ANEMIA

PRESENTED TO :- PRESENTED BY :-
Mrs. Sunita Rani
ROLL NO. 1 TO 10
ASST. Prof.
CON . DMC&H
 INTRODUCTION

• Anemia is a medical condition in which red blood cell count or hemoglobin count is
less than the normal.
• It reflects the presence of fewer than the normal number of erythrocytes within the
circulation.
• As a result, the amount of oxygen delivered to body tissues is also diminished.
• Anemia is not a specific disease state but a sign of underlying disorder
• It is by far the most common hematologic condition.
• Anemia is typically defined as if hemoglobin level is less than -
o In men -13.5gm/100ml
o In women – 12.0 gm/100ml.
• Anemia may be the acute or chronic.
• Chronic anemia may develop slowly over a period of time with long term
illness such as diabetes ,CKD, cancer.
 CAUSES OF ANEMIA
Any process that can disrupt the normal life span of normal
red blood cell may cause anemia . Normal life span of a red
blood cell is typically around 120 days . Red blood cells are
made in the bone marrow.
ANEMIA classified into three broad etiologic categories:
1. Anemia caused by blood loss
2. Decreased or faulty production of RBC.
3. Increased destruction of RBC.
 RISK FACTORS
Blood loss from
Diet low in iron , surgery or an
vitamin, minerals injury.

Long term
Menstruation infections

Long term serious illnesses , such

as kidney disease , cancer ,diabetes.
PATHOPHYSIOLOGY
A decrease in hemoglobin concentration or the number of functional red blood
cells due to one or more of the following :
 Insufficient production of red blood cell by bone marrow.
 Defective synthesis of the red blood cells due to absence of essential factors .
 Increase loss of red blood cells caused by bleeding.

Transport of the oxygen is impaired . Hemoglobin is lacking or the number of the

red cells is too low to carry adequate oxygen to tissues and hypoxia develops .

ANEMIA
 CLINICAL MANIFESTATIONS
• Dyspnea , chest pain , muscle pain or cramping , tachycardia.
• Weakness , fatigue , general malaise
• Pallor of the skin and mucous membranes.
• Jaundice
• Brittle , ridged , concave nails and pica in patients with iron-
deficiency anemia.
 CLASSIFICATION OF ANEMIA

1)Hypoproliferative Anemia.
2)Hemorrhagic Anemia.
3)Hemolytic Anemia.
1. HYPOPROLIFERATIVE ANEMIA :- Anemias resulting from
defective or reduced red blood cells production. Hypoproliferative anemias
result from deficient erythropoietin or a diminished response to it . Its main
causes are metabolic and endocrine disorders.
o Iron Deficiency Anemia.
o Vitamin B12 Deficiency Anemia And Pernicious Anemia.
o Folic Acid (Folate) Deficiency Anemia.
o Aplastic Anemia.

2.HEMORRHAGIC ANEMIA:- It result from loss of red blood cells

or blood loss . Blood loss can also cause anemia – whether it’s because of
excessive bleeding due to injury , surgery etc..
o Acute Hemorrhagic Anemia.
o Chronic Hemorrhagic Anemia.
3. HEMOLYTIC ANEMIA ;- It resulting from excessive RBC destruction .Rarely
anemia is due to problem that cause the red blood cell to die or be destroyed
prematurely.
INHERITED HEMOLYTIC ANEMIAS
 Sickle cell anemias
 Thalassemias.
 Hereditary spherocytosis
 Hereditary elliptocytosis (ovalocytosis)
 Glucose-6-phosphate dehydrogenase (G6PD) deficiency.
 Pyruvate kinase deficiency.
ACQUIRED HEMOLYTIC ANEMIAS
 Immune hemolytic anemia
 Autoimmune hemolytic anemia.
 Alloimmune hemolytic anemia.
 Drug induced hemolytic anemia.
 Mechanical hemolytic anemia .
 Paroxysmal nocturnal hemoglobinuria.
 Non-immune hemolytic anemia caused by chemicals or toxins.
 IRON DEFICIENCY ANEMIA
• When the intake of dietary iron is inadequate for hemoglobin
synthesis .
• It is the most common type of anemia in all age groups.

CAUSES
o It is caused by an inadequate supply of iron needed to synthesize hemoglobin. Iron
is key part of hemoglobin, the oxygen carrying protein in blood . Blood normally
get iron through diet and by recycling iron from old red blood cells . Without iron
the blood cannot carry oxygen effectively. Oxygen is needed for every cell in body
to function normally.
o Iron deficiency anemia an be consequences of several factors including;
 Chronic blood loss.
 Insufficient iron in diet.
 Poor or impaired absorption of iron by the body.
 Periods of rapid growth.
 SIGNS AND SYMPTOMS

• Decreased serum iron level • Decreased Hb level

• Feeling of tiredness and fatigue • Sore tongue
• Lack of energy • Weakness
• Brittle nails • Restless leg syndrome
• Decreased apetite. • Angular cheilosis( mouth
• Dizziness or light headedness ulceration)
• Pale skin colour
ASSESSMENT AND DIAGNOSTIC METHODS
o Bone marrow aspiration.
o Lab values including serum ferritin levels ( indicates iron stones)
 Blood cell count ( hemoglobin , hematocrit , RBC count , MCV)
 Serum iron level
 Total iron binding capacity.
MEDICAL MANAGEMENT
• Search for the cause , which may be curable GI cancer or uterine fibroids.
• Test stool specimen for occult bloods .
• People aged 50 years or older should have periodic colonoscopy , endoscopy , or X-
RAY examination of GI tract to detect ulcerations , gastritis ,polyps ,or cancer
• Administer prescribed iron preparations ( oral ,IM, IV )
NURSING MANAGEMENT
 Administer IM or IV iron in some cases when oral iron is not absorbed , is poorly
tolerated , or is needed in large amounts.
 Administer a small test dose before IM injection to avoid risk of anaphylaxis.
 Advise patient to take iron supplements an hour before meals .
 Inform patient that iron salt changes stool to dark green or black.
 Advise patient to take liquid forms of iron through a straw, to rinse the mouth with
water and practice good oral hygiene after taking this medication.
 Teach preventive education , because iron deficiency anemia is common in
menstruation and pregnant woman.
 Educate patient regarding foods high in iron ( beans, leafy green vegetables ,raisins ,
molasses)
 Encourage patient to continue iron therapy for total therapy time , even when fatigue
is no longer present.
MEGALOBLASTIC ANEMIA
It is characterized by very large red blood cells . In addition to cells are being large , the
inner contents of each cells being large , the inner contents of cell are not completely
developed.
It is caused by deficiency of vitamin B12 or folic acid , identical bone marrow and
peripheral blood changes occur because both vitamins are essential for normal DNA
synthesis.
1. Folic acid deficiency
2. Vitamin B12 deficiency.
 PATHOPHYSIOLOGY
1. FOLIC ACID DEFICIENCY
Folic acid is stored as compounds referred to as folates . The folate stored in body are
much smaller than those of vitamin b12, and they are quickly depleted when the dietary
intake of folate is deficient. Folate deficiency occur in people who rarely eat uncooked
vegetables .
Alcohol increase folic acid requirements ; folic acid requirements also increased with
patients with chronic hemolytic anemia and in woman who are pregnant .
Same patient with malabsorbtive diseases of small bowel may not absorb folic acid
normally.
2. VITAMIN B12 DEFICIENCY
 A deficiency of vitamin B12 can occur in several ways .
 Inadequate dietary intake is rare but can develop in strict vegetarians who
consume no meat or dairy products.
 Faulty absorbtion of GI tract is more common , as with conditions such as
Crohn’s disease or after ileal resection or gastrectomy.
 Another cause is the absence of intrinsic factor.
 A deficiency may also occur if disease involving the ileum or pancreas impairs
absorption.
 The body normally has large stones of vitamin B12 , so years may pass before
the deficiency results in anemia.
 CLINICAL MANIFESTATIONS

• Weakness ,fatigue
• Possible development of
smooth ,sore ,red tongue
• Mild jaundice, vitiligo
• Confusion may occur
• Lack of neurological
manifestation with folic acid
deficiency alone
• Without treatment patient die,
usually as a result of heart failure
secondary to anemia.
ASSESSMENT AND DIAGNOSTIC
FINDINGS
 Schilling test ( primary diagnostic tool)
 Complete blood cell count
 Serum levels of folate and vitamin B12 ( folic acid deficiency
and deficient vitamin B12)
 MEDICAL MANAGEMENT
 FOLIC ACID DEFICIENCY:
• Increase intake of folic acid in patient’s diet and administer 1mg folic acid daily.
• Administer IM folic acid for malabsorption syndromes.
• Prescribe additional supplements , because the amount in multivitamins may be
inadequate to fully replace deficient body stones.
• Prescribe folic acid for patient with alcoholism as long they continue to consume
alcohol.

 Vitamin B12 deficiency

• Provide vitamin B12 replacement : vegetarians can prevent or treat deficiency with
oral supplements with vitamins or fortified soy milk.
• To prevent recurrence of pernicious anemia , vitamin B12 therapymust be continued for
life.
 NURSING MANAGEMENT
o Assess patient at risk for megaloblastic anemia for clinical manifestation ( eg.
Inspect the skin , sclera ,note vitiligo)
o Perform careful neurological assessment.
o Refer for physical and occupational therapy as needed.
o When sensation is altered , instruct patient to avoid excessive heat an cold.
o Explain that other nutritional deficiencies , such as alcohol induced anemia , can
induce neurological problems.
o Teach patient about chronicity of disorder and need for monthly vitamin B12
injections even when patient having no symptoms . Instruct patient how to self
administer injections , when appropriate.
 APLASTIC ANEMIA
 It is a rare and serious blood disorder which bone marrow stops making enough red
blood cells.
 This is because the bone marrow’s stem cells are damaged.
 It can develop suddenly or slowly.

Clinical manifestations;
• Fatigue
• Pallor
• Dyspnea
• Retinal hemorrhages
• Purpura
• Repeated throat infections with possible cervical lymphadenopathy.
 Assessment and diagnostic methods
• Diagnosis is made by a bone marrow aspirate that show an extremely
hypoplastic or even aplastic marrow replaced with fat.

Medical management
o Supportive therapy plays a major role in management of aplastic anemia .
Any offending agent is discontinued . The patient is supportive with
transfusions of PRBCs and platelets as necessary.
o The disease can be managed with immunosuppressive therapy , commonly
using a combination of antithymocyte globulin ( ATG) and cyclosporine or
androgens .
 Nursing management
 Assess patient carefully for signs of infection and bleeding.
 Monitor the side effects of therapy , particularly for hypersensitivity reaction while
administering ATG .
 Carefully assess each new prescription for drug-drug interactions , as the metabolism
of ATG is altered by other medications .
 Ensure that patient understand the importance of not abruptly stopping their
immunosuppressive therapy.
 HEMOLYTIC ANEMIA
SICKLE CELL ANEMIA
 It is inherited disease.
 It is severe hemolytic anemia resulting from the inheritance of sickle hemoglobin
(HbS) gene , which cause a defective hemoglobin molecule.

Clinical manifestations
 Anemia , with hemoglobin value in the range of 7 to 10 g/dl.
 Jaundice is characteristic , usually obvious in the sclera.
 Tachycardia , cardiac murmurs
 Dysrhythmias and heart failure may occur in adults .
 Severe pain in various parts of body.
Assessment and diagnostic methods
• The patient with sickle cell trait usually has a normal hemoglobin level , a normal
hematocrit and a normal blood smear.
• In contrast , the patient with sickle cell anemia has a low hematocrit level and sickle
cells on the smear.
• The diagnosis is confirmed by hemoglobin electrophoresis.

Medical management
 Pharmacological therapy : Hydroxyurea , a chemotherapy agent , has been
shown to be effective in increasing fetal hemoglobin level in patients with sickle
cell anemia.
 Transfusion therapy .
 Fluid restriction may beneficial. Corticosteroids may be useful.
 Folic acid is administered daily for increased marrow requirements .
 Supportive care involves pain management ( aspirin ,NSAIDs , morphine ), oral
or IV hydration , physical and occupational therapy , physiotherapy etc…
 NURSING PROCESS
The patient with anemia
ASSESSMENT
 Obtain a healthy history , perform a physical examination , and obtain lab values .
 Ask patient about extent and type of symptom experienced and impact on
symptoms on lifestyle ; medication history ; alcohol intake .
 Ask about family history of inherited anemias .
 Perform nutritional assessment
 Monitor relevant laboratory test results ,note changes .
 Assess cardiac status.
 Assess for GI function.
 Assess for neurological deficits .
DIAGNOSIS
 Fatigue related to decreased hemoglobin and diminished oxygen-carrying capacity
of he blood .
 Altered nutrition ,less than body requirements , related to inadequate intake of
essential nutrients.
 Altered tissue perfusion related to inadequate hemoglobin and hematocrit.
 Noncompliance with prescribed therapy.
Collaborative problems / potential complications
 Heart failure
 Angina
 Confusion
PLANNING AND GOALS
The major goal of the patient may include ;
 Decreased fatigue
 Maintenance of adequate nutrition
 Maintenance of adequate tissue perfusion
 Compliance with prescribed therapy.
 Absence of complications
 NURSING INTERVENTIONS
 Managing fatigue
 Assist patient to prioritize activities and establish a balance between activity and
rest .
 Encourage patient with chronic anemia to maintain physical activity and exercise
to prevent deconditioning .

 Maintaining adequate nutrition

 Encourage a healthy diet .
 Teach patient to avoid or limit intake of alcohol .
 Plan dietary teaching sessions for patient and family ; consider cultural
aspect of nutrition .
 Discuss nutritional supplements.
 Maintaining adequate perfusion
 Monitor vital signs , pulse oximetry closely .
 Administer supplemental oxygen , transfusions ad IV fluid as ordered .

 Promoting compliance with prescribed therapy

 Discuss with a patient the purpose of their medication , how to take the medication
and over what time period , how to manage any side effects
 Assist the patient ti incorporate the therapeutic plan into everyday activities ,
rather than merely giving the patient list of instructions .

 Monitoring and managing complications

 Assess patient with anemia for heart failure
 Perform a neurological assessment for patient with known or suspected
megaloblastic anemia.
 EVALUATION

Expected patient outcomes

 Reports less fatigue
 Attains and maintain adequate nutrition
 Maintains adequate perfusion
 Experiences no or minimal complications
SUMMARIZATION:-
 Introduction of Anemia
 Causes
 Risk factors
 Pathophysiology
 Clinical manifestation
 Classification of Anemia
 Hypoproliferative anemia
 Hemorrhagic anemia
 Hemolytic anemia
o Iron deficiency anemia
o Megaloblastic anemia
• Folic acid deficiency
• Vitamin b12 deficiency
o Aplastic anemia
o Sickle cell anemia
 Nursing process ( the patient with anemia)
 RECAPITULATION

1.What is anemia ?
2.Classify anemia?
3. Sickle cell anemia is inherited disease . ( true / false)
4.A serious blood disorder in which bone marrow stops making
enough red blood cells.
a)Megaloblastic anemia
b)Aplastic anemia
c)Sickle cell anemia.