Anemia

Anemia, classification, management and diagnosis for Nursing

1. ANEMIA Prepared by: Kopila Mugrati (MSN)

2. Definition: Anemia is a clinical condition in which the hemoglobin concentration is lower than normal ; it reflects the presence of fewer than the normal number of erythrocytes (i.e., red blood cells [RBCs]) within the circulation. As a result, the amount of oxygen delivered to body tissues is also diminished (hypoxia).

3. Anemia is not a specific disease state but a sign of an underlying disorder. Men: Hb < 13.5 or HCT < 41% Women: Hb < 12.0 or HCT < 36%

4. Incidence: The  prevalence of anemia  among pregnant women was even higher (75%). In other words, three out of four pregnant women in  Nepal  are anaemic .

5. Risk factors: Aging ( adults 65 and older) (Hereditary anemias) Family history: Risk increases if family has a history of an inherited anemia, such as sickle cell anemia. A diet lacking in certain vitamins and minerals:   A diet consistently low in iron, vitamin B-12 and folate increases the risk of anemia. Intestinal disorders:   Having an intestinal disorder that affects the absorption of nutrients in your small intestine — such as Crohn's disease and celiac disease —are at risk of anemia. Menstruation: In general, women who haven't had menopause have a greater risk of iron deficiency anemia than do men and postmenopausal women. Menstruation causes the loss of red blood cells.

6. continue.. Pregnancy:   In pregnancy, lacking intake of a multivitamin with folic acid and iron, increases risk of anemia. Chronic conditions : In cases like cancer, kidney failure, diabetes or another chronic condition, can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source within your body can deplete your body's store of iron, leading to iron deficiency anemia. Other factors :  A history of certain infections, blood diseases and autoimmune disorders increases the risk of anemia. Alcoholism, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia

7. Classification of Anemia Etiologic Classification Impaired RBC production Excessive destruction Blood loss Morphologic Classification Macrocytic anemia Microcytic hypochromic anemia Normochromic normocytic anemia

8. Etiology/causes:

9. Etiological classification of anemia Decreased RBC production: defective DNA synthesis Decreased hemoglobin synthesis Decreased number of erythrocyte precursors

10. Increased RBC destruction (hemolysis) ( c on t . ) Hemolytic anemia Intracorpuscular defect Membrane : Hereditary spherocytosis Hereditary ovalocytosis, etc. Enzyme : G-6PD deficiency, PK def., etc. Hemoglobin : Thalassemia, Hemoglobino- pathies

11. Increased RBC destruction (hemolysis) ( c on t . ) Extracorpuscular defect Mechanical : March hemolytic anemia MAHA (Microangiopathic HA) Chemical/Physical Infection : Clostridium tetani Antibodies : HTR , SLE Hypersplenism

12. Morphological classification of anemia Macrocytic anemia Microcytic hypochromic anemia Normochromic normocytic anemia

13. Macrocytic Anemia Develops due to: i . Megaloblastic dyspoiesis / erythropoiesis: Vit. B12 deficiency : Pernicious anemia Folic acid deficiency : Nutritional megaloblas tic anemia, Sprue, Other malabsorption Inborn errors of metabolism : Orotic aciduria, etc. Abnormal DNA synthesis : Chemotherapy, Anticonvulsant, Oral contraceptives

14. Macrocytic Anemia (cont..) ii . Non-megaloblastic erythropoiesis: In chronic hemolytic anemia Liver diseases hypothyroidism

15. Microcytic Hypochromic Anemia Fe deficiency anemia : Chronic blood loss, Inadequate diet, Malabsorption, Increased demand, etc. Abnormal globin synthesis : Thalassemia with or without Hemoglobinopathies Abnormal porphyrin and heme synthesis : Pyridoxine responsive anemia, etc. Other abnormal Fe metabolism

16. Normocytic Normochromic Anemia 1. Blood loss Increased plasma volume : Pregnancy, Overhydration Hemolytic anemia : depend on each cause Hypoplastic marrow : Aplastic anemia, RBC aplasia Infiltrate BM : Leukemia, Multiple myeloma, Myelofibrosis, etc. Abnormal endocrine : Hypothyroidism, Adrenal insufficiency, etc. Kidney disease / Liver disease / Cirrhosis

17. Who grading of anemia Hemoglobin level Grade of anemia 10gm /dl Mild anemia 7gm /dl Moderate anemia < 7gm /dl Severe anemia

18. Clinical grading of anemia Pallor observed in Grade of anemia conjunctiva, mucous membrane only Mild anemia Skin Moderate anemia Palmar creases along with skin and mucous membrane Severe anemia

19. Clinical manifestations Fatigue Listlessness Anorexia Lately: pallor in conjunctiva, mucous membrane, Skin, Palmar creases Weakness Vertigo Headache malaise

20. Drowsiness Sore tongue Tachypnea Shortness of breath on exertion Tachycardia Palpitation Hepatomegaly in some cases, enlarged lymph gland.

21. Diagnostic measures

22. complications Circulatory collapse Shock CCF Systemic or local infection enlarged heart (cardiomegaly) (When the hemoglobin level is low, the heart attempts to compensate by pumping faster and harder in an effort to deliver more blood to hypoxic tissue)

23. management Medical management includes: Immediate control of bleeding/ blood loss Restore blood volume by I/V infusion, blood transfusion along with the treatment of shock and cause of bleeding Iron supplement, folic acid, Vitamin B- 12 , and replacement of specific nutrients Removal of toxins if present.

24. Nursing management: Assess the Health history and physical exam: Assessment of the GI system may disclose complaints of nausea, vomiting (with specific questions about the appearance of any emesis [e.g., looks like “coffee grounds”]), melena (dark stools), diarrhea, anorexia, and glossitis (inflammation of the tongue). Stools should be tested for occult blood. Women should be assessed about their menstrual periods (e.g., excessive menstrual flow, other vaginal bleeding) and the use of iron supplements during pregnancy. Medication  history . Some medications can depress bone marrow activity, induce hemolysis, or interfere with folate metabolism.

25. History of alcohol intake . An accurate history of alcohol intake including the amount and duration should be obtained. Family history . Assessment of family history is important because certain anemias are inherited. Athletic endeavors . Assess if the patient has any athletic endeavor because extreme exercise can decrease erythropoiesis and erythrocyte survival. Nutritional assessment . Assessing the nutritional status and habits is important because it may indicate deficiencies in essential nutrients such as iron, vitamin B12 , and folic acid.

26. Nursing diagnosis Fatigue  related to decreased hemoglobin and diminished oxygen-carrying capacity of the blood. Altered nutrition, less than body requirements , related to inadequate intake of essential nutrients. Altered tissue perfusion  related to insufficient hemoglobin and hematocrit. Risk for infection related to general weakness.

27. Nursing Interventions maintaining adequate nutrition managing fatigue activity intolerance promoting adherence with prescribed therapy monitoring and managing potential complications