ANEMIA

Your company information

 DEFINITION

Anemia is defined as decrease in number

of red blood cells (RBCs) or less than the normal
quantity of hemoglobin in the blood.
TYPES
IRON DEFICIENCY ANEMIA

It is defined as the chronic, slow Progressive

decrease in circulating RBC’s. It is the most
common form of anemia
 CAUSES

• Chronic blood loss (internal bleeding)

• Increased use of iron (pregnancy)

• Decreased absorption of iron (mal absorption)

CLINICAL MANIFESTATIONS

• Tiredness
• Weakness
• Shortness of breath
• A fast heartbeat
• Glossitis
• Angular stomatitis
• Heavy menstrual bleeding
 DIAGNOSIS

• Hematology studies (Decreased Hb, HCT, iron &

increased total binding capacity)
• Peripheral blood smear (Microcytic &
hypochromic)
• Bone marrow Aspiration (absence of stainable
iron)
 MANAGEMENT

• Dietary changes & supplements, medicines, &

surgery.
• Severe iron-deficiency anemia may require
treatment in hospital, blood transfusions, iron
rejections, or intravenous iron therapy.
 APLASTIC ANEMIA

It defined as the failure of bone marrow to

produce adequate amounts of erythrocytes,
leukocytes & platelets
 CAUSES

• Damage to the bone marrow's stem cells

• Acquired diseases (HBsAg, EBV)

• Toxins(pesticides)

• Radiation & chemotherapy

• Medicines (chloramphenicol)

• Autoimmune disorders (lupus & rheumatoid arthritis)

CLINICAL MANIFESTATIONS
• Fatigue
• Shortness of breath
• Dizziness
• Headache
• Coldness in your hands or feet
• Pale skin, gums & nail beds
• Chest pains
• Purpura, Petechiae
• Ecchymosis
 DIAGNOSIS

• Peripheral blood smear (pancytopenia)

• Hematology studies (decreased granulocytes,

RBC’s, thrombocytes)
• Bone Marrow Biopsy (fatty marrow with
reduction of stem cells)
 MANAGEMENT

• Treatment for aplastic anaemia includes blood transfusions,

blood & marrow stem cell transplants, & medication.
• These treatments can prevent or limit complications, relieve
symptoms, & improve quality of life.
• Blood & marrow stem cell transplants may cure the disorder.

• Removing a known cause of aplastic anaemia, such as

exposure to a toxin, may also cure the condition.
 HEMOLYTIC ANEMIA

It is defined as destruction of red blood cells &

removed from blood stream before their normal life
span.
 CAUSES

• Thalassaemias

• Hereditary spherocytosis

• Hereditary elliptocytosis

• Glucose-6-phosphate dehydrogenase (G6PD) deficiency

• Pyruvate kinase deficiency

• Paroxysmal nocturnal haemoglobinuria

CLINICAL MANIFESTATIONS
• Shortness of breath
• Dizziness
• Headache
• Coldness in your hands or feet
• Pale skin
• Gums & nail Beds
• Chest pain.
• Jaundice
• Pain in the upper abdomen
• Leg ulcers & pain
• A severe reaction to a blood transfusion
 DIAGNOSIS

• Peripheral blood smear (increased reticulocyte

counts)
• Hematological studies (increased lactate
dehydrogenase, decreased haptoglobin level)
• Combs test (positive)
 MANAGEMENT

• Treatments for haemolytic anaemia include blood

transfusions, medicines, plasmapheresis, surgery, blood &
marrow stem cell transplants & lifestyle changes.
• People who have mild haemolytic anaemia may not need
treatment, as long as the condition doesn't worsen.
• People with severe haemolytic anaemia usually need ongoing
treatment.
 SICKEL CELL ANEMIA

It is as congenital hemolytic anemia resulting

from a defective Hb molecule that causes RBC’s to
roughen & become sickle shaped.
 CAUSES

• It is an inherited disorder – they are passed on from

parents to their children through genes
CLINICAL MANIFESTATIONS
• Fatigue

• Shortness of breath

• Dizziness

• Headache

• Coldness in the h&s & feet

• Pale skin

• Chest pain

• Sudden pain
 DIAGNOSIS

• Stained blood smear (shows sickle cells)

• Hematologic studies (low Hb, RBC’s, ESR,

elevated WBC’s, platelets)
• Lateral chest x-Ray (Lincoln log)
 MANAGEMENT

• Sickle cell anaemia has no widely-available cure, treatments

can help relieve symptoms & treat complications.
• The goals of treating sickle cell anaemia are to relieve pain,
prevent infections, eye damage & strokes, & control
complications.
• Bone marrow transplants may offer a cure in a small number
of sickle cell anaemia cases.
 PERNICIOUS ANEMIA

It is defined as the chronic, progressive

megaloblastic anemia caused by a deficiency of
intrinsic factor, which results in impaired absorption
of vitamin B12
 CAUSES

• A lack of intrinsic factor

• Inadequate dietary intake

• Bacterial or parasitic infections

• Poor absorption of vitamin B12

• Certain medicines

• Surgical removal of part of the small intestine

CLINICAL MANIFESTATIONS
 DIAGNOSIS

• Schilling Test (positive)

• Peripheral blood smear (oval, macrocytic,
hyperchromic)
• Bone marrow (increased megaloblasts, few
maturing erythrocytes)
• Blood Chemistry (increased biluribin, decreased
HCT, Hb
 MANAGEMENT
• Well balanced diet with increased food intake of vitamin B12.

• Frequent monitoring of laboratory studies such as Hb, HCT,

bilirubin.
• A Packed RBC’s will be transfused in case of very severe
conditions.
• Administration of oral vitamin agents such cyanocobalamin
(B12) and vitamins.
TYPES
MEDICAL MANAGEMENT
 ORAL IRON

• Mild to moderate iron-deficiency anemia is treated by oral iron

supplementation with ferrous sulfate, ferrous fumarate, or ferrous
gluconate.
• When taking iron supplements, stomach upset and/or darkening of
the feces are commonly experienced. The stomach upset can be
alleviated by taking the iron with food.
• Vitamin C aids in the body's ability to absorb iron, so taking oral
iron supplements with orange juice is of benefit.
 ORAL IRON

• Recombinant erythropoietin or epoetin alfa, to stimulate RBC

production, although since there is also concurrent iron deficiency
and inflammation present, parenteral iron is advised to be taken
concurrently.
 INJECTABLE IRON

• The body can absorb up to 6 mg iron daily from the gastrointestinal
tract.
• In many cases the patient has a deficit of over 1,000 mg of iron which
would require several months to replace.
• This can be given concurrently with erythropoietin to ensure sufficient
iron for increased rates of erythropoiesis

• Vitamin supplements given orally (folic acid or vitamin B12) or

intramuscularly (vitamin B12) will replace specific deficiencies.

 BLOOD TRANSFUSIONS

• Blood Transfusions are only recommended when the hemoglobin is

below 70 or 80 g/L.
 HYPERBARIC OXYGEN
THERAPY
• The use of HBO is indicated when oxygen delivery to tissue is not
sufficient in patients who cannot be given blood
transfusions for medical or religious reasons.
• HBO may be used for medical reasons when threat of blood
product incompatibility or concern for transmissible disease are
factors. 
HYPERBARIC OXYGEN
THERAPY
 ESA

• The motive for the administration of an erythropoiesis-stimulating

agent (ESA) is to maintain hemoglobin at the lowest level that both
minimizes transfusions and meets the individual persons needs.  
• They should not be used for mild or moderate anemia.  

• They are not recommended in people with chronic kidney

disease unless hemoglobin levels are less than 10 g/dL or they have
symptoms of anemia.
• Their use should be along with parenteral iron.
 NURSING MANAGEMENT

• Monitoring of vital signs and signs of bleeding.

• Administer I.V fluids and blood products.

• Administer oxygen therapy and monitor pulse Oximetery.

• Maintain the activity as tolerated, provide gentle mouth and skin care.

• Explain the home care instructions and care.

• Assess the patient for internal bleeding, hematuria, melena,

hematemesis, muscle hematomas.
 NURSING MANAGEMENT
• Assess the location & intensity of pain & medicate it.

• Stop bleeding by applying pressure to the bleeding site & using cold compress.

• Educate about the home care instructions such as wear joint & muscle splints
& orthopedics as prescribed.
• Comply with the activity restrictions & take the measure to avoid bleeding
episodes.
• Encourage turning, coughing & deep breathing exercises at periodic intervals.
 NURSING MANAGEMENT

• Assess the cardiovascular status, respiratory status & fluid balance.

• Provide mouth care before & after meals.

• Monitor the stools for occult blood.

• Monitor & record vital signs, intake output chart, urine & stool
studies.
• Fluid intake & output must be evaluated during hydration therapy to
avoid fluid overload & underehydration.
 NURSING MANAGEMENT

• Assessment of patient nutritional status in collaboration

with the dietitian, to offset the inadequate food intake that
can result from GI symptoms of fullness, pain & dyspepsia.
• Active or passive leg exercises & ambulation whenever
possible.
 NURSING DIAGNOSIS
• High risk of infection related to an inadequate secondary defenses
(decreased hemoglobin leucopenia, or a decrease in granulocytes
(inflammatory response depressed)).
• Changes in nutrition less than body requirement related to failure to
digest or inability to digest the food / nutrient absorption necessary
for the formation of red blood cells.
• Activity intolerance related to imbalance between oxygen supply
(delivery) and demand.
• Changes in tissue perfusion related to decreased cellular components
required for the delivery of oxygen / nutrients to the cells.
 NURSING DIAGNOSIS

• High risk of damage to skin integrity related to circulatory and

neurological changes.
• Constipation or diarrhea related to decreased dietary inputs; changes
in the digestive process; the side effects of drug therapy.
• Lack of knowledge in relation to the lack of exposure / recall;
incorrect interpretation of information; do not know the source of
information.