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  1. 1.
  2. 2. DefinitionAnemia is a reduction in RBCswhich in turn decreases the oxygencarrying capacity of blood.Anemia is not a specificdisease state but a sign of anunderlying
  3. 3. Blood Components Red blood cells or erythrocytes appear asbiconcave discs averaging about 8 micro meter indiam. This flexible shape allows RBCs to squeezethrough narrow capillaries which is 3 micrometerwide. RED cells normally make up 40-50% of thetotal blood volume. Hemoglobin inside RBCscombine with oxygen to form oxyhemoglobin. Thered cells are produced continuously in our bonemarrow from stem cells at a rate of about 2-3million cells per second. People who are anemicgenerally have a deficiency in red
  4. 4. Leukocytes White cells, or leukocytes make up a very small part ofbloods volume normally only about 1% in healthypeople. They occur most notably in the spleen, liver, andlymph glands. Most are produced in our bone marrowfrom the same kind of stem cells that produce red bloodcells. Others are produced in the thymus gland, which is atthe base of the neck. Some white cells are the firstresponders for our immune system. They seek out,identify, and bind to protein on bacteria, viruses, and fungiso that they can be removed. Other white cells (calledgranulocytes and macrophages) then arrive to surroundand destroy the alien cells. Individual white cells usuallyonly last 18-36 hours before they are removed, thoughsome types live as much as a
  5. 5. Platelets or thrombocytes, are cell fragments without nucleithat work with blood clotting chemicals at the site ofwounds. They do this by adhering to the walls of bloodvessels, thereby plugging the rupture in the vascularwall. They also can release coagulating chemicals whichcause clots to form in the blood that can plug up bloodvessels. Recent research has shown that platelets help fightinfections by releasing proteins that kill invading bacteriaand some other microorganisms. In addition, plateletsstimulate the immune system. Individual platelets are about1/3 the size of red cells. They have a lifespan of 9-10days. Like the red and white blood cells, platelets areproduced in bone marrow from stem
  6. 6. Classification of anemia1. Hypoproliferative (resulting fromdefective production of Rbc) Iron deficiency Vitamin B12 deficiency Folate deficiency Decreased erythropoietin
  7. 7. 2. Bleeding disorders(resulting from RBC loss) GI tract bleeding Menorrhagia Epistaxis
  8. 8. 3.Hemolytic (resulting from RBCdestruction) RBC membrane abnormality Sickle cell anemia Trauma Altered erythropoiesis Hemolysis Drug induced anaemia
  9. 9. Iron deficiency anaemia Iron deficiency anaemia is caused by aninadequate supply of iron needed tosynthesis hemoglobin. Associated with inadequate absorptionor excessive loss of iron. Bone marrow produces Rbc`s that aredeficient in hemoglobin
  10. 10. Causes of iron deficiencyanaemia Acute & Chronic Bleeding Inadequate Intake of iron rich foods. Malabsorption syndrome Alcohol abuse (GI bleeding) Gastrectomy Pregnant women Menstruating
  11. 11. Clinical Manifestations Clients often appear pale, particularly of palmlines,nailbeds,conjunctiva. Dry mucous membrane. Tissue hypoxia Fatigue Shortness of breath Dyspnea on exertion Palpitations
  12. 12. Diagnostic tests: Hematology# Hb level: as low as 3.6gm/dl# Total erythrocyte count : below 3 million cells/dl# MCHC:20-30gm/dl# Serum iron level: as low as 10mg/dl#Iron binding capacity:350-500mg/dl Peripheral blood smear# Microcytic &hypochromic RBC`
  13. 13. Medical management Monitoring vital signs Semifowlers position Oxygen therapy Diet: high in iron,protein,vitamin [spinach, redmeat,eggyolk,wheat products] Oral iron preparations-ferrous sulfate0.2g tid,ferrous gluconate 0.3g bid. IV/IM administration iron dextran 100-250mg/
  14. 14. Aplastic Anaemia Failure of bone marrow toproduce adequate amount oferythrocytes, leukocytes,
  15. 15. Causes of aplastic anaemia Idiopathic Exposure to chemicals causes bone marrowfailure Chemotherapy Radiation Drug
  16. 16. Clinical Manifestations Fatigue Dyspnea Multiple infections Anorexia Pallor Palpitations Melena EpistaxisShort-limbed dwarfismwith bowing, combinedimmune deficiency,and late onset
  17. 17. Diagnostic test*Hematology: Peripheral blood Smear:pancytopenia. Erythrocyte count less than 1 million/mm2 Leukocyte count less than 2000/mm3 Total iron binding capacity :slightly reduced Platelet count 30,000-15,000/mm3*Fecal occult blood: positive*Urine chemistry: hematuria*Bone marrow
  18. 18. Medical management Monitoring vital signs Semi fowlers position Oxygen therapy Transfusion therapy: platelets & RBCs Antibiotics: penicillin. Analgesics Diet high protein, high calorie . Ferrous sulfate& iron
  19. 19. Pernicious Anemia Pernicious Anemia is a progressive anemiacaused by lack of intrinsic factor essentialfor the absorption of vitamin B12cobalamin. Lack of glycoprotein produced by parietalcells of gastric
  20. 20.
  21. 21. Causes Deficiency of intrinsic factor Prolonged iron deficiency Malabsorption Poor administration of Vitamin B12 aftergastrectomy Bacterial /parasitic
  22. 22. Clinical Manifestations Weakness Pallor Sore mouth Glossitis Dyspepsia (indigestion) Anorexia Wt
  23. 23. Sign&
  24. 24. Diagnostic test*Hematology Pbs Hb decreased. Erythrocyte count: blw 3 million/dl* Bone marrow Biopsy• Gastric analysis• Schilling
  25. 25. Medical management Vitamin derivatives Cyanocobalamin 100mg IM 2-3 times / week Folic acid upto 1mg/day orally Ferrous agents
  26. 26. Sickle cell Anemia Sickle cell Anemia is a severe hemolytic anemiathat results from inheritance of sickle Hb (HBS)gene. This gene causes Hb molecule to be defective. The sickle Hb acquires a crystal like formationwhen exposed to low oxygen tension. RBC containing HBS loses its round, pliable,biconcave, disk shape & becomes deformed rigid&sickle
  27. 27. Characteristics of sickle cellsRBCS 120 day life span Hb has normal oxygencarrying capacity 12-14 g/ml of HbSICKLED CELLS 30-40 day life span Hb has decreasedoxygen carryingcapacity 6-9 g/ml of
  28. 28. Clinical Manifestations CNS Hemorrhage Paralysis Sensory deficits CVS CHF Heart rate
  29. 29. Cont… Pulmonary Atelectasis Infarction Pneumonia Pulmonary hypertension Resp rate increased GIT Acute hepatomegaly
  30. 30. Cont… GU Hematuria Diuresis Musculoskeletal Painful swelling of hands & feet Ophthalmology Hemorrhage Blindness Retinopathy Dermatology Ulcers of hand &
  31. 31. Diagnostic test Stained blood smear- sickle cell observed Sickle turbidity tube test:Pts blood is mixed with sickledex solution,turbid solution indicates presence of HBS Hb electrophoresis Erythrocyte life
  32. 32. Medical management Hydroxyurea & erythropoietin increase fetalHb. Transfusion therapy Oxygen therapy Analgesics:morphine,meperidine Nutritional supplements Monitoring vital signs Genetic
  33. 33. NURSING MANAGEMENTIRON DEFICIENCY ANAEMIA Activity intolerance r/t decreasedblood supply or low Hb levels asevidenced by fatigue,dyspnea,& pallor.INTERVENTION Help client plan balance between rest &activity to reduce cardiac workload. Monitor pulse, respiration to identify signs ofincreased cardiopulmonary
  34. 34. cont.. Encourage pt to discuss feelings r/t fatigue. A unit of packed rbc`s may be administered toimprove overall blood volume. The gauge of the needle used for transfusionvaries with the product being infused.(20 gauge)
  35. 35. Cont.. Imbalanced nutrition less than bodyrequirement r/t inadequate intake of essentialnutrients.INTERVENTION Healthy dietProvide soft food &nonirritating fluids todecrease discomfort& irritation Frequent mouth care to remove secretionsAdminister iron medicationObserve for difficulty in swallowing todetermine need for changes in
  36. 36. Cont..Pernicious anemia Risk for injury r/t sensory & motor losses,alteration in mental status.INTERVENTION Assist with ambulation to avoid falls. Use bed rest with side rails up as needed toprevent falls caused by weakness Use footboard to prevent pressure on
  37. 37. Nsg mgt Risk for impaired skin integrity r/t capillaryfragility. Observe skin colour, warmth, texture, moisture Proper hygiene to prevent irritation Maintain warm, clean envt to decreasesensitivity to cold. Advise pt to prevent scratching to avoidirritation &
  38. 38. Cont.. Impaired gas exchange r/t inadequate count &impaired functioning of erythrocytes. Provide bed rest Monitor vital signs Observe mood, behaviour to determine mentalstatus Monitor lab values to determine oxygenationof
  39. 39. Cont..Aplastic anemia Activity intolerance r/t inadequate tissueoxygenation. Risk for infection r/t increased susceptibility.• Observe for increase in temp, pulse, respiration.sore. throat, anorexia• Administer antibiotics• Encourage deep breathing, turning,&
  40. 40. Nsg mgmtSickle cell anemia Impaired skin integrity r/t altered circulation totissues Risk for injury r/t joint swelling & fragility. Pain r/t increased intra abdominal pressure &discomfort. Position pt in sitting position& change position Remove constrictive clothing Give frequent& small
  41. 41. Cont.. Altered renal tissue perfusion r/t to cellsickling Inspect for edema for signs of impairedrenal function. Measure wt I/O to assess renal status Observe urine for colour,content & odour Maintain fluid
  42. 42. Thankyou!