A presentation about anaemia, causes, types and management

1. ANAEMIA

2. OBJECTIVES
By the end of the session, students should
acquire knowledge on anaemias.

3. Specific objectives
At the end of the lesson students should be able
to:
1.Define anemia
2.Describe the classes of anemia
3.Outline causes of anemia

4. Specific objectives cont’
4.Explain the pathophysiology of anemia
5.Explain clinical manifestations of anemia
6.Explain the management of anemia

5. Definition
• Is a condition that occurs when the
number of red blood cells and or the
amount of hemoglobin found in the red
blood cells drops below normal.
• RBC and the hemoglobin contained within
them are necessary for the transport and
delivery of oxygen from the lungs to the
rest of the body.

6. • Anemia is not a disease on its own, but a
manifestation of other underlying
conditions

7. Classes of anemia
Anemia can be classified as:
-Mild Hb 10-14g/dl
-Moderate Hb 6-10g/dl
-Severe Hb < 6 g/dl
It depends on the extent to which the RBC
count /or hemoglobin level are decreased

8. CAUSES OF ANEMIA
In general, anemia has three main causes
• Impaired or decreased production of RBC,
example in iron deficiency, B vit.
deficiencies and aplastic anemia.
• Decreased survival, increased destruction
of RBC as in hemolytic anemia.
• Excessive blood loss

9. TYPES OF ANAEMIA
• Iron deficiency
• Pernicious anaemia and B vit deficiency
• Aplastic
• Hemolytic
• Anaemia of chronic diseases

10. DESCRIPTION OF THE TYPES
Type Description Example of
causes
Iron deficiency Lack of iron leads
to decreased
amounts
hemoglobin; low
levels of
hemoglobin in turn
leads to
decreased
production of
normal RBCs
Blood loss; diet
low in iron; poor
absorption of
iron

11. Type Description Example of
causes
Pernicious
anemia and B
vit.deficiency
Lack of B vitamins
does not allow
RBCs to grow and
then divide as they
normally would
during
development;
leads to
decreased
production of
normal RBCs
Lack of intrinsic
factor; diet low
in B vitamins;
decreased
absorption of B
vitamins

12. Type Description Example of
causes
Aplastic Decreased
production of all
cells produced
by the bone
marrow of
which RBCs are
one type
Cancer therapy,
exposure to
toxins,
autoimmune
disorders, viral
infections

13. Type Description Example of
causes
Hemolytic RBCs survive
less than the
normal 120
days in the
circulation;
leads to overall
decreased
numbers of
RBCs
Inherited causes
include sickle cell
and thalassemia;
other causes
include transfusion
reaction,
autoimmune
disease, certain
drugs (penicillin)

14. Type Description Example of
causes
Anemia of
chronic
diseases
Various
conditions over
the long term
can cause
decreased
production of
RBCs
Kidney disease,
diabetes,
tuberculosis or
HIV

15. Anemia caused by blood loss
Can be acute or chronic
Acute
Sudden hemorrhage due to trauma,
surgery resulting into reduced total
blood volume and low cardiac output
which may cause hypovolemic shock.

16. • Bleeding can be internal or external.
internal hemorrhage can lead to tissue
distension, organ displacement, nerve
compression

17. • With sudden on set of blood loss, the body
reacts with vasoconstriction to maintain
adequate blood volume and meet oxygen
requirements.Only volume is lost but
concentration of RBC is the same

18. Chronic anaemia
May develop slowly over a period of time
with long term illnesses such as
Tuberculosis, HIV and Cancer.
In these situations, the anemia may not be
apparent because symptoms are masked
by the underlying disease

19. Causes of chronic anemia
• Bleeding ulcers
• Hemorrhoids
• Menstruations
• Haematuria
• Gastritis
Chronic blood loss results into depletion of
iron store leading into iron deficiency
syndrome

20. PATHOPHYSIOLOGY
Red blood cells (RBC) transport
haemoglobin which carries oxygen to body
tissues, reduction in RBC reduces the
oxygen carrying capacity resulting into
hypoxia.
Physiological effects of anemia are caused
by tissue hypoxia and activation of
compensatory mechanisms that attempt to
meet cellular oxygen needs.

21. PATHOPHYSIOLOGY CONT’
These mechanisms include
• Redistribution of blood from tissues that
have low oxygen requirement (e.g. skin) to
tissues that have high oxygen needs e.g.
brain, muscles, and heart.
• Increased cardiac output achieved by
increased heart rate or stroke volume to
meet oxygen demands of the tissues.

22. PATHOPHYSIOLOGY CONT’
• Increase in erythrocytes synthesis by
kidneys resulting into increased rate of
RBC production.

23. Clinical manifestations
Subjective data (symptoms)
Symptoms differ according to condition,
severity, and chronicity.
• A general feeling of tiredness or weakness
(fatigue)
• Lack of energy

24. Severe anaemia
• Headache
• Dizziness
• Feeling of cold or numbness in hands and
or feet
• Shortness of breath

25. Subjective data cont’
• Heart palpitations
• Loss of libido
• Chest pain

26. Objective data
• Pale complexion (pallor in palms, nails and
conjunctiva
• Fast or irregular heart beat
• Cardiomegaly
• Spleenomegaly
• Hepatomegaly
• Claudication

27. Objective data cont’
• Edema of the lower extremities (ankle)
• Weight loss

28. Diagnostic tests
• Full blood count
-Hb
-W B C
-RBC and
-Platelets

29. • Differential – look at the shape, size and
relative maturity of the blood cells to
determine the cause of the anemia and to
guide treatment.

30. IRON DEFICIENCY ANAEMIA
• Iron is an essential trace element and is
necessary for the production of healthy red
blood cells (RBCs). It is one component of
heme, a part of hemoglobin, the protein in
RBCs that binds to oxygen and enables
RBCs to transport oxygen throughout the
body.

31. • If not enough iron is taken in compared to
what is needed by the body, then iron that
is stored in the body begins to be used up

32. • If iron stores are depleted, fewer red blood
cells are made and they have decreased
amounts of hemoglobin in them resulting
in anemia.

33. Signs and Symptoms
That are more unique to iron deficiency and that
may appear as iron stores in the body are
increasingly depleted may include:
-Brittle or spoon-shaped nails
-Swollen or sore tongue
-Cracks or ulcers at the corners of the mouth,
-Or a craving to eat unusual non-food substances
such as ice or dirt (also known as “pica”).

34. CAUSES OF IRON DEFICIENCY
• Bleeding
If bleeding is excessive or occurs over a
period of the time (chronic), the body may
not take in enough iron or have enough
stored to produce enough hemoglobin
and/or red blood cells to replace what is
lost.

35. In women, iron deficiency may be due to
heavy menstrual periods, but in older
women and in men, the bleeding is usually
from disease of the intestines such as
ulcers and cancer.

36. • Dietary deficiency
Iron deficiency may be due simply to not
eating enough iron in the diet. In children
and pregnant women especially, the body
needs more iron. Pregnant and nursing
women frequently develop this deficiency
since the baby requires large amounts of
iron for growth.

37. Lack of iron can lead to low birth weight
babies and premature delivery. Pregnant
women are routinely given iron
supplements to prevent these
complications.

38. • Newborns who are nursing from deficient
mothers tend to have iron deficiency
anemia as well.

39. • Absorption problem
Certain conditions affect the absorption of
iron from food in the gastrointestinal (GI)
tract and over time can result in anemia.
These include, for example,Crohn’s
disease.

40. pernicious anemia and other B
vitamin deficiencies
Pernicious anemia is a condition in which
the body does not make enough of a
substance called “intrinsic factor”. Intrinsic
factor is a protein produced by parietal
cells in the stomach that binds to vitamin
B12 and allows it to be absorbed from the
small intestine. Vitamin B12 is important in
the production of red blood cells (RBCs).

41. • Without enough intrinsic factor, the body
cannot absorb vitamin B12 from the diet
and cannot produce enough normal RBCs,
leading to anemia. In addition to lack of
intrinsic factor, other causes of vitamin
B12 deficiency and anemia include dietary
deficiency and conditions that affect
absorption of the vitamin from the small
intestine.

42. Examples are surgery, certain drugs,
digestive disorders (Crohn’s disease), and
infections.

43. • Vitamin B12 deficiency can result in
general symptoms of anemia as well as
nerve problems.

44. SIGNS AND SYMPTOMS
-weakness or fatigue
-lack of energy
-numbness and tingling that start first in
the hands and feet

45. • Additional symptoms may include:
-muscle weakness,
-slow reflexes,
-loss of balance and unsteady walking.

46. • In severe cases can lead to
-confusion,
-memory loss,
-depression, and/or
- dementia

47. • Folic acid is another B vitamin, and
deficiency in this vitamin may also lead to
anemia. Folic acid, also known as folate, is
found in many foods, especially in green,
leafy vegetables. Folic acid is needed
during pregnancy for normal development
of the brain and spinal cord.

48. • It is important for women to take folate
supplements during pregnancy to make
sure they are not folate deficient. Folate
deficiency early in pregnancy can cause
problems in the development of the brain
and spinal cord of the baby.

49. Anemia resulting from vitamin B12 or folate
deficiency are sometimes referred to as
“macrocytic” or “megaloblastic”
anemia because red blood cells are larger
than normal. A lack of these vitamins does
not allow RBCs to grow and then divide as
they normally would during development,
which leads to their large size, leading to
anaemia.

50. AT RISK GROUPS
• People with diets poor in iron and
vitamins.
• Chronic diseases e.g. kidney disease,
diabetes, cancer, inflammatory bowel
disease.
• Family history of inherited anaemia.

51. At risk groups cont’
• Chronic infections such as Tuberculosis or
HIV
• Those who have had significant blood loss
from injury or surgery

52. MEDICAL MANAGEMENT
Acute blood loss
• Identify source of bleeding and stop the
bleeding.
• Replace blood and fluid volume.
• Iv fluids-plasma expander e.g. dextran and
crystalloids such as Ringers Lactate for
electrolytes replacement.

53. • Check Hb, Grouping and X-match.
• Monitor vital signs
-pulse rate
-respirations and
-BP

54. Medical management cont’
• If blood loss is significant, blood
transfusion (whole blood or packed cells)
depending on severity
• In case of post operative,monitor blood
loss from drainage tubes and dressings.

55. Med- management cont’
• Administer supplementary iron i.e. ferrous
sulphate 200mg once daily orally for 1-3
months.

56. Chronic and iron deficiency
anaemia management
• Treat underlying cause e.g. malnutrition.
• Increase iron dietary intake-food rich in
iron.
• Encourage small frequent meals.

57. Management cont’
• Ferrous sulphate 200mg 8 hourly
Side effects include
- Heart burn
- Constipation
- Diarrhoea
- Dark stools because of excess iron
excreted by GIT

58. • Avoid milk or antacids during iron
supplements as it reduces iron absorption

59. NURSING MANAGEMENT
Nursing diagnosis 1. Impaired gas exchange in
the lungs related to reduced oxygen carrying
capacity as shown by increased rate of
breathing, shortness of breath, dyspnea on
exertion and cyanosis.
• Expected patient outcome
- Demonstrates improved ventilation as
evidenced by respiratory rate within normal
limits and having no cyanosis

60. • Nurse patient in semi-fowlers position to
improve ventilation by decreasing venous
return to the heart and increasing thoracic
capacity.
• Check and record respirations for rate,
rhythm and depth half hourly to evaluate
changes in respiratory status.

61. • Give humidified oxygen through a mask or
nasal cannula 4-6L/ min to improve
oxygen saturation
• Check for cyanosis half hourly to note
effectiveness of treatment.

62. • Assist the patient in clearing the airway by
encouraging the patient to cough out
secretions, if he/she can or suction the
airway to clear the airway.

63. Nursing diagnosis 2
• Altered nutrition less than body
requirement related to fatigue, malaise as
manifested by weight loss iron and vitamin
deficiencies.

64. Expected patient outcome
• Consume an adequate diet
• Gradual increase and stabilize body
weight

65. Nursing interventions
• Teach patient to increase intake of
essential nutrients
-HPD
-High calories and iron to maintain
nutritional values
• Involve the patient in dietary plan to
increase compliance and gain weight

66. • Suggest eating small frequent meals with
snacks in between, to reduce oxygen
demand.

67. Nursing interventions cont’
• Iron supplement-ferrous sulphate for 2-3
months hence teach compliance

68. Nursing diagnosis 3
• Activity intolerance related to blood’s
decreased oxygen carrying capacity
manifested by difficult in tolerating activity,
breathlessness

69. Expected patient outcome
• Participating in activities of daily living

70. Nursing interventions
• Plan to alternate periods of rest and
activity
• Assist in activities of daily living as needed
• Place objects within patients reach to
conserve energy
• Limit visitors, noise, and interruptions to
decrease demand placed on the patient

71. Interventions cont’
• Monitor vital signs to evaluate activity
tolerance
• Monitor Hb
• Nurse patient in a quiet well ventilated
room to promote rest.

72. Nursing diagnosis 4
• Non compliance to treatment related to
lack of knowledge about life style,
appropriate nutrition, medication
manifested by questioning

73. Expected patient outcome
• Gain knowledge about life style changes,
nutrition and medication regime
• Demonstrate compliance with the
treatment

74. Nursing interventions
• Explain the causes and symptoms and
treatment of the diseases
• Teach about nutrition, medication and life
style to promote compliance
• Suggest follow-up to help the patient
adjust, gain and maintain throughout
recovery

75. NURSING DIAGNOSIS 5
• Anxiety related to change in health status
as evidenced by restlessness, and
irritability.
• Expected patient outcome
- Demonstrate decreased levels of anxiety
by breathing normally and involvement in
managing the condition

76. • Create an atmosphere to facilitate trust, for
example answering questions nicely, to
promote sense of security
• Use a calm ,reassuring approach to
increase confidence in care giver and
relieve anxiety
• Explain all procedures to patient to
promote sense of security.

77. • Let patient identify the feeling about the
condition and how to cope to assist with
insight and identify coping ways.
• Reinforce information on diagnosis
process and treatment e.g. measures to
reduce stress to reduce symptoms.
• Encourage patient to follow the treatment
guidelines to reduce symptoms

78. Complications of anaemia
• Heart failure
• Angina
• Myocardial infarction
• Hepatomegaly
• Spleenomegaly
• Cardiomegaly

79. Discharge plan
• Include family members in the dietary
planning
• Stress the importance of iron supplements
compliance and keep follow up
appointments

80. References
• http:/www. labtestsonline.org
• Books on course outline