Anaemia

By
Dr.Fakhria Jaber.
 Objectives

Identify the components of blood.

Enumerates what does blood do.
Define the anaemia.
Discus the etiologic classification of
anaemia.
 Objectives Cont.
Identify the clinical manifestations,
Aetiology, Diagnosis, Treatment,
Nursing care for:
Iron deficiency anaemia.
Megaloblastic or Macrocytic
Anaemia:
Cobalamin(vitamin B12)
Folic acid deficiency
A plastic Anaemia
 Hematology

Study of blood and blood forming

tissues
Key components of hematologic
system are:
 Blood
 Blood forming tissues
Bone marrow
Spleen
Lymph system
 What Does Blood Do?
Transportation
Oxygen
Nutrients
Hormones
Waste Products
Regulation
Fluid, electrolyte
Acid-Base balance
Protection
Coagulation
Fight Infections
 Components of Blood

Plasma
55%

Blood Cells
45%
Three types
Erythrocytes/RBCs
Leukocytes/WBCs
Thrombocytes/Platelets
 Erythrocytes/Red Blood Cells
Composed of hemoglobin
Erythropoiesis
= RBC production
Stimulated by hypoxia
Controlled by erythropoietin
Hormone synthesized in kidney

Hemolysis
= destruction of RBCs
Releases bilirubin into blood stream
Normal lifespan of RBC = 120 days
 Leukocytes/White Blood Cells

5 types
Basophils
Eosinophils
Neutrophils
Monocytes
Lymphocytes
Thrombocytes/Platelets

Must be present for clotting to

occur
Involved in homeostasis
 Anaemia
Definition
The term of anaemia refers to a
deficiency in the number of
circulating red blood cells available
for oxygen transport

What is the etiologic classification of

anaemia ?
1- Iron deficiency anaemia
Anaemia Cont.
 Iron deficiency anaemia Cont.
Aetiology
Inadequate dietary intake,
malabsorption.
Blood loss of haemolysis
Gastrointestinal blood loss e.g.
Peptic ulcer, gastritis, oesophagitis.
Menstrual bleeding....45 ml.....loss
of 22mg of iron
Pregnancy...diversion of iron to
 Iron deficiency anaemia Cont.
Clinical manifestation
In early course , the client may be free of symptoms
Mild.... Pallor , fatigue and exertion dyspnea.

Sever.....
Nail become brittle and concave and longitudinal ridges.
Glossitis (inflammation of tongue), bright- red .
Cheilosis (inflammation of lips- The corners of mouth may
be cracked, reddened and painful.
Headache, paresthesia.
Burning sensation of the tongue result to lack of iron
in tissues.
 Iron deficiency anaemia Cont.
Management
Diagnosis
Peripheral blood smears (CBC)
Low serum iron levels, and elevated serum iron- binding
capacity.
Absent iron stores in the bone marrow.
 endoscopy, or colonoscopy to detect GI bleeding.

Treatment
Increasing the intake of iron.
Administer nutrients for erythroporesesis
 Iron deficiency anaemia Cont.
Role of nutrients for erythroporesesis
Cobalamin (Vit B12) has role in RBC maturation found in red
meat especially liver.

Folic acid has role in RBC maturation in leaves, fish.

Vitamin B6 has role in haemoglobin synthesis found in eggs,

whole grain and bread, potatoes.

Amino acids has role in synthesis of nucleoproteins

found in eggs, meat, milk, milk products

Vitamin C has role in conversion of folic acid to its active

forms aids in absorption.
 Iron deficiency anaemia Cont.

Medical therapy
Oral iron supplements (ferrous
sulphate)
It should be taken after meals and
with orange juice
Told the client that the stool will be
black.
Megaloblastic or Macrocytic Anaemia
It characterized by morphological
changes caused by defective DNA
synthesis and abnormal RBC
matured.

The common forms of mgaloblastic

anaemia:
1- Cobalamin(vitamin B12)
oResult from dietary deficiency.
Megaloblastic or Macrocytic Anaemia Cobalamin(vitamin B12)

Symptoms
•General symptoms of anaemia .

•GIT manifestation a a sore tongue,

anorexia, nausea, vomiting and
abdominal pain.

•Neurovascular manifestation as
Megaloblastic or Macrocytic Anaemia Cobalamin(vitamin B12)

Diagnosis
Abnormal Schilling test result which demonstrates, the
inability to absorb vitamin B12.

Treatment
•Parenteral administration of vitamin B12 once/month.

•The nurse should ensure that injuries are not sustained

because of the diminished sensation to heat and pain due to
neurologic impairment.

•Protect client from burn and trauma.

•Evaluate skin for redness.

 Megaloblastic or Macrocytic Anaemia
Folic acid deficiency

Folic acid required for DNA synthesis leading to RBC

formation and maturation.
Daily requirement of folic acid 100 to 200 mg.

Causes
Poor nutrition (Lack of vegetable, yeast, nuts, grains.
Malabsorption syndrome.
Drugs that impede the absorption and use of F acid
(oral contraceptives ,anti seizure agents).
Alcohol abuse and anorexia.
Haemodialysis client because of folic aid is dialyzable.
Pregnancy, and increased requirement & malnutrition.
Megaloblastic or Macrocytic Anaemia Folic acid deficiency

Clinical manifestation
Similar to cobalamin deficiency except the absence of
neurologic problem, this lack of neurologic involvement
differentiate folic acid deficiency from vit. B12.

Diagnosis
Low serum folate level.

Treatment
Anaemia caused by a dietary deficiency can be treated with 1
mg of folic acid for 3- month period.
Diet ... Orange, meat, eggs, cabbage, citrus fruits .
 A plastic Anaemia
Related to reduced or impaired erythrocyte
production (fatty bone marrow).

Aetiology
It can be divided into the major groups:
1- Congenital
Caused by chromosomal alterations.
2- Acquired as a result of exposure to:
Ionizing radiation, chemical agents (DDT, alcohol)
Viral and bacterial infection(hepatitis, miliary TB)
 A plastic Anaemia
Aetiology Cont.
Prescribed medication(alkalating
agents, antimicrobial)
Pregnancy.
Idiopathic
Pathophysiology
It caused by depression of activity of all blood-producing
elements { There is decrease in white blood
cells(Leukopoenia), Platelets(Thrombocytopoenia), and
decrease in the formation of RBC,
 A plastic Anaemia Cont.
Clinical Manifestation
Pallor of skin and mucous
membranes.
Cardiovascular (fatigue, and
dyspnea on exertion, palpitation)
 Cerebral responses
Infection of skin and mucous
membrane.
 A plastic Anaemia Cont.
Management.
•The CBC characteristically reveals a pancytopoenia (a
marked decrease in the numbering of cell types)
•The reticulocyte count is low .
•Bone marrow examination and biopsy

Treatment
Bone marrow transplantation
from a donor with identical human
leukocyte antigen for person
 A plastic Anaemia Cont.
The remainder of persons are treated with
immunosuppressive therapy.
Nursing care
Is based on careful assessment and
management of complications of
pancytopoenia by:
oPrivate room.
oProtective isolation
oProvide and instruct the client on meticulous hygiene.
oAssessment and maintenance of oral
 A plastic Anaemia Cont.
Nursing Care Cont.
oAvoid bladder catheterization.
oInstruct family and visitors on careful hand washing.
oNursing intervention for preventing bleeding.........

Teaching the person with a plastic anaemia include:

Prevent infection.
Prevent haemorrhage.
Prevent fatigue.
 Haemolytic Anaemia
Definition
Premature destruction of erythrocyte occurring at such a rate
that the bone marrow is unable to compensate for the loss of
cells.

Haemolysis can occur either extra vascular or

intravascular.
In extra vascular, the spleen removes erythrocytes from
circulation at much more rapid rate.

In Intravascular it is secondary to the erythrocyte lysing

and spilling the cell contents into the spleen
 Haemolytic Anaemia Cont.
Aetiology
The causes may be acquired form or hereditary forms
Acquired forms
Immune system-mediated haemolysis is caused or
associated with transfusion reactions, haemolytic disease
of the newborn
Traumatic haemolysis is caused by presence of prosthetic
heart valves; structural abnormalities of the heart;
haemodialysis.
Infectious haemolysis are due to bacterial infection
(cholera, typhoid)
 Haemolytic Anaemia Cont.
Toxic (chemical) haemolysis occurs as the result of
exposure to toxic chemical agents; haemodialysis or
uraemia.
Physical haemolysis are due to burns and radiation.
Hypophosphatemic haemolysis are due to
hypophosphatemia (phosphate deficiency in plasma.

Hereditary Form
Structural defect i.e., plasma membrane defect,
destruction due to fragility of the erythrocyte.
Enzyme deficiency i.e., deficiency of glycol tic enzymes
 Haemolytic Anaemia Cont.
Clinical Manifestation
Ischemia occurs when red cells clump in the capillary
beds, causing cyanosis, pain and paresthesia.
Haemoglobinuria.

Management
Diagnosis
The presence of the antibody or complement on the
RBCs (direct Coomb’s test) or in the serum(indirect
Coomb’s test)
Decreased Hct.
Increased reticulocyte and bilirubin
 Anaemia caused by blood loss
Anaemia resulting from blood loss
may be caused by either acute or
chronic.
Aetiology /Pathophysiology
•Trauma
•Complications of surgery
•Diseases that disrupt vascular integrity.
There are two clinical concerns in such situation
First
There is sudden reduction in the total blood volume that
 Haemolytic Anaemia Cont.
Treatment
Mild cases require no treatment.
Supportive care includes:
Administering corticosteroids and blood products.
Removing the spleen.

Nursing Management
Teach the client about drug therapy.
Preparing the client for surgery.
Anaemia caused by blood loss Cont.

Second
If the acute loss is more gradual, the
body maintains its blood volume by
slowly increasing the plasma volume.
Consequently, the circulating fluid
volume is preserved. But the number
of RBCs available to carry oxygen is
Anaemia caused by blood loss Cont.
Clinical Manifestation
Clinical manifestation of acute blood loss according to varying
degrees of blood volume loss as follows:
Volume Clinical manifestation
loss
10% None

20% No detectable signs or symptoms at rest, tachycardia with exercise

and slight postural hypertension.
30% Normal supine blood pressure and pulse at rest , postural
hypertension and tachycardia with exercise.
40% Blood pressure, central venous pressure, and cardiac output below
normal at rest, rapid , threading pulse and cold and clammy skin.

50% Shock and potential death

 Anaemia caused by blood loss Cont.
Management
Replacing blood volume to prevent
shock.
Identify the source of
haemorrhage and stopping blood
loss.
IV fluid used in emergency includes
dextran, albumin, or crystalloid
Thank You