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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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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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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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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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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