHO estimates that 42% of children less than 5 years of age and 40% of

pregnant women worldwide are anaemic. 

Maternal anaemia is an important global health problem that affects about 500 million

women of reproductive age. Much is known about the consequences of anaemia during

pregnancy, including the increased risks of low birthweight, preterm birth, perinatal mortality,

and neonatal mortality. It also places the mother at increased risk of death during and after

childbirth.  Severe anaemia can lead to circulatory decompensation, increased cardiac output, an
increased risk of haemorrhage, and decreased ability to tolerate blood loss, leading to circulatory

shock and death.

II. Types/Kinds

Anemia of pregnancy

- During pregnancy, the volume of blood increases. This means more iron and vitamins

are needed to make more red blood cells. If you don't have enough iron, it can cause

anemia. It's not considered abnormal unless your red blood cell count falls too low.

Iron deficiency anemia

- is due to insufficient iron. Without enough iron, your body can't produce enough of a

substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result,

iron deficiency anemia may leave you tired and short of breath.

- You can usually correct iron deficiency anemia with iron supplementation. Sometimes

additional tests or treatments for iron deficiency anemia are necessary, especially if your

doctor suspects that you're bleeding internally.

Vitamin B12–deficiency anemia (cobalamin deficiency)

- a condition that develops when your body can't make enough healthy red blood cells

because it doesn't have enough vitamin B12. Your body needs vitamin B12 to make

healthy red blood cells, white blood cells, and platelets. You can get vitamin B12
 deficiency if you can’t absorb vitamin B12 due to problems with your gut or if you have

pernicious anemia, which makes it difficult to absorb vitamin B12 from your intestines.

Without enough vitamin B12, blood cells do not form properly inside your bone marrow,

the sponge-like tissue within your bones. These blood cells die sooner than normal,

leading to anemia.

Folate-deficiency anemia

- is the lack of folic acid in the blood. Folic acid is a B vitamin that helps your body make

red blood cells. If you don’t have enough red blood cells, you have anemia.

- Low levels of folic acid can cause megaloblastic anemia. With this condition, red blood

cells are larger than normal. There are fewer of these cells. They are also oval-shaped, not

round. Sometimes these red blood cells don’t live as long as normal red blood cells.

- Common in pregnant, this is because the developing baby needs more folic acid. Also,

the mother absorbs it more slowly. A lack of folate during pregnancy is linked to major

birth defects that affect the brain, spinal cord, and spine (neural tube defects).

III. Predisposing Factors/Causes

- Iron deficiency.

- Vitamin B12 deficiency.

- Folate deficiency.
 IV. Signs and symptoms/ Clinical Manifestations

 Fatigue.

 Cold.

 Shortness of breath.

Other symptoms include:

 Dizziness or weakness.

 Fast heartbeat.

 Headache.

 Pale, dry or easily bruised skin.

 Sore tongue.

 Unintended movement in the lower leg (restless legs syndrome).

V. Diagnostic Procedures

 Complete blood count 

- is one of the most common blood tests. It's often done as part of a routine checkup. This

test measures many different parts of your blood, including red blood cells, white blood

cells, and platelets. Red blood cell levels that are higher or lower than normal could be a

sign of anemia.

Ferritin test
 - Determines how much iron your body stores. If a ferritin test reveals that your blood

ferritin level is lower than normal, it indicates your body's iron stores are low and you

have iron deficiency. As a result, you could be anemic.

Reticulocyte count 

- Measures the number of immature red blood cells (reticulocytes) in your bone marrow. It

is also to find out if your bone marrow is producing enough red blood cells. This test is

one of many ways to diagnose and monitor conditions that affect your red blood cells.

VI. Medical/Surgical Management

- Nutritional supplements. Use of nutritional supplements should be appropriately taught to

the patient and the family because too much intake cannot improve anemia.

- Blood transfusion. Patients with acute blood loss or severe hemolysis may have

decreased tissue perfusion from decreased blood volume or reduced circulating

erythrocytes, so transfusion of blood would be necessary.

- Intravenous fluids. Intravenous fluids replace the lost volumes of blood or electrolytes to

restore them to normal levels.

 VII. Nursing Management

- Provide client and family teaching. Discuss using iron supplements and increasing dietary

sources of iron as indicated.

- Prepare for blood-typing and crossmatching, and for administering packed PBCs during

labor if the client has severe anemia.

- Provide support and management for clients with anemia

VIII. Nursing Diagnosis applied

- Fatigue related to Decreased hemoglobin and diminished oxygen-carrying capacity of the

blood.

- Knowledge deficit related to complexity of treatment

- Risk for infection related to bone marrow malfunction

- Risk for bleeding

- Activity Intolerance related to Imbalance between oxygen supply and demand

IX. Health teachings

- Eat foods high in folic acid, vitamin C and B-12

- Consistent iron supplement as ordered

- Increase fluid intake

- Take iron tablets on an empty stomach. If possible, take your iron tablets when your stomach

is empty.
- Don't take iron with antacids. Medications that immediately relieve heartburn symptoms can

interfere with the absorption of iron.

- Take iron tablets with vitamin C. Vitamin C improves the absorption of iron.