Anemia

Blood Disorders

Anemia

Anemia is a lack of blood. Hemoglobin deficiency can be qualitative or quantitative. It is not an illness; rather, it is one of many other diseases' symptoms. Laboratory results such as female Hgb 12Hct 36 and male Hgb 13.5 and Hct 41 can be used to identify anemia. The most prevalent blood condition is anemia. Anemia can take many different forms and have a number of underlying causes. There are two main methods:

•  The "kinetic" approach which involves evaluating production, destruction and loss.
•  The "morphologic" approach which groups anemia by red blood cell size.

Classifications

The main classes of anemia include

• Excessive blood loss: acute or chronic e.g. trauma or injury, GI bleeding etc
• Excessive blood cell destruction (hemolysis) eg Sickle cell anemia, thalassemia, infection (Epstein- Barr virus, typhoid fever, Escherichia coli, Streptococcus), tumors, autoimmune disorders, medication side effects (acetaminophen, penicillin, chlorpromazine, interferon alfa, quinine etc.), leukemia, lymphoma
• Deficient or reduced red blood cell production (ineffective hematopoiesis) e.g. F e2+ vitaminB12 and folic acid deficiency, aplastic anemia, genetic defects etc.

Signs and Symptoms

• Mild Anemia
  • Hemoglobin below normal, usually asymptomatic.
  • Symptoms usually follow strenuous activities; palpitation, dyspnea, diaphoresis.
• Moderate Anemia
  • Dyspnea,
  • Palpitation,
  • Diaphoresis,
  • Chronic fatigue.
• Severe Anemia
  • Pale, exhausted all the time,
  • Severe palpitations,
  • Sensitivity to cold,
  • Loss of appetite,
  • Profound weakness,
  • Dizziness, headache,
  • Cardiac complications- CHF, angina pectoris.
• Pallor- pale skin, mucosal lining and nail beds
• Pica - iron deficiency anemia

Diagnosis

• History: diet (types, quality, quantity), bleeding from any body part, exhaustion dyspnea, fatigue etc
• Physical examination-pulse, pallor, spleen, liver
• Blood test: CBC, RBC, Hgb, serum iron, vitamin B12, etc
• Bone marrow examination

Management

• Treat according to causes and severity of the disease,
• Vitamin B12 - 1000 micrograms intramuscularly monthly or 1000-2000 micrograms po Q daily,
• Oral iron salts: ferrous sulfate - 325 mg po Q day; Parenteral if not tolerated oral iron or noncompliant with therapy,
• Vitamin C can facilitate iron absorption,
• Blood transfusion,
• Injection Erythropoietin,
• Splenectomy.

Nursing Management

• Monitor for signs and symptoms of bleeding, hypoxia, infection.
• Provide for adequate rest-plan activities so as not to overtire.
• Provide diet high in protein, iron, vitamins Frequent turning and positioning to prevent complications of immobility.
• Provide or suggest small easily digestible meal.
• Monitor blood transfusion Protect from source of infection.
• Advice or provide good oral hygiene according to the condition of the patient.
• Provide teaching about.
• Self Care: maintain good personal hygiene, avoid smoking, alcohol, maintain adequate rest etc
• Dietary Instruction such as eat a high vitamin- rich diet such as Iron-rich foods (meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables, and dried fruit), folic acid (fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products), vitamin B-12 (meat, dairy products, and fortified cereal and soy products, and vitamin C (citrus fruits and juices, peppers, broccoli, tomatoes, melons and strawberries, which helps increase iron absorption). Avoid phosphates containing diet such as soft drinks, beer, ice cream, candy bars that block the absorption. Increase dietary fiber to prevent constipation.
• Medication: avoid aspirin or medicines containing aspirin (increase risk of bleeding) antacid (blocks iron absorption). Take iron tablet afte meal etc.
• Safety Precaution same as prevention of bleeding in leukemia.
• Follow up visit.