Anaemia

By MITTI EUGINE.
Definition

 It is a Blood disorder where there is reduced

haemoglobin for the age and sex of an
individual which may be due to excessive
destruction of RBCs, inadequate production
of RBCs, or loss of blood. (Kumar & Clark
2005)
 Is a reduction in either the number of RBCs,
the amount of hemoglobin or the hematocrit
(Ignatavicius D and Workman M. L,2006)
Various cells in the blood vessel
Definition cont

 It is a reduction of oxygen carrying capacity

of blood as a result of fewer circulating
erythrocytes in blood.
 It is a reduction in the number of circulating
red blood cells or in their content of
hemoglobin or both usually characterized by
pallor, tachycardia and malaise.
Classification

 Anaemia may be classified in two ways ie.

 According to:
 cause or
 according appearance of the RBC.
Classification according to causes

 Haemorrhagic anaemia (Anaemia due to blood loss)

 Haemolytic anaemia (Anaemia due to excessive
destruction of RBCs)
 Aplastic anaemia (Anaemia due to bone marrow
aplasia)
 Blood forming element deficiency anaemia. (e.g.
Iron anaemia, folic acid and vitamin B12 deficiency
anaemia) NOTE some times this may be considered
under aplastic anaemia.
Classification according to appearance
of the RBCs

 Macrocytic hyperchromic anaemia ( Cell appears

larger than normal and appears red usually seen in
folic acid or vitamin B deficiency anemia)
 Microcytic hypocromic anaemia (The cell appear
smaller than normal and they appear pale. Usually
due to iron deficiency)
 Normocytic normocromic (The cells are normal in
size and colour) Seen an acute blood loss.
This picture shows large, dense, oversized, red blood cells that are seen
in megaloblastic anemia. Megaloblastic anemia can occur when there is a
deficiency of vitamin B-12.
Specific types of anaemia and there
causes

 The four types of anaemia alluded earlier will

be discussed in detail below,
Blood forming element deficient
anaemia .

 The cause of this type of anaemia include the

shortage of the elements like iron, vitamin B12 and
folic acid in the body.
 The sub types under this include;
 Iron deficiency anaemia
 Vitamin B12 deficiency anaemia (Pernicious
anaemia) a type of megaloblastic anaemia.
 Folic acid deficiency anaemia This is also a type of
megaloblastic leukaemia.
Blood forming element deficient
anaemia .

 The bone marrow needs iron to make hemoglobin.

 Without adequate iron, the body can't produce
enough hemoglobin for red blood cells resulting in
iron deficiency anemia.
 One way your body gets needed iron is when blood
cells die — the iron in them is recycled and used to
produce new blood cells
Blood forming element deficient
anaemia cont.

 So, if you lose blood, you lose iron.

 Women with heavy periods who lose a lot of
blood each month during menstruation are at
risk of iron deficiency anemia.
 Slow, chronic blood loss from a source
within the body — such as an ulcer, a colon
polyp or even colon cancer can lead to iron
loss and iron deficiency anemia
Blood forming element deficient
anaemia .

 In addition to iron, your body needs folate

(folic acid) and vitamin B-12 to produce
sufficient numbers of healthy red blood cells.
 A diet lacking in these and other key
nutrients can cause decreased red blood cell
production.
Blood forming element anaemia
deficient cont

 People who have an intestinal disorder that affects

the absorption of nutrients are prone to this type of
anemia.
 Some people are unable to absorb vitamin B-12 for a
variety of reasons and develop vitamin B-12
deficiency anemia, which is sometimes called
pernicious anemia.
 Vitamin deficiency anemias fall into a group of
anemias called megaloblastic anemias, in which the
bone marrow produces large, abnormal red blood
cells.
Aplastic anemia

 This is a life-threatening anemia caused by

a decrease in the bone marrow's ability to
produce all three types of blood cells i.e. .red
blood cells, white blood cells and platelets.
 Many times, the cause of aplastic anemia is
unknown, but it's believed to often be an
autoimmune disease.
Aplastic anemia cont

 Some factors that can be responsible for this

type of anemia include chemotherapy and
radiation therapy.
 Some drugs like chloramphenicol, may also
depress the bone marrow causing aplastic
anaemia.
Aplastic anemia cont

. A variety of diseases, such as leukemia and

myelodysplasia, a pre-leukemic condition,
can cause anemia by affecting blood
production in the bone marrow.
• The effects of these types of cancer and
cancer-like disorders vary from a mild
alteration in blood production to a complete,
life-threatening shutdown of the blood-
making process.
Haemolytic anaemia

 This is a type of anaemia caused by

destruction of red blood cells.
 The cause include;
 sickle cell anaemia
 Infections like malaria
 Blood transfusion incompatibility
 Toxic drugs and poisons e.g. lead poison
and snake venom
Haemorrhagic anaemia

 This anaemia due to sudden blood loss from

a blood vessel
 E.g. Following trauma
 Surgery
 Child birth
 Chronic epistaxis
Haemorrhagic anaemia cont

 Schistosomiasis
 Menorrhagia
 anti-inflammatory drugs or
 anti-coagulant medications
 This may cause haemorrhage
Predisposing factors

 Dietary deficiency - lack of iron, vitamin B12 or folic

acid in the diet.
 Malabsorption - caused by conditions such as
coeliac disease.
 Inherited disorders - such as thalassaemia or sickle
cell disease.
 Autoimmune disorders - such as autoimmune
haemolytic anaemia, where the immune cells attack
the red blood cells and decrease their life span.
Predisposing factors cont

 Certain drugs - including alcohol, antibiotics, anti-

inflammatory drugs or anti-coagulant medications.
 Infection - such as malaria and septicaemia, which
reduces the life span of red blood cells.
 Certain drugs - including alcohol, antibiotics, anti-
inflammatory drugs or anti-coagulant medications.
 Periods of rapid growth or high energy
requirements - such as puberty or pregnancy.
Predisposing factors cont

 Blood loss - due to trauma, surgery, cancer, peptic

ulcer, heavy menstruation, bowel cancer or frequent
blood donations.
 Chronic diseases - such as rheumatoid arthritis and
tuberculosis.
 Hormone disorders - such as hypothyroidism.
 Bone marrow disorders - such as cancer, infection
or certain medications
Pathophysiology

 Red Blood Cells are produced at the same rate of

their destruction
 This ensures that the level remain within normal
range.
 The average life span of an erythrocyte is 120 days
after which they are destroyed.
 When the rate of production is exceeded by the rate
of destruction a deficit results, giving rise to anaemia.
Pathophysiology cont

 Low Hb means reduced oxygen carrying

capacity of blood.
 This will lead to the use of the compensatory
mechanism to meet the body demand for
oxygen.
 The compensatory mechanisms include;
 Tachycardia, in order to meet the body
demand for oxygen.
Pathophysiology cont

 This mechanism leads to cardiomegally due

to hypertrophy of cardiac muscles.
 This will eventually make the heart less
efficient giving rise to various symptoms.
General signs and symptoms of
anaemia

 Pallor due to low Hb

 Heart palpitations due to tachycardia and
myocardial hypoxia
 Dizziness due to cerebral hypoxia
 Easy fatigability due to tissue hypoxia
 Dyspnea on exertion due to cardio
pulmonary involvement
 Fainting spells due to cerebral hypoxia
General signs and symptoms of
anaemia cont

 Headache due to cerebral hypoxia

 Feeble rapid pulse due to reduced blood
volume and due to hypoxia
 Bleeding tendencies due to lack of clotting
factors
 Susceptibility to infection due to
accompanying leukocytopaenia
 Cyanosis due to tissue hypoxia
General signs and symptoms of
anaemia cont

 Difficulties to concentrate due to cerebral

hypoxia.
 Cracked or reddened tongue
 Strange food cravings due to deficiencies
Diagnosis

 Medical history - including any chronic illnesses

and regular medications.
 Physical examination will show pallor
 Blood tests - including Full blood count and blood
iron levels.
 Gastroscopy or colonoscopy to r/o ulcers and
cancers respectively
 Bone marrow biopsy to r/o bone marrow aplasia
 Faecal occult to r/o chronic blood loss
Treatment

 Folic acid 5-10mg od for 14/7.

 Ferrous sulphate 200mg bd for 14/7
 Iron injections - if the person is very low on
iron. e.g.. Inferon 2mls bd for 5/7
 Vitamin B12 (by injection) - required for
pernicious anaemia.2mls Bd every 2 weeks
and maintenance of 1ml for life.
Treatment cont

 Altering the dose or regimen of regular

medications - such as anti-inflammatory
drugs, if necessary.
 Blood transfusions - if required.
 Oxygen therapy - if required.
 Surgery to prevent abnormal bleeding -
such as heavy menstruation.
Treatment cont

 Iron injections - if the person is very low on

iron. e.g.. Iron dextran 50-100mg
 For headache panadol can be given
1000mg tds for 3/7
 Antibiotics - if infection is to blame. E.g..
Ampicillin 500mg qid for 5/7
Complications

 Cardiomegally
 Heart failure
 Renal failure
 Hepatomegally
PREVENTION
 Anaemia caused by dietary deficiency can be
prevented by making sure that certain food groups
are consumed on a regular basis, including dairy
foods, lean meats, nuts and legumes, fresh fruits
and vegetables
 Vegetarians who prefer not to eat any dairy foods
(vegans) should consider taking vitamin and mineral
supplements regularly.
PREVENTION cont

 Intestinal disorders. Having an intestinal

disorder that affects the absorption of
nutrients in the small intestine — such as
Crohn's disease and celiac disease — puts
you at risk. These should be managed
properly to prevent anaemia
PREVENTION cont

 Iron and folic acid supplementation

during pregnancy: This will help to prevent
anaemia during pregnancy.
 Prompt and adequate management of
infections like malaria: To prevent malaria.
 Avoiding of unprescribed drugs: This will
help prevent anaemia that may be caused by
some drugs like chloramphenicol,
PREVENTION cont

 Regular deworming. To prevent worm infestation

such as hook worm which may cause anaemia.
 Child spacing: should be practiced in order to
enable the body recover and replace its iron stores
before another pregnancy.
 Encourage pregnant women to attend antenatal
and post natal clinic: This will help prevent ante
and post partum haemorrhage, thereby preventing
anemia.
Nursing Care

 AIMS
 To eliminate the cause.
 To increase the oxygen carrying capacity of
blood.
 To reduce the demand for oxygen.
 Alleviate discomfort.
 Prevent complications.
 Prevent acquisition of infection
Environment

 The patient will be nursed in a general ward,

however reverse barrier nursing will be used
to prevent nosocomial infection.
 The room should be warm because the
patient has cold intolerance in order to
promote patients comfort.
 The room should be well ventilated to
promote air circulation and prevent R.T.I.
Environment cont

 Oxygen apparatus will be made available for use

when in time of dyspnoea
 The room should be well lit for easy observation
 I will include the bed blocks on the room for elevating
the foot end of the bed incase of shock.
 Patient will be nursed in a railed bed to prevent fails
as patient is dyspnic
Position

 The patient will be propped up to relieve

dyspnoea.
 In case of shock the foot end of the bed will
be elevated to promote blood supply to the
brian.
 As the condition improves I will allow the
patient to adopt any position of comfort
Rest and activity

 The patient will be on bed rest in in the acute phase

in order to reduce the demand for oxygen.
 In severe cases of anaemia, complete bed rest is
necessary until HB is raised to prevent hypoxia.
 I will plan my nursing care in such a way that periods
of rest are allowed in order to conserve patients
energy.
 I will provide a quiet environment to promote rest.
Rest / activity
 I will nurse the patient in a quiet room to promote
rest
 I will play the radio at low volume to promote rest
 I will answer all phone calls promptly to prevent
disturbing the patient there by promote rest
 I will do related procedures in blocks to promote rest
 I will administer prescribed analgesics to relieve
headache there by promote rest
 I will ensure that squeaking trolleys a oiled to prevent
noise and there by promote rest
Observations

 I will do vital sign and BP to act as the base line data

in order to know if the condition is improving or
deteriorating
 I will observe for cyanosis if improving or getting
worse and give oxygen therapy when necessary
 I will observe Dyspnea if present will prop up the
patient to promote lung expansion and there by
relieve dyspnea
 I will observe the pressure area to detect on set of
pressure sore development
Observations cont

 I will observe the patient’s facial expressions to

detect pain and administer prescribed analgesics like
panadol
 I will observe the feeding pattern of my patient and
take measures like giving small frequent meals to
promote appetite
 I will observe the respirations to detect tachypnoea
and report accordingly
Psychological care
 I will explain the disease process in order to raise the
knowledge levels and thereby alley anxiety
 I will encourage the patient to ask questions and I
will answer accordingly those I cant answer I will
refer to the physician
 I will explain all procedures to my patient in order to
allay anxiety
 I will involve a successfully managed case to come
and talk to my patient in order to allow the patient
ask pressing questions and get answer this will
improve the patients out look on his condition.
Psychological care

 I will involve the loved ones in his care in order for

him not to feel neglected.
 I will provide diversional therapy in order to shift the
patient’s mind from the hospital routine and his
condition
 I will involve him in planning his own care in order for
him not to feel left out
 I will explain to him that as the health care team we
are doing everything possible to ensure that he get
better in order to promote co-operation.
Elimination

 I will provide a lot of fluids and roughage to

prevent constipation
 I will prove copious fluids in order to promote
renal wash out and there by prevent renal
problems
 I will offer a bed pan if he is confined to bed
to ensure bowel movement
Hygiene

 I will encourage the patient to take plunge

baths in order to remove dead epithelium
and promote comfort
 I will do hair care to promote self esteem and
also prevent pediculosis
 I will do nail care to prevent auto infection
and bruising self which can lead to bleeding
Hygiene cont

 I will do mouth care with a soft brush to

prevent halitosis and causing bleeding
because patient has bleeding tendancies
 Any soiled linen and clothes will be changed
to promote comfort
Nutrition

 I will provide energy giving foods like inshima

to provide the energy needed for the
metabolic processes
 I will provide protein foods like fish and
beans to promote replacement of worn out
tissues
 Vegetables and fruits will be provided to
raise the immunity and promote skin and
mucous membrane
Nutrition cont

 I will provide a lot of oral fluids to prevent

dehydration due to excessive sweating and
promote bringing up of phlegm
 I will serve small frequent meals to promote
appetite
 I will provide Iron rich food such as liver,
meat, green leafy vegetables to promote
blood formation
Nutrition cont

 I will allow visitors to bring food preferred by

the patient in order to promote appetite
 I will do regular mouth washes in order to
promote appetite
Activity

 If my patient is confined to bed i will do passive

exercises like limb movement and massage in order
to prevent muscle atrophy and promote blood
circulation
 I will encourage the patient to do deep breathing
exercises in order to promote lung expansion
 I will encourage early ambulation as soon as the
condition permits in order to prevent deep vein
thrombosis and other complications of immobility
Medication

 I will administer prescribed analgesic like

panadol at the right time to promote rest
 I will give prescribed antibiotics like X-pen to
promote quick recovery
 I will ensure that I offer my patient iron and
folic acid to promote blood formation
 I will ensure that the drugs are swallowed in
my presence to promote recovery.
Medication

 I will ensure that I sign for the drug to prevent

over dosing the patient
 I will give the drug at the right time and
frequency to ensure required plasma level
are maintained thereby promoting recovery
Advise on discharge
 I will educate the patient about his condition in order
to create awareness and prevent recurrence of the
condition
 I will explain the need for taking the medication in
order to promote compliance and recovery.
 I will educate the patient about the sign and
symptoms of the condition for early diagnosis and
treatment thereby preventing complications
 I will talk to the patient about the need to take a
balanced diet using locally available foods in order to
boost the immunity and blood formation.
Advise on discharge

 I will educate the patient about the need keep the

review dates so that his progress is monitored to
ensure full recovery
 I will advise the patient to ensure that he is
dewormed at least twice in a year in order to
prevent worm infestation thereby prevent
anaemia.
 I will advise my patient to have malaria promptly
treated to avoid haemolysis which can lead
anaemia
THE END

NATOTELA SANA PAKU MPAKO AMATWI

YENU

May God bless you all

(MWATA MITTI.]