1. Anemia
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2. Definition
Anemia is a reduction in RBCs
which in turn decreases the oxygen
carrying capacity of blood.
Anemia is not a specific
disease state but a sign of an
underlying disorder.
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3. Blood Components
 Red blood cells or erythrocytes appear as
biconcave discs averaging about 8 micro meter in
diam. This flexible shape allows RBCs to squeeze
through narrow capillaries which is 3 micrometer
wide. RED cells normally make up 40-50% of the
total blood volume. Hemoglobin inside RBCs
combine with oxygen to form oxyhemoglobin. The
red cells are produced continuously in our bone
marrow from stem cells at a rate of about 2-3
million cells per second. People who are anemic
generally have a deficiency in red cells.
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4. Leukocytes
 White cells, or leukocytes make up a very small part of
blood's volume normally only about 1% in healthy
people. They occur most notably in the spleen, liver, and
lymph glands. Most are produced in our bone marrow
from the same kind of stem cells that produce red blood
cells. Others are produced in the thymus gland, which is at
the base of the neck. Some white cells are the first
responders for our immune system. They seek out,
identify, and bind to protein on bacteria, viruses, and fungi
so that they can be removed. Other white cells (called
granulocytes and macrophages) then arrive to surround
and destroy the alien cells. Individual white cells usually
only last 18-36 hours before they are removed, though
some types live as much as a year.
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5. Platelets or thrombocytes, are cell fragments without nuclei
that work with blood clotting chemicals at the site of
wounds. They do this by adhering to the walls of blood
vessels, thereby plugging the rupture in the vascular
wall. They also can release coagulating chemicals which
cause clots to form in the blood that can plug up blood
vessels. Recent research has shown that platelets help fight
infections by releasing proteins that kill invading bacteria
and some other microorganisms. In addition, platelets
stimulate the immune system. Individual platelets are about
1/3 the size of red cells. They have a lifespan of 9-10
days. Like the red and white blood cells, platelets are
produced in bone marrow from stem cells
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6. Classification of anemia
1. Hypoproliferative (resulting from
defective production of Rbc)
 Iron deficiency
 Vitamin B12 deficiency
 Folate deficiency
 Decreased erythropoietin production
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7. 2. Bleeding disorders
(resulting from RBC loss)
 GI tract bleeding
 Menorrhagia
 Epistaxis
 Trauma
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8. 3.Hemolytic (resulting from RBC
destruction)
 RBC membrane abnormality
 Sickle cell anemia
 Trauma
 Altered erythropoiesis
 Hemolysis
 Drug induced anaemia
 Infection
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9. Iron deficiency anaemia
 Iron deficiency anaemia is caused by an
inadequate supply of iron needed to
synthesis hemoglobin.
 Associated with inadequate absorption
or excessive loss of iron.
 Bone marrow produces Rbc`s that are
deficient in hemoglobin concentration.
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10. Causes of iron deficiency
anaemia
 Acute & Chronic Bleeding
 Inadequate Intake of iron rich foods.
 Malabsorption syndrome
 Alcohol abuse (GI bleeding)
 Gastrectomy
 Pregnant women
 Menstruating women
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11. Clinical Manifestations
 Clients often appear pale, particularly of palm
lines,nailbeds,conjunctiva.
 Dry mucous membrane.
 Tissue hypoxia
 Fatigue
 Shortness of breath
 Dyspnea on exertion
 Palpitations
 Stomatitis
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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`S
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13. Medical management
 Monitoring vital signs
 Semifowlers position
 Oxygen therapy
 Diet: high in iron,protein,vitamin [spinach, red
meat,eggyolk,wheat products]
 Oral iron preparations-ferrous sulfate0.2g tid,
ferrous gluconate 0.3g bid.
 IV/IM administration iron dextran 100-
250mg/dl
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14. Aplastic Anaemia
 Failure of bone marrow to
produce adequate amount of
erythrocytes, leukocytes,
platelets.
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15. Causes of aplastic anaemia
 Idiopathic
 Exposure to chemicals causes bone marrow
failure
 Chemotherapy
 Radiation
 Drug induced:chloramphenicol
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16. Clinical Manifestations
 Fatigue
 Dyspnea
 Multiple infections
 Anorexia
 Pallor
 Palpitations
 Melena
 Epistaxis
Short-limbed dwarfism
with bowing, combined
immune deficiency,
and late onset aplastic
anemia.
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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 biopsy
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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 dextran.
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19. Pernicious Anemia
 Pernicious Anemia is a progressive anemia
caused by lack of intrinsic factor essential
for the absorption of vitamin B12
cobalamin.
 Lack of glycoprotein produced by parietal
cells of gastric lining.
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20. www.drjayeshpatidar.blogspot.in

21. Causes
 Deficiency of intrinsic factor
 Prolonged iron deficiency
 Malabsorption
 Poor administration of Vitamin B12 after
gastrectomy
 Bacterial /parasitic infections.
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22. Clinical Manifestations
 Weakness
 Pallor
 Sore mouth
 Glossitis
 Dyspepsia (indigestion)
 Anorexia
 Wt loss
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23. Sign&symptoms
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24. Diagnostic test
*Hematology
 Pbs
 Hb decreased.
 Erythrocyte count: blw 3 million/dl
* Bone marrow Biopsy
• Gastric analysis
• Schilling test
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25. Medical management
 Vitamin derivatives
 Cyanocobalamin 100mg IM 2-3 times / week
 Folic acid upto 1mg/day orally
 Ferrous agents
 Digestants
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26. Sickle cell Anemia
 Sickle cell Anemia is a severe hemolytic anemia
that results from inheritance of sickle Hb (HBS)
gene.
 This gene causes Hb molecule to be defective.
 The sickle Hb acquires a crystal like formation
when exposed to low oxygen tension.
 RBC containing HBS loses its round, pliable,
biconcave, disk shape & becomes deformed rigid
&sickle shaped.
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27. Characteristics of sickle cells
RBCS
 120 day life span
 Hb has normal oxygen
carrying capacity
 12-14 g/ml of Hb
SICKLED CELLS
 30-40 day life span
 Hb has decreased
oxygen carrying
capacity
 6-9 g/ml of Hb
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28. Clinical Manifestations
 CNS
 Hemorrhage
 Paralysis
 Sensory deficits
 CVS
 CHF
 Heart rate increased
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29. Cont…
 Pulmonary
 Atelectasis
 Infarction
 Pneumonia
 Pulmonary hypertension
 Resp rate increased
 GIT
 Acute hepatomegaly
 Spleenomegaly
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30. Cont…
 GU
 Hematuria
 Diuresis
 Musculoskeletal
 Painful swelling of hands & feet
 Ophthalmology
 Hemorrhage
 Blindness
 Retinopathy
 Dermatology
 Ulcers of hand &feet
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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 span.
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32. Medical management
 Hydroxyurea & erythropoietin increase fetal
Hb.
 Transfusion therapy
 Oxygen therapy
 Analgesics:morphine,meperidine
 Nutritional supplements
 Monitoring vital signs
 Genetic counselling.
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33. NURSING MANAGEMENT
IRON DEFICIENCY ANAEMIA
 Activity intolerance r/t decreased
blood supply or low Hb levels as
evidenced by fatigue,dyspnea,& pallor.
INTERVENTION
 Help client plan balance between rest &
activity to reduce cardiac workload.
 Monitor pulse, respiration to identify signs of
increased cardiopulmonary workload.
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34. cont..
 Encourage pt to discuss feelings r/t fatigue.
 A unit of packed rbc`s may be administered to
improve overall blood volume.
 The gauge of the needle used for transfusion
varies with the product being infused.(20 gauge)
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35. Cont..
 Imbalanced nutrition less than body
requirement r/t inadequate intake of essential
nutrients.
INTERVENTION
 Healthy diet
Provide soft food &nonirritating fluids to
decrease discomfort& irritation
 Frequent mouth care to remove secretions
Administer iron medication
Observe for difficulty in swallowing to
determine need for changes in diet.www.drjayeshpatidar.blogspot.in

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 to
prevent falls caused by weakness
 Use footboard to prevent pressure on lower
extremities.
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37. Nsg mgt
 Risk for impaired skin integrity r/t capillary
fragility.
 Observe skin colour, warmth, texture, moisture
 Proper hygiene to prevent irritation
 Maintain warm, clean envt to decrease
sensitivity to cold.
 Advise pt to prevent scratching to avoid
irritation & abrasion.
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38. Cont..
 Impaired gas exchange r/t inadequate count &
impaired functioning of erythrocytes.
 Provide bed rest
 Monitor vital signs
 Observe mood, behaviour to determine mental
status
 Monitor lab values to determine oxygenation
of blood.
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39. Cont..
Aplastic anemia
 Activity intolerance r/t inadequate tissue
oxygenation.
 Risk for infection r/t increased susceptibility.
• Observe for increase in temp, pulse, respiration.
sore. throat, anorexia
• Administer antibiotics
• Encourage deep breathing, turning,& increase
fluids.
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40. Nsg mgmt
Sickle cell anemia
 Impaired skin integrity r/t altered circulation to
tissues
 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 feedings
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41. Cont..
 Altered renal tissue perfusion r/t to cell
sickling
 Inspect for edema for signs of impaired
renal function.
 Measure wt I/O to assess renal status
 Observe urine for colour,content & odour
 Maintain fluid intake.
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42. Thankyou!
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