ANEMIA

Definition
• A decrease in the number of RBCs, the
quantity of Hgb, and/or the volume of
PRBCs (which is measured by Hct).
• It is not a disease, it is a symptom of a
disease or condition
• Can lead to tissue hypoxia
• How do you know if someone has
hypoxia?
 Etiologies
• Inadequate production of RBCs
• Premature or excessive destruction of
RBCs
• Acute or chronic blood loss
• Nutrition deficits
• Hereditary factors
• Chronic diseases
 Types of Anemias
 Hypoproliferative—Inadequate production of RBCs
 Iron deficiency, aplastic anemia, B-12 deficiency, folic acid
deficiency, renal dz, chronic inflammation, cancer,
chemotherapy induced

 Hemolytic—Increased RBC destruction (usually

hereditary)
 Thalassemia, G6PD

 Blood loss—Usually caused by trauma or an underlying

condition or disease—can be slow or fast
 Acute: injury, PUD
 Chronic: metorrhagia, colon cancer, PUD
 General Manifestations of Anemia
• Deficient oxygenation of tissues results in:
– Pallor
– Complaints of feeling cold
– Fatigue, shortness of breath
– Dizziness, headache, light-headedness,
slowing of thought processes, irritability,
restlessness, depression
– Increased cardiac workload manifested as
tachycardia, palpitations, chest pain, and even
CHF in those patients with weak myocardium.
 Specific Manifestations and Complications

• Glossitis, chelitis, spoon-shaped nails, petechiae, chronic

leg ulcers
• Tingling, numbness, confusion, ataxia
• Joint pain
• Mental retardation
• Hepatomegaly, splenomegaly
• Sudden hemorrhage, tachycardia, hypotension, murmurs,
angina
• Injury from falls (bone deformities, fractures, fainting)
 General Labs

• CBC (RBC and indices; H & H)

• Hgb electrophoresis (identifies abnormal forms
of hemoglobin)
• Serum iron
• Serum ferritin Iron deficiency
• Iron-binding capacity
• Microscopic analysis—tells size/shape/color
• Schilling test or serum gastrin—B-12 deficiency
• Bone marrow examination
 Microscopic Analysis
• Hemoglobin & Hematocrit
– Males—14-18 g/dL; 42-52%
– Females—12-16 g/dL; 37-47%
– NB—14-24; 44-64
– 2-6 mos 10-17; 35-50
• RBC (values are approximate):
– males 4-6
– females 4-5.5
– Newborns 5-7
– 2-6 months 3.5-5.5
 RBC Indices

– MCV—size
• Macrocytic (H): B12 or folic acid deficiency
• Microcytic (L): iron deficiency or Thalassemia
– MCH—average amount of Hgb in a cell
• Follows values for size
– MCHC—color (has to do with concentration)
• Hypochromic (L): iron deficiency or Thalassemia
• Normochromic (may read as H due to abnormal shape of
cell): hemolytic anemia
– RDW—has to do with identifying a wide variation of
sizes in the cells, indicating abnormal blood
conditions
 Treatments

• Depends on type of anemia identified

– Pharmacologic therapy—iron, folic acid, vitamin B-12
– Improved nutrition—eggs, red meat, dark green
leafies, dried fruit, fish, seafood, iron-fortified cereals
and grains, bean family
– Blood transfusions
– Transplants
 Nursing Assessment

• Ask about SOB, fatigue, weakness dizziness, syncope,

palpitations, bleeding, menstrual hx, meds, chronic
diseases, diet, ETOH and cigarettes
• Look at general appearance, skin color, VS, heart and
lung sounds, pulses, cap refill, abdominal tenderness,
pain, bleeding, bruising
 Nursing Diagnoses
• Activity Intolerance
• Altered Oral Mucous Membranes
• Self-Care Deficit
• Decreased Cardiac Output
• Fatigue
• Deficient fluid volume
• Impaired gas exchange
• Risk for injury
• Impaired physical mobility
• Ineffective tissue perfusion
• Imbalanced nutrition
 Nursing Management

• Direct general management toward addressing the cause

of anemia and replacing blood loss as needed to sustain
adequate oxygenation
• Promote optimal activity and protect from injury
• Reduce activities and stimuli that cause tachycardia and
increase cardiac output
• Provide for nutritional needs
• Provide teaching
 Client Education
 Organize activities with rest periods
 Identify situations that cause palpitations, dyspnea
 Explain the need to ensure adequate oxygenation
 Drink at least 2-3 liters of fluid a day
 Instruct the client to report signs of fluid retention,
paresthesias, poor coordination, ataxia and
confusion
 Discuss dietary requirements and meds
 Encourage a well balanced diet
 Advise the client to avoid alcoholic beverages and
spicy foods
 Explain the need for ongoing lab tests and treatment
 Specific Anemias
• Iron deficiency
• Vit B-12 deficiency
• Folic acid deficiency Hypoproliferative
• Anemia of chronic dz (renal, cancer,
inflammation)
• Aplastic
• Thalassemia Hemolytic
• Glucose-6-Phosphate Dehydrogenase Deficiency
(G6PD)
 Fe Deficiency

• Most common
• Usually from inadequate diet or blood loss
• Smooth, sore tongue
• Brittle nails
• Angular cheilosis
• Pica
• Low ferritin, microcytic RBCs
 Ferrous Sulfate
• Action: Replaces iron stores needed for RBC development, energy,
and O2 transport
• Dosage: po 750-1500 mg/d; IV 125 mg in 100 mL over 1h; requires
IV push test dose first.
• SE: Nausea, constipation, epigastric pain, black stools
• Nursing: If giving IV, give IVP test dose first to assess for reactions.
If giving IM, give Z-track in large muscle.
• Education: (Related to po route only) Take tabs whole, between
meals with juice. If upset occurs, take after meals. Do not take with
antacids or milk. Drink liquid through straw. Store in tight, light
resistant container. Stools will turn black. Do not substitute one type
with another. Take 1h before lying down. Eat iron-rich foods.