This document contains a seminar presentation on anemia given to Mr. Melese. It discusses the definition, epidemiology, classification, signs and symptoms, diagnosis, and management of anemia. It provides details on different types of anemia including iron deficiency anemia, aplastic anemia, pernicious anemia, hemolytic anemia, and sickle cell anemia. Laboratory findings, treatment options, and case examples are also presented. The presentation aims to give a comprehensive overview of anemia for health science students.

1. SALALE UNIVERSITY COLLEGE OF HEALTH SCIENCE POST
GRADUATE PROGRAM IN AHN.
SEMINAR PRESENTATION ON ANEMIA .
SUBMIT TO: MR. MELESE ( BSC,MSC)
SUBMIT BY: 1.MESFIN SHIFARA ID NO….185/15
2.AZAZHU ABATE NO …177/15
3.YORDANOSE LEMA….195/15
4.AMENSISA DEBESA…176/15
OCT 2023
FITCHE 1
Brain Tumors
11/4/2023

2. Presentation outline
Introduction
Epidemiology
pathophysiology
classification
Clinical Manifestation
Risk factor
Diagnosis
Management
Nursing Diagnosis
prevention
Reference
2
11/4/2023 Brain Tumors

3. Definition
Anemia ( from Greek word anemia, meaning lack of
blood) is a decrease in number of red blood cells (RBCs)
or less than the normal quantity of hemoglobin in the
blood.
Men .Hb < 13.5 gm/dl
Women .Hb < 12.0 gm/dl
Anemia in pregnancy < 11 gm / dl
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4. WHO Grading of anemia
Grade 1 (Mild Anemia): 10 g/dl
Grade 2 (Moderate Anemia): 7-10 g/dl
Grade 3 (Severe Anemia): below 7 g/dl
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5. Normal ranges of RBC measurements in adults:
Test (parameter) Females Males
Hemoglobin (g/dL): 12.0 - 16.0 13.5 - 17.7
Hematocrit (Hct, %): 36 - 48 40 - 52
RBC count (x 106/L): 4.0 - 5.4 4.5 - 6.0
Mean cell volume 90 ± 8 90 ± 8
_____________________________________________
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6. Epidemiology
One-fourth of the global population is estimated to be
anemic, with cases increasing rapidly for women,
expectant mothers, young girls, and children younger
than age 5.
In 2021, 1.92 billion people globally had anemia. This is
an increase of 420 million cases over three decades
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8. Classification of Anemia
A. Pathophysiological classification:
This is based on the underlying causes and RBC kinetics
These anemia's are usually caused by one or more of 3
independent mechanisms:
1. Decreased RBC production (IDA, MA, ACD, AA, etc.)
2. Increased RBC destruction: Hemolysis (immune-
mediated, hereditary, malaria)
3. Blood loss (Bleeding)
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9. B. Morphological Classification:
This classification is based on the peripheral blood
morphology and the MCV value:
1. Normocytic Anemias (MCV 80-100 fl): ACD, BM failure
syndromes, Endocrine and Renal failure-related to anemia's.
2. Microcytic Anemias (MCV< 80fl): IDA, ACD, Thalassemia,
Sideroblastic anemia's .
3. Macrocytic Anemias (MCV > 100 fl):
3.1 Megaloblastic marrow: Megaloblastic anemia
3.2 Normoblastic marrow: Hemolysis, Liver disease
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11. Causes of anemia
CHF, CLD
Renal failure
Malaria
Malabsorption
syndrome
Bacterial
endocarditis
TB
MDS (myelodysplastic
syndrome)
Malnutrition, IDA
Aplastic anemia
Hemolytic :
thalassemia, sickle cell
Drug induced anemia
alcohol
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12. Clinical Evaluation of the Patient with Anemia
Integration of the History + Physical examination + Lab
A. History:
1. Duration of symptoms
2. Nutritional/dietary history
3. Blood loss, menstrual history, pregnancy
5. Regular blood donation?
6. Family history (hereditary hemolytic anemia's)
7. Underlying disease (comorbid conditions)
8. Exposure to drugs or toxins and travel history malaria
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13. Symptoms
1.Cardiovascular: exercise intolerance, Palpitations, Syncope, Angina,
Intermittent claudication, Peripheral edema.
2. Gastrointestinal: Anorexia, Nausea, Indigestion, Diarrhea
3. Genitourinary: Menstrual irregularities, Urinary frequency, Loss of
libido or Impotence.
4.Neuromuscular: Fatigue, Throbbing headaches, Fainting,
Lightheadedness, Tinnitus, Vertigo, Increased cold sensitivity, Visual
impairment, Irritability and difficulty in concentration, Low-grade
fever.
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14. B. Physical Examination:
1. G/A and nutritional status of the patient
2. V/s (Postural hypotension, Tachycardia, wide pulse pressure)
3. Examination of the Mucous Membranes and Skin for:
Pallor Bleeding sites
Icterus Abnormalities of fingernails
Angular stomatitis and Nail beds
Atrophy of the tongue * Palmar creases
Sore tongue Leg ulcers; hemolytic anemia
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15. 4. Cardiovascular examination:
Wide pulse pressure
Modest tachycardia
Systolic ejection murmur and Peripheral edema
5. Abdominal examination:  Hepatomegaly and Splenomegaly
6. Digital per-rectum and Pelvic examination
7. Lymphadenopathy, Bone tenderness...hematologic malignancy
8. Neurological examination: Gait, Reflexes, Vibration, and
Position sense
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16. Lab tests for anemia
1.CBC
2.Stool hemoglobin test
3.Peripheral blood smear
4.Iron level
5.Transferrin level
6.Folate
7.Vitamin B12
8.Bilirubin
9.Reticulocyte count, RFT and LFT
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17. Iron
Corticosteroid
Folate
Vit B12
Cobalamin
Pyridoxine
Erythropoietin
Blood Transfusion
Splenectomy
Bone Marrow Transplantation
Gene Therapy: sickle cell anemia
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The treatment of anemia may range from the simple
administration of hematinics to bone marrow
transplantation and gene therapy:

18. Indications for Blood Transfusion Therapy:
There is no threshold of Hb or Hct value that mandates transfusion.
The decision to administer blood must be based on the symptoms
and functional status of the patient:
 The development of congestive heart failure
 The development of hypoxic symptoms or signs
 The consideration of surgical, obstetric and/or gynecological
procedures a patient with acute and ongoing bleeding may
require immediate blood transfusion.
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19. Consider the Risks and Benefits of Blood Transfusion
carefully before its Administration.
Adhere to blood component transfusion therapy when
ever possible:
● Packed red blood cells
● Platelet concentrates
● Granulocytes concentrates
● Plasma derivatives (Fresh frozen plasma, Cryoprecipitate,
Albumin, Factor concentrates)
 Transfuse Whole Blood only when there is Significant
Volume loss due to Hemorrhage.
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20. TYPES OF ANEMIA
1.Iron deficiency anemia
Is the most prevalent anemia in all age groups in the
world.
Inadequate supply of iron is the most common type of
anemia.
Iron deficiency anemia (IDA) develops when body iron
stores become inadequate for the needs of normal
erythropoiesis.
IDA is a sign of an underlying disease condition and is
not in itself a complete diagnosis.
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ANEMIA

21. Cause
Inadequate intake of iron for Hgb synthesize
Blood loss
Pregnancy and Iron malabsorption
S/S - anemia
Sore tongue
Brittle and rigid nail
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22. Investigation of the Patient with IDA:
A. Laboratory evaluation:
1. CBC, Reticulocyte count
2. RBC indices
3. Peripheral blood morphology
4. Iron studies
4.1 Serum iron (SI):
 Normal range: 50 – 150 μg/dL (9-27 μmol/L).
 < 30 µg/dL suggests IDA.
4.2 Total iron binding capacity (TIBC):
 Normal range: 250 – 370 μg/dL
 > 400 µg/dL suggests IDA.
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23. Treatment of IDA:
1. Identify and treat or correct the underline cause first.
2. Administer effective oral iron replacement therapy (IRT) for a
sufficient period of time.
3.Increasing dietary iron intake (e.g. organ meat)
4. Oral iron replacement is the therapy of choice:
 Ferrous sulfate 325 mg (66 mg elemental iron) three times
daily is cost effective.
5. Follow-up:
 Reticulocyte response
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24. 2.Aplastic anemia (pancytopenia)
Describes a condition in which the bone marrow is
depressed resulting in a decrease in RBCs, WBCs, &
platelets
Is a very serious diseases resulting to death
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ANEMIA

25. Causes may include:
Excessive radiation
Toxicity to various drugs (e.g. CAF)
Chemicals (e.g. benzene)
Infections (e.g. hepatitis, HIV/AIDS)
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ANEMIA

26. 26
INTERPRETING TEST RESULTS
Low Hgb and Low Hct.
Low RBC count.
Thrombocytopenia—low platelet count.
Leukopenia—low WBC.
Reticulocyte count low.
Positive fecal occult blood test.
Decreased cell counts in bone marrow biopsy as body
stops producing
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27. HALLMARK SIGNS AND SYMPTOMS
27
Fatigue due to hypoxemia and weakness due to tissue hypoxia
Pallor due to lack of oxygen reaching superficial tissues
Infections due to low white blood cell production, causing
decreased ability to fight infection
Bruising (ecchymosis), hemorrhages due to decrease in
platelets, Bleeding from mucous membranes (GI tract, mouth,
nose, vagina)
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28. Mgt
Administer hematopoietic growth factor to correct anemia
in patients with low erythropoietin levels
Packed RBC transfusions when anemia is symptomatic.
Platelet transfusion for severe bleeding.
Bone marrow transplant replaces functioning stem cells
Blood transfusion
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ANEMIA

29. 3. Pernicious anemia
is also called megaloplastic anemia Is caused by a lack
of a gastric substance called intrinsic factor which is
produced in the stomach.
The body needs intrinsic factor to absorb Vit B12 from
blood in the small intestine.
Vit B12 is necessary for the body’s proper absorption &
use of iron & protection of nerve fibers
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ANEMIA

30. Causes of Cobalamin Deficiency MA
1. Inadequate dietary intake : vegans Animal products (meat
and dairy products).
2. Malabsorption (Main cause of Cbl deficiency MA)
3. Rare congenital disorders
4. Acquired
 Repeated and protracted exposure to nitrous oxide.
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31. S/S
Smooth, sore red tongue & mild diarrhea
Mental changes – confusion
Neurological changes – paresthesia & trouble with
balance on walking
Sx progress to CHF if not treated.
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ANEMIA

32. Diagnosis of MA
1. CBC + RBC indices +Retic count + Biochemical studies
2. Peripheral Blood Smear:
The earliest morphologic sign: hypersegmented
neutrophils.
RBC morphologic abnormalities
3. Bone marrow: Hypercellular with a decreased
myeloid to erythroid ratio
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33. Mgt
The patient must take Vit B12 by injection for life.
Vit B12 can’t be taken orally because the patient lacks
intrinsic factor necessary for absorption.
Additionally, patient may receive iron supplements,
and folic acids.
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34. 4.Hemolytic anemia
is caused by destruction of RBCs prior to their normal life
span (120 days)
Is caused by:
Certain drugs & toxins
Antibodies (e.g. blood transfusion rxn)
Malaria parasite
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ANEMIA

35. S/S
Manifestations of hypoxemia Sx relate to the impaired
transport of O2 & include: dyspnea & limited exercise
tolerance.
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ANEMIA

36. Laboratory Features:
1. Evidence of peripheral and BM response to
hemolysis:
Decreased Hb or Hct level, Increased MCV
Reticulocytosis
Examination of the peripheral blood smear:
 This is the single most useful and cheap laboratory test
for the initial evaluation of HA.
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37. Mgt
Rx of this type of anemia relates to Dx & to the
causative factors.
Corticosteroids & splenectomy may also be of
benefit
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38. 5.Sickle cell anemia
Is a genetic disease in which the person’s RBCs become
crescent or sickle-shaped when exposed to decreased
oxygen.
Sickled cells can’t carry as much O2 as normal cells.
When sickled RBCs can enter the smaller blood vessels,
they become obstructing blood flow →sickle cell crisis
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ANEMIA

39. S/s of crisis include:
Unpredictable pain in the extremities and abdomen.
Jaundice, skin irritation & ulceration
Fever, dyspnea, cough, swelling of hands & feet,
and ↑infection.
Management…. Long term RBC transfusion
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40. Summary
1. Anemia is a common clinical problem.
2. A correct etiologic diagnosis is essential before
treatment is initiated.
3. The treatment of anemia ranges from the
administration of hematinics to bone marrow
transplantation or gene therapy
4. If blood transfusion is indicated, adhere to blood
component transfusion therapy when ever possible!
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41. Biographical data
Full name: Diribe Jima
Sex: F Age: 45yrs old MRN: 518603
Date of admission: 12/2/16 Address: Dagam
Source of information: patient
Reliability: Reliable information
C/C- Abdominal distention/
-Shortness of breath / 4wks duration
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42. History of present illness (HPI)
This 45yrs old female patient admitted to this medical ward
with a diagnosis of sever anemia secondary to chronic liver
disease.
She was presented with gradually developed abdominal
distention, shortness of breathing, bilateral leg swelling for
four weeks duration.
The problem is associated with cough, dizziness, fatigability,
intermittent head ach, loss of appetite and low grade fever.
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43. HPI…
The symptoms are aggravated when she tries to walk,
work and lessens at rest; Other wise
She has no history of chest pain and tightness
She has no history of vomiting, constipation or diarrhea
She has no history of flank pain, pain during urination
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44. History of past illness
She has no past history of similar problem and Hospital
admission.
She has no history chronic medical illness Like DM, HTN…
Family history
She has no family member with similar conditions
She has no family history chronic medical illness
Like DM, HTN…
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45. Social history
She is a married woman with three children's
She drinks alcohol like ‘’caticala 1 small glass in the night
every day for 3 yrs.
Se also use cultural drink “Farso” every day.
Physical examination
G/A: chronic sick looking
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46. Vital signs
BP: 112/60 mmHg
PR: 128 beats/min
RR: 28 breaths/min
Temperature: 36.6
SPO2: 97% 0n INO2 (Cylinder)
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47. HEENT
Eye: white paper pale conjunctiva
No jaundice on sclera and skin
Respiratory system:
Chest is symmetric
Accessory muscle use
Clubbing finger
No capillary refill
No stridor, friction sound on auscultation.
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48. CVS: S1 and S2 well heard
No murmurs and gallops
GIT: Distended abdomen
Dull sound heard under percussion
Legs: Bilateral pitting edema
CNS: She is oriented to TPP
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49. Assessment: severe anemia secondary to CLD (?)
Plan : CBC (Hgb=5), RBS (150),
Abdominal ultra sound,
Ascitic fluid analysis, chest x-ray
LFT, RFT, Electrolyte and CT- scan
Treatment
• Spirolactone 25mg po bid
• Lasix 40mg iv bid
• Two units OF whole blood
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50. NURSING DIAGNOSES
Activity intolerance related to low hgb AEB weakness,
fatigue, and general malaise
Imbalanced nutrition less than body requirements,
related to inadequate intake of essential nutrients AEB
weight loss.
Deficient knowledge R/t disease process AEB patient
verbalization.
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51. Nursing Interventions
Put on INO2
Transfused two units of whole blood
Administered prescribed medication
Advice nutritional diet
Patients with chronic anemia need to maintain some
physical activity and exercise to prevent the deconditioning
that results from inactivity.
Providing education and support
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52. REFERENCE
1. Georgieff M. The importance of Iron deficiency on
fetal, neonatal infant developmental program
outcomes 2023; 162
2. Anemia: Practice essentials pathophysiology,
etiology… Nov 2021.
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