The document discusses different types of anemia including iron deficiency, vitamin B12 and folate deficiency, chronic disease, and hemolytic anemias. It provides definitions, causes, signs and symptoms, diagnostic evaluations, and medical and nursing management approaches for various forms of anemia. The nursing management focuses on assessing and addressing fatigue, maintaining adequate nutrition and tissue perfusion, and monitoring for complications related to anemia.

1. Mr. HIREN GEHLOTH
JG COLLEGE OF NURSING

2. • Anemia is a major killer in India.
• Statistics reveal that every second Indian woman is anemic
• One in every five maternal deaths is directly due to anemia.
• Anemia affects both adults and children of both sexes, although pregnant
women and adolescent girls are most susceptible and most affected by this
disease.
INTODUCTION

3. ‘’Anemia is a condition in which the hemoglobin
concentration is lower than normal; it reflects the presence of
fewer than the normal number of erythrocytes within the
circulation.’’
As a result, the amount of oxygen delivered
to body tissues is also diminished.
Anemia is not a specific disease state
but a sign of an underlying disorder.
It is by far the most common hematologic
condition.
DEFINITION

10. • Iron Deficiency Anemia:
• Iron deficiency anemia typically results when the intake of dietary iron is
inadequate for hemoglobin synthesis.
• The most common cause of iron deficiency anemia in men and
postmenopausal women is bleeding from ulcers, gastritis, inflammatory
bowel disease, or GI tumors.
• The most common causes of iron deficiency anemia in premenopausal
women are menorrhagia (ie, excessive menstrual bleeding) and pregnancy
with inadequate iron supplementation.
• Patients with chronic alcoholism often have chronic blood loss from the GI
tract, which causes iron loss and eventual anemia. Other causes include iron
malabsorption, as is seen after gastrectomy or with celiac disease.

11. • Anemia of Chronic Disease
• The term anemia of chronic disease is a misnomer in that only
the chronic diseases of inflammation, infection, and
malignancy cause this type of anemia.
• Many chronic inflammatory diseases are associated with a
normochromic, normocytic anemia (ie, the erythrocytes are
normal in color and size).

12. • Aplastic Anemia:
• Aplastic anemia is a rare disease caused by a decrease in or
damage to marrow stem cells, damage to the microenvironment
within the marrow, and replacement of the marrow with fat.
• The precise etiology is unknown, but it is hypothesized that the
body’s T cells mediate an inappropriate attack against the bone
marrow resulting in bone marrow aplasia (ie, markedly reduced
hematopoiesis). Therefore, in addition to severe anemia,
significant neutropenia and thrombocytopenia (ie, a deficiency
of platelets) also occur.

13. • Megaloblastic Anemia:
• In the anemias caused by deficiencies of vitamin B12 or folic acid,
identical bone marrow and peripheral blood changes occur because
both vitamins are essential for normal DNA synthesis. In either
anemia, the erythrocytes that are produced are abnormally large and
are called megaloblastic red cells.
Folic Acid Deficiency
The folate stores in the body are much smaller than those of vitamin
B12, and they are quickly depleted when the dietary intake of folate is
deficient (within 4 months). Folate is found in green vegetables and
liver. Folate deficiency occurs in people who rarely eat uncooked
vegetables.

14. Vitamin B12 Deficiency
• A deficiency of vitamin B12 can occur in several
ways. Inadequate dietary intake is rare but can
develop in strict vegetarians who consume no meat
or dairy products.
• Faulty absorption from the GI tract is more
common.
• This occurs in conditions such as Crohn’s disease, or
after ileal resection or gastrectomy.

15. • Another cause is the absence of intrinsic factor, as in pernicious anemia.
Intrinsic factor is normally secreted by cells within the gastric mucosa; it
binds with dietary vitamin B12 and travels with it to the ileum, where the
vitamin is absorbed. Without intrinsic factor, orally consumed vitamin
B12 cannot be absorbed, and erythrocyte production is eventually
diminished.
• Even if adequate vitamin B12 and intrinsic factor are present, a
deficiency may occur if disease involving the ileum or pancreas impairs
absorption.
• Pernicious anemia, which tends to run in families, is primarily a disorder
of adults, particularly the elderly.

16. • Hemolytic Anemia:
• In hemolytic anemias, the erythrocytes have a shortened lifespan; thus,
their number in the circulation is reduced.
• Fewer erythrocytes result in decreased available oxygen, causing hypoxia,
which in turn stimulates an increase in erythropoietin release from the
kidney. The erythropoietin stimulates the bone marrow to compensate by
producing new erythrocytes and releasing some of them into the
circulation somewhat prematurely as reticulocytes.
• If the red cell destruction persists, the hemoglobin is broken down
excessively; about 80% of the heme is converted to bilirubin, conjugated
in the liver, and excreted in the bile.

17. • Sickle Cell Anemia:
• Sickle cell anemia is a severe hemolytic anemia that results from
inheritance of the sickle hemoglobin gene. This gene causes the
hemoglobin molecule to be defective.
• The sickle hemoglobin (HbS) acquires a crystal-like formation when
exposed to low oxygen tension.
• The oxygen level in venous blood can be low enough to cause this
change; consequently, the erythrocyte containing HbS loses its round,
pliable, biconcave disk shape and becomes deformed, rigid, and sickle
shaped.

23. PALLOR SKIN
PICA
Koilonychia
Stomatitis
Wobbly Gait
(Unsteady Gait)

25. ASSESSMENT AND DIAGNOSTIC EVALUATION
• Complete hematologic studies (eg, hemoglobin, hematocrit,
reticulocyte count, and red blood cell (RBC) indices, particularly The
mean corpuscular volume [MCV] and RBC distribution width
[RDW])
• Iron studies (serum iron level, total iron-binding capacity [TIBC],
percent saturation, and ferritin)
• Serum vitamin B12 and folate levels; haptoglobin and
erythropoietin levels
• Bone marrow aspiration
• Other studies as indicated to determine underlying illness

26. MEDICAL MANAGEMENT
• Management of anemia is directed toward correcting or controlling the
cause of the anemia.
• if the anemia is severe, the erythrocytes that are lost or destroyed may
be replaced with a transfusion of packed RBCs (PRBCs).
The treatment aims to increase the number of RBCs, which, in turn,
increases the amount of oxygen in the blood.
•Iron-deficiency anemia: Iron supplements and dietary changes can
help, and, when relevant, a doctor will identify and address the cause
of excessive bleeding.

27. •Vitamin B-12 deficiency anemia: Treatments can include dietary supplements
and vitamin B-12 shots.
•Thalassemia: Treatments include folic acid supplements, iron chelation, and, for
some people, blood transfusions and bone marrow transplants.
•Anemia due to chronic disease: The doctor will focus on resolving the underlying
condition.
•Aplastic anemia: Treatment involves blood transfusions or bone marrow transplants
•Sickle cell anemia: Treatment typically involves oxygen therapy, pain relief
medication, and intravenous fluids, but it can also include antibiotics, folic acid
supplements, blood transfusions, and a cancer drug called hydroxyurea.
•Hemolytic anemia: The treatment plan may include immunosuppressant drugs,
treatments for infections, and plasmapheresis, which filters the blood.

28. NURSING MANAGEMENT
Assessment:
• Obtain a health history, perform a physical examination, and obtain
laboratory values.
• Ask patient about extent and type of symptoms experienced and impact of
symptoms on lifestyle; medication history; alcohol intake; athletic endeavors
(extreme exercise).
• Ask about family history of inherited anemias.
• Perform nutritional assessment: Ask about dietary habits resulting in
nutritional deficiencies, such as those of iron, vitamin B12, and folic acid.
• Monitor relevant laboratory test results; note changes.

29. • Assess cardiac status (for symptoms of increased workload or heart failure):
tachycardia, palpitations, dyspnea, dizziness, orthopnea, exertional dyspnea,
cardiomegaly, hepatomegaly, peripheral edema.
• Assess for GI function: nausea, vomiting, diarrhea, melena or dark stools, occult
blood, anorexia, glossitis; women should be questioned about their menstrual periods
(eg, excessive menstrual flow, other vaginal bleeding) and the use of iron supplements
during pregnancy.
• Assess for neurologic deficits (important with pernicious anemia): presence and
extent of peripheral
numbness and paresthesias, ataxia, poor coordination, confusion.

30. Nursing Diagnoses
• Fatigue related to decreased hemoglobin and diminished oxygen-
carrying capacity of the blood
• Altered nutrition, less than body requirements, related to
inadequate intake of essential nutrients
• Altered tissue perfusion related to inadequate hemoglobin and
hematocrit.

31. NURSING INTERVENTIONS
Managing Fatigue
• Assist patient to prioritize activities and establish a balance between activity
and rest.
• Encourage patient with chronic anemia to maintain physical activity and
exercise to prevent deconditioning.
Maintaining Adequate Nutrition
• Encourage a healthy diet.
• Teach patient to avoid or limit intake of alcohol.
• Plan dietary teaching sessions for patient and family; consider cultural aspects
of nutrition.
• Discuss nutritional supplements (eg, vitamins, iron, folate) as
prescribed.

32. Maintaining Adequate Perfusion
• Monitor vital signs and pulse oximeter readings closely, and adjust or
withhold medications (antihypertensives) as indicated.
• Administer supplemental oxygen, transfusions, and IV fluids as ordered.
Monitoring and Managing Complications
• Assess patient with anemia for heart failure.
• Perform a neurologic assessment for patients with known or suspected
megaloblastic anemia.
Expected Patient Outcomes
• Reports less fatigue
• Attains and maintains adequate nutrition
• Maintains adequate perfusion
• Experiences no or minimal complications