Anemia notes for nursing course

2. ANAEMIA

3. Anatomyof blood
• blood is the river of life, is genuinely true.
• constituent of human body and it forms the circulatory
system.
• occupies 8% of total body weight and has an average
density of about 1060 kg/m3.
• intricate network of veins and arteries, distributes blood
throughout the body.

4. Cont..
• circulating fluid providing the body with nutrition,
oxygen, and waste removal.
• The average person has about 5 liters (more than a
gallon) of blood.

5. COMPONENTS:
1. Red blood cells
2. White blood cells
3. Platelets
4. Proteins

6. FUNCTIONS:
Supplies oxygen and nutrients.
Removes waste products like, urea, lactic acid and
carbon dioxide from our body.
Provides immunity
Helps in transportation of hormones
Aids in blood clotting
Regulates and maintains normal temperature
Maintains pH balance inside the body.
The pH of blood lies in the range of 7.35 to 7.45
Help in homeostasis.

7. Anaemia:
WORD ORIGIN AND HISTORY
FOR ANAEMIA:
• 1824, from French medical term (1761), Modern Latin,
from Greek anaimia "lack of blood," from anaimos
"bloodless," from an- "without" (an- (1) + haima "blood"
(-emia).

8. DEFINITION
• Anemia is defined as the reduction in the red blood
cells or in concentration of hemoglobin, below the
lower limit of the normal range for age and sex of the
individual.

9. HEMOGLOBIN VALUES:
AGE NORMAL VALUE MEAN VALUE
Birth 13.5 - 24.0 g/dl 16.5 g/dl
< 1 month 10.0 - 20.0 g/dl 13.9 g/dl
1-2 months 10.0 - 18.0 g/dl 11.2 g/dl
2-6 months 9.5 - 14.0 g/dl 12.6 g/dl
0.5 - 2 years 10.5 - 13.5 g/dl 12.0 g/dl
2 - 6 years 11.5 - 13.5g/dl 12.5 g/dl
6-12 years 11.5 -15.5 g/dl 13.5g/dl
Female:
 12-18 years
 >18 years
12.0 -16.0 g/dl
12.1 - 15.1 g/dl
14.0 g/dl
14.0 g/dl
Male:
 12-18 years
 >18 years
13.0 -16.0 g/dl
13.6 - 17.7 g/dl
14.5 g/dl
15.5 g/dl

10. CLASSIFICATION
1. BASED ON
MORPHOLOGY
2. BASED ON
ETIOLOGY

11. 1. BASED ON MORPHOLOGY
1.Microcytic anemia
2.Normocytic anemia
3.Macrocytic anemia

12. 1.Microcytic
Anemia
2.
Normocytic
Anemia
3.Macrocytic
Anemia
•Abnormally small
cells are present in
the iron deficiency
anemia and certain
non iron
deficiency anemia
•like sideroblastic
anemia and
thalassemia.
•RBC’s are normal
in shape but
anemia occurs due
to the blood loss,
hemolysis or bone
marrow failure.
•RBC’s are
normally large in
shape. It is usually
due to vitamin B12
or folic acid
deficiency.
Example:
megaloblastic
anemia.

13. On thebasisof haemoglobincontent in RBC,anemiamaybe:
1.Hypochromic:
• abnormally decreased haemoglobin content.
2. Normochromic:
• Normal haemoglobin content.

14. 2. BASED ON ETIOLOGY
1. Anemia due to blood loss
2. Anemia due to impaired cell
production
3. Anemia due to increased cell
destruction

15. 1. Anemia due to blood loss:
i. Acute post hemorrhagic anemia
ii. Chronic post hemorrhagic anemia

16. 2. Anemia due to impaired cell
production
A. Deficiency of substances essential for the
erythropoiesis:
Iron deficiency anemia
Vitamin B12 and folate deficiency
B. Disturbance of proliferation and differentiation of
stem cells:
 Aplastic anemia
 Aplasia of pure red cells

17. C. Disturbance of bone marrow functions or due to
systemic disease:
Anemia due to infection
Anemia in renal disease
Anemia in liver disease
Anemia in disseminated malignancy
Anemia in endocrinopathies

18. D. Anemia due to bone marrow dysfunction:
• Leukemia
• Myelosclerosis
• Multiple myeloma
E. Congenital anemia:
• Sickle cell anemia
• Congenital dyserythropoietic defect anemia

19. 3. Anemia due to increased cell
destruction
A. Anaemia due to intracorpusular defect:
 Sickle cell anemia
 Thalassemia
B. Anaemia due to extracorpusular defect:
 Haemolytic disease of newborn
 Effect of cytotoxic drugs
 Effects of venoms or poisoning from substance like lead
 Thermal injury or burn
 Transfusion reactions

20. OTHER CAUSES:
 Fluid overload (hypervolemia) causes decreased
hemoglobin concentration and apparent anemia
 General causes of hypervolemia include excessive
sodium or fluid intake, sodium or water retention and
fluid shift into the intravascular space.

21. 1. Sickle cell Anemia
2. Aplastic Anemia
3. Hemolytic Anemias
4. Vitamin Deficiency Anemias
5. Thalassemia
6. Heinz Body Anemia
7. Refractory Anemia
8. Iron Deficiency Anemia

22. 1. Sicklecell Anemia:
 known as Hemoglobin S disease .
 Inherited disorder.
 Red blood cells become crescent-shaped
 They break down rapidly, so oxygen does not get to the
body's organs, causing anemia.
 The crescent-shaped red blood can cells also get stuck
in tiny blood vessels, causing pain.
 sickle-shaped red blood cells that are stiff and unable to
squeeze through blood vessels. Infections and heart
failure can also occur.

23. SYMPTOMS:
• Susceptibility to infection
• Fatigue
• Delayed growth and development in
children
• Episodes of severe pain, especially in the
joints, abdomen, and limbs

24. TREATMENT
 administration of oxygen
 pain-relieving drugs
 oral and intravenous fluids : reduce pain and prevent
complications
 blood transfusions
 folic acid supplements
 antibiotics
 bone marrow transplant
 cancer drug: hydroxyurea (Droxia, Hydrea)

25. 2. Aplastic Anemia:
most rare forms of anemia.
two to six people per million have this type of anemia.
results from an unexplained failure of the bone marrow
to produce all types of blood cells.
found in adolescents and young adults.
Symptoms can include bleeding in the mucous
membranes.
Chemicals such as benzene and certain pesticides

26. TREATMENT
blood transfusions to boost levels of red blood
cells.
bone marrow transplant if bone marrow is
diseased and can't make healthy blood cells.

27. 3. Hemolytic Anemia:
premature destruction of red blood cells.
antibodies produced by the immune system damage red
blood cells.
Toxic materials : lead, copper, and benzene (causes)
Hemolytic anemia can be acquired or inherited
Sickle cell disease and thalassemia are both inherited
types of hemolytic anemia.
Treatment:
»Blood Transfusion

28. TREATMENT
• avoiding suspect medications, treating related infections
and taking drugs that suppress immune system, which
may be attacking red blood cells.
• depending on the severity of anemia, a blood
transfusion or plasmapheresis may be necessary.
• Plasmapheresis is a type of blood-filtering procedure. In
certain cases, removal of the spleen can be helpful.

29. 4. VITAMIN DEFICIENCY
ANEMIAS:
 Vitamin B-12 is also essential in hemoglobin production.
Normally, a chemical secreted by the stomach helps the body
absorbs this vitamin. However, some people can't readily absorb
B-12. The result is B-12 deficiency (pernicious anemia).
 symptoms develop gradually this condition may not be
immediately recognized.

30. Those with thyroid disease or diabetes mellitus
are at increased risk for this type of anemia. The
condition occurs most often in 40- to 80-year-
old northern Europeans with fair skin.
A lack of folic acid, another one of the B
vitamins, can also lead to anemia. Folic acid
deficiency is a particular problem for
alcoholics.

31. SYMPTOMS
• A tingling, "pins and needles" sensation in
the hands or feet
• Lost sense of touch
• A wobbly gait and difficulty walking
• Clumsiness and stiffness of the arms and
legs
• Dementia
• Hallucinations, schizophrenia.

32. TREATMENT
dietary supplements and increasing these nutrients in
your diet.
If digestive system has trouble absorbing vitamin B-12
from the food eat: vitamin B-12 injections can be
given.

33. 5. THALASSEMIA:
• defects in the genes producing hemoglobin.
• 2 major forms: thalassemia minor and thalassemia
major
• As its name implies, thalassemia minor is mild and
those suffering from this condition go on to live a full
life. Treatment is often unnecessary.
• Thalassemia major is also called Cooley's anemia,
named after the doctor who first described it in 1925.
Thalassemia major can be serious, but it is very rare.
• Transfusions or bone marrow transplants are usually
required.

34. Treatment
• blood transfusions
• folic acid supplements
• removal of the spleen (splenectomy)
• bone marrow transplantation

35. 6. Heinz body anemia:
 Hemolytic anemia resulting from oxidation of globin
and formation of Heinz bodies
which are seen in blood smears as dark
refractile intracytoplasmic bodies and stain
with new methylene blue.
 Some common causes are ingestion of onions and plants
in the Brassicaeae family, phenazopyridine, methylene
blue and acetaminophen (paracetamol).
 Hinz body form in the cytoplasm of the RBC'S and
appears like small dark dots under the microscope.

36. 6. Refractory anemia:
• Any of various anemic conditions that are not
successfully treated by any means other than blood
transfusions (and that are not associated with another
primary disease).

37. 7. Iron Deficiency Anemia:
• The body needs iron to produce the hemoglobin
necessary for red blood cell production. In general, most
people need just 1 milligram of iron daily. Menstruating
women need double that dose.

38. Symptoms :
• A hunger for strange substances such as
paper, ice, or dirt (a condition called pica)
• Upward curvature of the nails, referred to as
koilonychias
• Soreness of the mouth with cracks at the
corners

39. ANAEMIA SYMPTOMS
Chronic Lead
Poisoning
 A blue-black line on the gums referred to as a
lead line
 Abdominal pain
 Constipation
 Vomiting
Chronic Red
Blood Cell
Destruction
 Jaundice (yellow skin and eyes)
 Brown or red urine
 Leg ulcers
 Failure to thrive in infancy
 Symptoms of gallstones
Sudden Red
Blood Cell
Destruction
 Abdominal pain
 Brown or red urine
 Jaundice (yellow skin)
 Small bruises under the skin
 Seizures
 Symptoms of kidney failure

40. • Other common symptoms
of anemia:
Extreme fatigue
Pale skin
Weakness
Shortness of breath
Chest pain
Frequent infections
Headache

41. Cold hands and feet
Inflammation or soreness of tongue
Brittle nails
Fast heartbeat
Unusual cravings for non-nutritive substances,
such as ice, dirt or starch
Poor appetite, especially in infants and children
with iron deficiency anemia.
An uncomfortable tingling or crawling feeling
in your legs (restless legs syndrome)

42. DIAGNOSTICTESTS FOR ANAEMIA:
Physical examination:
• Complete blood count (CBC)
• Iron tests: which measure the amount of iron in blood.
• A Reticulocyte count to see how well treatment is
working. Reticulocytes are immature red blood cells
produced by the bone marrow and released into the
bloodstream. When reticulocyte counts increase, it
usually means that iron replacement treatment is
effective.

43. • A ferritin level test ,which reflects how much
iron may be stored in the body.
• A test to determine the size and shape of your
red blood cells. Some of red blood cells may
also be examined for unusual size, shape and
color.

44. TREATMENT:
• Anemia treatment depends on the cause.
Iron deficiency anemia:
• This form of anemia is treated with changes in diet and
iron supplements.
• If the underlying cause of iron deficiency is loss of
blood — other than from menstruation — the source of
the bleeding must be located and stopped. This may
involve surgery.

45. ORAL IRON THERAPY:
• An increase in hemoglobin of 1 g per dl after one month
of treatment shows an adequate response to treatment
and confirms the diagnosis.
• In adults, therapy should be continued for three months
after the anemia is corrected to allow iron stores to
become replenished.

46. Premature neonates 2 to 4 mg elemental iron/kg/day
divided every 12 to 24 hours
(maximum daily dose = 15 mg).
Infants and children less
than 12 years
Prophylaxis: 1 to 2 mg elemental
iron/kg/day (maximum 15 mg) in
1 to 2 divided doses.
Mild to moderate iron
deficiency anemia
3 mg elemental iron/kg/day in 1
to 2 divided doses.
Severe iron deficiency
anemia
4 to 6 mg elemental iron/kg/day
in 3 divided doses
Usual PediatricDosefor IronDeficiencyAnemia:

47. SIDE EFEECT OF ORAL IRON
THERAPY:
o Adherence to oral iron therapy can be a barrier to
treatment because of GI adverse effects such as
epigastric discomfort, nausea, diarrhea, and
constipation.
o These effects may be reduced when iron is taken with
meals, but absorption may decrease by 40 percent.

48. o Medications such as proton pump inhibitors
and factors that induce gastric acid hyposecretion
(e.g., chronic atrophic gastritis, recent
gastrectomy or vagotomy) are associated with
reduced absorption of dietary iron and iron
tablets.
o Side effects are dose-dependent, and the dose
may be adjusted.

49. Foods and drugs that impair iron
absorption:
Taking oral iron with food reduces absorption
Caffeinated beverages (especially tea)
Calcium containing foods and beverages
Calcium supplements
Antacids
H-2 receptor blockers
Proton pump inhibitors

50. Factors that affect the absorption of ironsupplements:
 The amount of iron absorbed decreases as doses get
larger. For this reason, it is recommended that most
people take their prescribed daily iron supplement in
two or three equally spaced doses.
 Oral iron supplements must dissolve rapidly in the
stomach so that the iron can be absorbed in the
duodenum or upper jejunum. Enteric-coated
preparations and long-acting supplements may be
ineffective, since they do not dissolve in the stomach.

51. • Ascorbic acid is an enhancer of iron absorption and
can reverse the inhibiting effects of substances such as
tea and calcium.
• Ascorbic acid facilitates iron absorption by forming a
chelate with ferric iron at acid pH that remains soluble
at the alkaline pH of the duodenum.
• To minimize side effects, iron supplements are often
taken with food. This may decrease iron absorption by
as much as 40-66%.
• Food and drug interactions may reduce the efficacy of
oral iron

52. Ways to Minimize Adverse
Effects of Oral Iron:
Start with half the recommended dose and
gradually increase to the full dose.
Take iron supplements with food to alleviate
gastrointestinal distress (this may decrease iron
absorption by as much as 40-66%).
Change to a different iron preparation .
Take the supplement in divided doses.
Concomitant use of a stool softener, such as
docusate, may help alleviate constipation.

53. Parenteral Iron Therapy:
• Parenteral therapy may be used in patients who cannot
tolerate or absorb oral preparations, such as those who
have undergone gastrectomy, gastrojejunostomy,
bariatric surgery, or other small bowel surgeries.

54. The most common indications for
intravenous therapy include:
• GI effects, worsening symptoms of
inflammatory bowel disease, unresolved
bleeding, renal failure–induced anemia treated
with erythropoietin, and insufficient absorption
in patients with celiac disease.

55. Prevention:
Choose a vitamin-rich diet:
• Many types of anemia can't be prevented. However, you
can help avoid iron deficiency anemia and vitamin
deficiency anemias by choosing a diet that includes a
variety of vitamins and nutrients, including:

56. •Iron:
• Iron-rich foods include beef and other meats,
beans, lentils, iron-fortified cereals, dark green
leafy vegetables, and dried fruit.

57. • Folate:
• This nutrient, and its synthetic form folic acid, can be
found in citrus fruits and juices, bananas, dark green
leafy vegetables, legumes, and fortified breads, cereals
and pasta.

58. Vitamin
• This vitamin is found naturally in meat and dairy
products. It's also added to some cereals and soy
products, such as soy milk.
•

59. • Vitamin C:
• Foods containing vitamin C — such as citrus fruits,
melons and berries — help increase iron absorption.

60. NURSING CARE PLAN FOR ANEMIA:
DIAGNOSIS:
Risk for Infection related to decreased
immunity, invasive procedures
Goal:
• Reduce risk factors for infection

61. Control of infection:
• Clean up the environment after use for other patients.
• Limit visitor when necessary and recommended for
adequate rest.
• Instruct patient’s family to wash their hands before and
after contact with the client.
• Use anti-microbe soap for hand washing.
• Make hand washing before and after nursing actions.

62. • Use clothes and gloves as a protective device.
• Maintain aseptic environment during the
installation of equipment.
• Perform wound care, and dresing infusion,
catheter every day if any.
• Increase intake of nutrients, and adequate fluid.
• Give antibiotics according to the program.

63. Protection of infection:
Monitor signs and symptoms of systemic and
local infections.

Monitor susceptibility to infection.
Maintain aseptic technique for each action.
Inspection of the skin and mucous mebran
redness, heat.

64. • Monitor changes in energy levels.
• Encourage clients to improve mobility and
exercise.
• Instruct the client to take antibiotics according to
the program.
• Teach family / client about the signs and
symptoms of infection and report suspected
infection.

65. Activity intolerance related to tissue hypoxia
associated with anemia resulting from:
decreased production of RBCs resulting from a decreased
intake and absorption of vitamins and minerals and an
inability of the liver to store vitamins and minerals
Or
excessive RBC destruction resulting from hypersplenism
(if venous congestion has resulted in splenomegaly, the
spleen will destroy RBCs faster than usual)

66. INTERVENTION:
Assess for signs and symptoms of
activity intolerance:
 fatigue or weakness
 exertional dyspnea, chest pain, diaphoresis, or dizziness
 abnormal heart rate response to activity (e.g. increase in
rate of 20 beats/minute above resting rate, rate not
returning to preactivity level within 3 minutes after
stopping activity, change from regular to irregular rate)
 a significant change (15-20 mm Hg) in blood pressure
with activity.

67. • Implement measures to improve activity
tolerance:
Perform actions to promote rest and/or
conserve energy
Maintain activity restrictions as ordered
Minimize environmental activity and noise
Organize nursing care to allow for periods of
uninterrupted rest
Limit the number of visitors and their length of
stay
Assist client with self-care activities as needed

68. • keep supplies and personal articles within easy reach
• Instruct client in energy-saving techniques (e.g. using
shower chair when showering, sitting to brush teeth or
comb hair)
• Implement measures to reduce fear and anxiety (e.g.
assure client that staff are nearby, Explain all tests and
procedures, encourage verbalization of fear and anxiety)

69. • Implement measures to promote sleep (e.g. elevate head
of bed and support arms on pillows to facilitate
breathing; maintain oxygen therapy during sleep;
discourage intake of fluids high in caffeine, especially in
the evening; encourage relaxing diversional activities in
the evening)
• Implement measures to reduce discomfort
• Discourage smoking and excessive intake of beverages
high in caffeine such as coffee, tea, and colas (nicotine
and caffeine can increase cardiac workload and
myocardial oxygen utilization, thereby decreasing
oxygen availability)

70. • Perform actions to improve breathing pattern in order to
decrease dyspnea and improve tissue oxygenation
• Maintain oxygen therapy as ordered
• Perform actions to improve nutritional status
• Perform actions to treat anemia (e.g. administer
prescribed iron, folic acid, and/or vitamin B12;
administer packed red blood cells if ordered)
• Increase client's activity gradually as allowed and
tolerated.

71. Instruct client to:
• Report a decreased tolerance for activity
• Stop any activity that causes chest pain, a
marked increase in shortness of breath, dizziness,
or extreme fatigue or weakness.
• Consult physician if signs and symptoms of
activity intolerance persist or worsen.
•

72. RESEARCH ABSTRACT:
• Premalatha T*, Valarmathi S, Parameshwari Srijayanth et.al.
conducted a study on “Prevalence of Anemia and its
Associated Factors among Adolescent School Girls in
Chennai, Tamil Nadu, INDIA”
• Anemia is a major public health problem but mostly ignored
whether the country is developing or developed. In developing
countries it serves as a primary cause for 40% of maternal death
either directly or indirectly

73. • . World Health report of 2002 identified anemia as one among the top 10 risks
for infant mortality, maternal mortality and preterm birth. During adolescence
anemia is more prevalent in both sexes due to growth spurt especially in girls
where they are exposed to risk of onset of menarche. Prevalence of anemia is
very high in vulnerable groups even in higher socioeconomic status. This
stresses the need to investigate the factors associated with the prevalence of
anemia. Prevention of anemia is effective when the strategy is focused right
from adolescence for their future reproductive life and this will contribute to
achieve Millennium Development Goals (MDG).
• Objective of the study: To estimate the prevalence of iron deficiency anemia
among adolescent school girls in the age group of 13-17 years in Chennai and
to study the associated factors. Study approach: A cross-sectional survey was
executed among 400 female school students in the age group of 13-17 years in
Chennai. Sociodemographic details, anthropometric measurements were
obtained. Haemoglobin was estimated using cyan method. Statistical analysis
was done using IBM SPSS (Statistical Package for the Social Sciences).

74. • Study results: The prevalence of anemia was found to be 78.75% among
school students. Chi-square statistics shows significant association (p<0.05) of
anemia is with type of family, socioeconomic status and diet. In this study m
42.5% of girls with BMI<18 were found to be anemic. Linear trend predicts
decrease in Hemoglobin with age as a factor if same dietary pattern is followed
over the years. Conclusions and recommendations: A high prevalence of
anemia is found in female students from nuclear families and whose mothers’
education is low. This study predicts that hemoglobin level tends to decrease as
age progresses especially in their maternal life that gives an alarming effect on
infant and maternal mortality rates. Health programs for housewives should
insist the utilization of easily available and affordable iron rich diet, forming
kitchen garden etc. School health programs, antenatal programs should focus on
anemia, targeting on individual’s benefit.
• Strategies on anemia prevention can be formed at primary health care level. Iron
fortification of commonly reachable vehicles like salt, sugar can be emphasized
which does not demand the individual co-operation. Community awareness
should be increased in overall nutritional status of women.
•
•

77. • Anemia is not a disease but, a condition caused by
various underlying pathologic processes. A proper
history and physical examination is more important in an
easy way of approaching a child with anemia. Lab exams
leads to definitive cause of anemia. All cases of anemia
are not necessary to be transfused

78. Bibliography
BOOKS:
Wilson David,Wong’s Essential Of Paediatric
Nursing,8th Edition,Published By Elsevier
Marlow Dorothyr,Text Book Of Paediatric
Nursing,6th Edition,Published By Elsevier
Paul K Vinod, Bagga Arvind. Essential Pediatrics. 8th
Edition. New Delhi (INDIA) .CBS Publisher; 2009.

79. Gupta Piyush; “Essential Pediatric Nursing”. A.P. Jain
& CO. New Delhi,1st edition;
Ghai OP “Essential Pediatrics”, 8th edition, CBS
publishers, Pp- 507-509
Sharma Rimple. Essential of Paediatric Nursing. 1st
Edition. Ludhiana Punjab. Jaypee Publisher; 2013.p
503-508

80. INTERNET/ JOURNAL:
http ://en.wikipedia.org/wiki/anemia
http://www.anemiadaassociation.org
Premalatha T, Valarmathi S, Srijayanth P, Sundar JS,
Kalpana S (2012) Prevalence of Anemia and its
Associated Factors among Adolescent School Girls in
Chennai, Tamil Nadu, INDIA. epidemiol 2:118. doi
:10.4172/2161-1165.