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
According to WHO estimates, India is one of the
countries in the world that has highest prevalence of
The bliss of motherhood thrives under the looming
presence of anemia in India.
Anaemia ( from Greek word anaimia, meaning lack
is a decrease in number of red blood cells (RBCs) or
less than the normal quantity of hemoglobin in the
•Hb < 13.5 gm/100ml
•Hb < 12.0 gm/100ml
Anemia cases in India on rise: NFHS 3
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
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.
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
develop in the bone marrow and circulate for about
100–120 days in the body before their components
are recycled by macrophages.
women 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
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.
measure of the average RBC size
10 x HCT (%)
Mean corpuscular hemoglobin concentration
measure of the concentration of Hb in a given
volume of packed RBCs.
32 to 36 g/dl
Mean corpuscular hemoglobin
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 Bentleyand P L Griffiths
Objective: 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
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.
• Iron deficiency
• Anemia of chronic
• Anemia from active
Anemia related to
Anemia related to
Sickle cell anemia:
Anemia related to
If 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.
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)
insufficient dietary intake
absorption of Iron
losses due to diseases.
bleeding lesions of the gastrointestinal tract
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
Megaloblastic anemia, the most common cause of
due to a deficiency of either vitamin B12, folic acid (or
gastric bypass surgery
Drugs that affect DNA
The anticonvulsant drug dilantin
overall hemoglobin levels are decreased,
but the red blood cell size(MCV) remains normal.
Acute blood loss
Anemia of chronic disease
decrease 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
congenital or acquired
Infections and pregnancy
certain medications, chemicals,
or radiation damage
severe form of anemia
hematocrit is below 10%
not respond to treatment.
often seen secondary to myelodysplastic syndromes.
Sickle cell anemia
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
the signs that may indicate anemia
Change in stool color
rapid heart rate
low blood pressure
pale or cold skin
yellow skin called jaundice if anemia is due to red blood
enlargement of the spleen with certain causes of anemia
complete blood count.
thorough evaluation of the patient
Physical examination and medical history
Activity intolerance related to weakness, fatigue, and
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
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.
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
Dietary teaching sessions should be individualized,
including cultural aspects related to food preferences
and food preparation.
MAINTAINING ADEQUATE PERFUSION
Lost volume is replaced with transfusions or intravenous
fluids, based on the symptoms and the laboratory
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.
PROMOTING COMPLIANCE WITH PRESCRIBED
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
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.
Taking 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
Eat foods high in fiber to minimize problems with
Remember that stools will become dark in color.
MONITORING AND MANAGING POTENTIAL
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.
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
Avoid forceful blowing.
Avoid contact on gingival when brushing and flossing
Avoid situations in which trauma may occur, such as
shaving with straight-edge razor, ambulating after
taking medication that may cause orthostasis, or using
Avoid purseful sexual intercourse and use adequate
Use of stool softeners or laxative to avoid PRN to
Ascorbic acid (Vitamin C) promotes iron absorption,
thus iron preparations should be taken with orange
Bowel movements will be black from excess iron
Iron supplements usually given for at least 6 months
to restore body stores.
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.
Avoid rectal thermometers, suppositories, and
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