ANEMIA

Introduction

Anemia is one of the most underdiagnosed conditions and, if left untreated, can have many serious implications such as cardiovascular disease and compromised immune functions

Introduction

According to WHO estimates, India is one of the countries in the world that has highest prevalence of anemia.

The bliss of motherhood thrives under the looming presence of anemia in India.

Definition

Anaemia ( from Greek word anaimia, meaning lack of blood)

is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood.

Definition

Men

• Hb < 13.5 gm/100ml

Women

• Hb < 12.0 gm/100ml

Anemia cases in India on rise: NFHS 3 report

Adolescence in India goes hand in hand with iron-deficiency anemia, medically known as IDA

While 56 % of adolescent girls are anemic, boys too are falling prey to the disease. Around 30 % of adolescent boys are suffering from anemia.

The Hb count in most of the adolescent girls in India is less than the standard 12 g/decilitre, the standard accepted worldwide.

the disease troubles 59 % cases of pregnancy while 63 %of lactating women are anemic. States like Bihar and Rajasthan register 60 % of pregnant women to be anemic.

Shall we learn some basics about our blood cells?

Red blood cell

cytoplasm is rich in Hb

mature red blood cells are flexible biconcave disks that lack a cell nucleus

2.4 million new erythrocytes are produced per second.

develop in the bone marrow and circulate for about 100–120 days in the body before their components are recycled by macrophages.

RBCwomen have about 4 to 5 million erythrocytes per microliter (cubic millimeter) of blood and

men about 5 to 6 million;

people living at high altitudes with low oxygen tension will have more

Each RBC contains approx. 270 million of Hb biomolecules, each carrying 4 heme groups.

RBCs of an average adult human male store collectively about 2.5 grams of iron, representing about 65% of the total iron contained in the body

RBC

RBC

Just for GK……..

Do u know????

The only known vertebrates without RBC are the crocodile

icefishes .They live in very oxygen rich

cold water and transport oxygen freely dissolved in their

blood.

RBC production

Immature RBC

about 1% of the red cells

develop and mature in the red bone marrow

then circulate for about a day in the blood stream before developing into mature red blood cells.

do not have a cell nucleus.

Reticulocytes

MCVmeasure of the average RBC size

allows classification

10 x HCT (%) ───────────────

RBC count (millions/mm3)..

MCV

MCVThe normal range for MCV

80-99 fL.

Mean corpuscular hemoglobin concentration

(MCHC)measure of the concentration of Hb in a given volume of packed RBCs.

32 to 36 g/dl

MCHCHb

────HCT

Mean corpuscular hemoglobinMCH

mean cell Hb

average mass of hemoglobin per red blood cell

MCH = Hb / RBC

27 to 31 picograms/cell

Anemia is actually a sign of a disease process rather than a disease itself

The burden of anemia among women in India

M E Bentley and P L GriffithsObjective: to investigate the prevalence and determinants of anemia among women in Andhra Pradesh.

Subjects:A total of 4032 ever-married women aged 15–49 from 3872 households.

Results:In all 32.4% of women had mild ,14.19% had moderate , and 2.2% had severe anemia . Protective factors include Muslim religion, reported consumption of alcohol or pulses, and high socioeconomic status, particularly in urban areas. Poor urban women had the highest rates and odds of being anemic. Fifty-two percent of thin, 50% of normal BMI, and 41% of overweight women were anemic.

Conclusion:New program strategies are needed, particularly those that improve the overall nutrition status of women of reproductive ages. This will require tailored programs across socio-economic groups and within both rural and urban areas, but particularly among the urban and rural poor.

Causes

Causes

• Iron deficiency anemia

• Anemia of chronic disease

• Anemia from active bleeding

Anemia related to pregnancyAnemia related to poor nutritionPernicious AnemiaSickle cell anemia:Thalassemia

AlcoholismBone marrow-related anemiaAplastic anemiaHemolytic anemiaAnemia related to medications

Classification

Acute

Chronic

ClassificationIf the cells are smaller than normal (under 80 fl), the anemia is said to be microcytic;

if they are normal size (80–100 fl), normocytic;

if they are larger than normal (over 100 fl), the anemia is classified as macrocytic.

Microcytic anemia

Heme synthesis defect • IDA• Chronic

diseases

Globin synthesis defect • alpha-, and

beta-thalassemia

• HbE syndrome• HbC syndrome• various other

unstable Hb diseases

Sideroblastic defect• Hereditary

sideroblastic • Acquired

sideroblastic • Reversible

sideroblastic

Iron deficiency anemia Iron is an essential part of Hb

low iron levels result in decreased incorporation of hemoglobin into red blood cells

hypochromic (paler than usual) and microcytic (smaller than usual)

Causes insufficient dietary intake absorption of Iron losses due to diseases.bleeding lesions of the gastrointestinal tractparasitic infestation

Anemia of chronic diseases

Any long-term medical condition .

The exact mechanism of this process in unknown,

chronic infection or a cancer

people with chronic (long-standing) kidney disease.

Anemia of chronic diseases

crohn’s disease SLE rheumatoi

d arthritis,

ulcerative colitis

Cancer Long-term infections,

Liver cirrhosis CKD

Thalassemia

ThalassemiaMajor

Intermedia

Minor

Macrocytic anemia

Megaloblastic anemia, the most common cause of macrocytic anemia

due to a deficiency of either vitamin B12, folic acid (or both).

Causes gastric bypass surgery Hypothyroidism Alcoholism Drugs that affect DNA Leukemia The anticonvulsant drug dilantin

Normocytic anemia

overall hemoglobin levels are decreased,

but the red blood cell size(MCV) remains normal.

Causes Acute blood loss Anemia of chronic disease Hemolytic anemia Aplastic anemia

Aplastic anemiadecrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat.

It results in bone marrow aplasia (markedly reduced hematopoiesis)

CAUSES

congenital or acquired

Idiopathic

Infections and pregnancy

certain medications, chemicals,

or radiation damage

Substances Associated With Aplastic Anemia

Analgesics

Antiseizure agents (mephenytoin, triethadione*)

Antihistamines

Antimicrobials*

Antineoplastic agents (alkylating agents, antitumor antibiotics,

antimetabolites)

Antithyroid medications

Benzene*

Chloramphenicol*

Gold compounds*

Heavy metals

Hypoglycemic agents

Insecticides

Organic arsenicals*

Phenylbutazone*

Phenothiazines

Sulfonamides*

Sedatives

Hyperanemia

severe form of anemia

hematocrit is below 10%

Refractory anemia

not respond to treatment.

often seen secondary to myelodysplastic syndromes.

Sickle cell anemiaautosomal recessive

RBC that assume an abnormal, rigid, sickle shape

Sickling decreases the cells' flexibility and results in a risk of various complications.

The sickling occurs because of a mutation in the hemoglobin gene

Sickle cell anemia

WHO Grading of anemia

Grade 1 (Mild Anemia): 10 g/dl

Grade 2 (Moderate Anemia): 7-10 g/dl

Grade 3 (Severe Anemia): below 7 g/dl

Koilonychia

Angular cheilitis

Splenomegaly

Pica

Pallor

Anemic eyes

ANEMIA SYMPTOMS

Anemic woman

the signs that may indicate anemia

Change in stool color

rapid heart rate

low blood pressure

rapid breathing

pale or cold skin

yellow skin called jaundice if anemia is due to red blood cell breakdown

heart murmur

enlargement of the spleen with certain causes of anemia

Anemia Diagnosis

complete blood count.

thorough evaluation of the patient

Physical examination and medical history

Lab tests for anemia

1.CBC

2.Stool hemoglobin test

3.Peripheral blood smear

4.Iron level

5.Transferrin level

6.Ferritin

7.Folate

8.Vitamin B12

9.Bilirubin

10.Lead level

11.Hemoglobin

electrophoresis

12.Reticulocyte count

13.LFT

14.RFT

15.Bone marrow biopsy

cause and the severity

iron supplements

investigations

hospitalization and transfusion of red blood cells

Medications

Iron

Vitamin supplements

epoetin alfa (Procrit or Epogen) injection

Stopping a medication that may be the cause of anemia

Anemia Prevention

eating a healthy diet and limiting alcohol use.

seeing a doctor regularly and when problems arise

routine blood work

Anemia Prognosis

cause of the anemia and how severe it is

age

makes almost any medical problem worse

NURSING PROCESS:

Assessment

NURSING DIAGNOSES

Activity intolerance related to weakness, fatigue, and general malaise

Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients

Ineffective tissue perfusion related to inadequate blood volume or HCT

Noncompliance with prescribed therapy

Nursing Interventions

MANAGING FATIGUE

Assist the patient to prioritize activities and to establish a balance between activity and rest that is realistic and feasible from the patient’s perspective.

Patients with chronic anemia need to maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.

Nursing Interventions

MAINTAINING ADEQUATE NUTRITION

A healthy diet should be encouraged.

Because alcohol interferes with the utilization of essential nutrients, the nurse should advise the patient to avoid alcoholic beverages or to limit their intake and should provide the rationale for this recommendation.

Dietary teaching sessions should be individualized, including cultural aspects related to food preferences and food preparation.

Nursing Interventions

MAINTAINING ADEQUATE PERFUSION

Lost volume is replaced with transfusions or intravenous fluids, based on the symptoms and the laboratory findings.

Supplemental oxygen may be necessary, but it is rarely needed on a long-term basis unless there is underlying severe cardiac or pulmonary disease as well.

The nurse monitors vital signs closely;

other medications, such as antihypertensive agents, may need to be adjusted or withheld.

Nursing Interventions

PROMOTING COMPLIANCE WITH PRESCRIBED THERAPY

Patients need to understand the purpose of the medication, how to take the medication and over what time period, and how to manage any side effects of therapy.

To enhance compliance, the nurse can assist patients in developing ways to incorporate the therapeutic plan into their lives, rather than merely giving the patient a list of instructions.

PATIENT EDUCATIONTaking Iron Supplements

Take iron on an empty stomach (1 hour before or 2 hours after a meal).

Start with only one tablet per day for a few days, then increase to two tablets per day, then three tablets per day

Increase the intake of vitamin C (citrus fruits and juices, strawberries,tomatoes, broccoli), to enhance iron absorption.

Eat foods high in fiber to minimize problems with constipation.

Remember that stools will become dark in color.

Nursing Interventions

MONITORING AND MANAGING POTENTIAL COMPLICATIONS

assessfor signs and symptoms of heart failure.

A serial record of body weights can be more useful than a record of dietary intake and output, because the intake and output measurements may not be accurate.

In the case of fluid retention resulting from congestive heart failure, diuretics may be required.

In megaloblastic forms of anemia, the significant potential complications are neurologic.

A neurologic assessment should be performed for patients with known or suspected megaloblastic anemia.

Nursing Interventions

Measure temperature of bath water with thermometer because anemia may cause poor circulation.

Provide blankets and warm clothing to increase comfort and aid circulation.

Notify physician if excessive vomiting, coughing or straining at stools occurs so that medication can be prescribed to alleviate symptom.

Avoid aspirin-containing products to prevent bleeding.

Avoid forceful blowing.

Nursing Interventions

Avoid contact on gingival when brushing and flossing teeth.

Avoid situations in which trauma may occur, such as shaving with straight-edge razor, ambulating after taking medication that may cause orthostasis, or using sharp utensils

Avoid purseful sexual intercourse and use adequate lubrication.

Nursing Interventions

Use of stool softeners or laxative to avoid PRN to avoid straining.

Ascorbic acid (Vitamin C) promotes iron absorption, thus iron preparations should be taken with orange juice.

Bowel movements will be black from excess iron excretion.

Iron supplements usually given for at least 6 months to restore body stores.

Nursing interventions Keep skin clean and bedclothes dry.

Encourage diet high in protein, vitamins, and minerals.

Encourage cool, bland foods; flavored ices and ice cream are well tolerated.

Monitor Hb/Hct and assess whether other factors (e.g., nutritional deficiencies, fluid and electrolyte disorders, depression, etc.) are contributing to symptomatology.

Assess activity schedule and suggest daily activities that allow for rest periods.

Transfuse whole blood and packed red blood cells as ordered by physician.

Nursing interventions Avoid rectal thermometers, suppositories, and enemas.

Avoid heating pads or hot water bottles.

Iron salts are gastric irritants and should always be taken following meals.

Iron preparation taken on empty stomach cause dyspepsia, abdominal discomfort, and diarrhea

Liquid iron preparations should be well diluted and taken through a straw (undiluted liquid iron stains teeth).