ANEMIA.ppt

Anemia notes for nursing course

2. ANAEMIA

3. Anatomy of blood
•bloodistheriveroflife,isgenuinelytrue.
•constituentofhumanbodyanditformsthecirculatory
system.
•occupies8%oftotalbodyweightandhasanaverage
densityofabout1060kg/m3.
•intricatenetworkofveinsandarteries,distributesblood
throughoutthebody.

4. Cont..
•circulatingfluidprovidingthebodywithnutrition,
oxygen,andwasteremoval.
•Theaveragepersonhasabout5liters(morethana
gallon)ofblood.

5. COMPONENTS:
1.Red blood cells
2.White blood cells
3.Platelets
4.Proteins

6. FUNCTIONS :
Suppliesoxygenandnutrients.
Removeswasteproductslike,urea,lacticacidand
carbondioxidefromourbody.
Providesimmunity
Helpsintransportationofhormones
Aidsinbloodclotting
Regulatesandmaintainsnormaltemperature
MaintainspHbalanceinsidethebody.
ThepHofbloodliesintherangeof7.35to7.45
Helpinhomeostasis.

7. Anaemia:
WORD ORIGIN AND HISTORY
FORANAEMIA:
•1824,fromFrenchmedicalterm(1761),ModernLatin,
fromGreekanaimia"lackofblood,"fromanaimos
"bloodless,"froman-"without"(an-(1)+haima"blood"
(-emia).

8. DEFINITION
•Anemiaisdefinedasthereductionintheredblood
cellsorinconcentrationofhemoglobin,belowthe
lowerlimitofthenormalrangeforageandsexofthe
individual.

9. HEMOGLOBIN VALUES:
AGE NORMAL VALUE MEAN VALUE
Birth 13.5 -24.0 g/dl 16.5 g/dl
<1month 10.0 -20.0 g/dl 13.9 g/dl
1-2months 10.0 -18.0 g/dl 11.2 g/dl
2-6months 9.5 -14.0 g/dl 12.6 g/dl
0.5-2years 10.5 -13.5 g/dl 12.0 g/dl
2-6years 11.5 -13.5g/dl 12.5 g/dl
6-12years 11.5 -15.5 g/dl 13.5g/dl
Female:
12-18years
>18years
12.0 -16.0 g/dl
12.1 -15.1 g/dl
14.0 g/dl
14.0 g/dl
Male:
12-18years
>18years
13.0 -16.0 g/dl
13.6 -17.7 g/dl
14.5 g/dl
15.5 g/dl

10. CLASSIFICATION
1. BASED ON
MORPHOLOGY
2. BASED ON
ETIOLOGY

11. 1. BASED ON MORPHOLOGY
1.Microcytic anemia
2.Normocytic anemia
3.Macrocytic anemia

12. 1.Microcytic
Anemia
2.
Normocytic
Anemia
3.Macrocytic
Anemia
•Abnormallysmall
cellsarepresentin
theirondeficiency
anemiaandcertain
non iron
deficiencyanemia
•likesideroblastic
anemia and
thalassemia.
•RBC’sarenormal
inshapebut
anemiaoccursdue
tothebloodloss,
hemolysisorbone
marrowfailure.
•RBC’s are
normallylargein
shape.Itisusually
duetovitaminB
12
orfolicacid
deficiency.
Example:
megaloblastic
anemia.

13. On the basis of haemoglobin content in RBC, anemia may be:
1.Hypochromic:
•abnormally decreased haemoglobin content.
2. Normochromic:
•Normal haemoglobin content.

14. 2. BASED ON ETIOLOGY
1. Anemia due to blood loss
2. Anemia due to impaired cell
production
3. Anemia due to increased cell
destruction

15. 1. Anemia due to blood loss:
i. Acute post hemorrhagic anemia
ii. Chronic post hemorrhagic anemia

16. 2. Anemia due to impaired cell
production
A.Deficiencyofsubstancesessentialforthe
erythropoiesis:
Irondeficiencyanemia
VitaminB
12andfolatedeficiency
B.Disturbanceofproliferationanddifferentiationof
stemcells:
Aplasticanemia
Aplasiaofpureredcells

17. C.Disturbanceofbonemarrowfunctionsordueto
systemicdisease:
Anemiaduetoinfection
Anemiainrenaldisease
Anemiainliverdisease
Anemiaindisseminatedmalignancy
Anemiainendocrinopathies

18. D. Anemia due to bone marrow dysfunction:
•Leukemia
•Myelosclerosis
•Multiple myeloma
E. Congenital anemia:
•Sickle cell anemia
•Congenital dyserythropoietic defect anemia

19. 3. Anemia due to increased cell
destruction
A. Anaemia due to intracorpusular defect:
Sickle cell anemia
Thalassemia
B. Anaemia due to extracorpusular defect:
Haemolytic disease of newborn
Effect of cytotoxic drugs
Effects of venoms or poisoning from substance like lead
Thermal injury or burn
Transfusion reactions

20. OTHER CAUSES:
Fluidoverload(hypervolemia)causesdecreased
hemoglobinconcentrationandapparentanemia
Generalcausesofhypervolemiaincludeexcessive
sodiumorfluidintake,sodiumorwaterretentionand
fluidshiftintotheintravascularspace.

21. 1. Sickle cell Anemia
2. Aplastic Anemia
3. HemolyticAnemias
4. Vitamin Deficiency Anemias
5. Thalassemia
6. Heinz Body Anemia
7. Refractory Anemia
8. Iron Deficiency Anemia

22. 1. Sickle cell Anemia:
knownasHemoglobinSdisease.
Inheriteddisorder.
Redbloodcellsbecomecrescent-shaped
Theybreakdownrapidly,sooxygendoesnotgettothe
body'sorgans,causinganemia.
Thecrescent-shapedredbloodcancellsalsogetstuck
intinybloodvessels,causingpain.
sickle-shapedredbloodcellsthatarestiffandunableto
squeezethroughbloodvessels.Infectionsandheart
failurecanalsooccur.

23. SYMPTOMS:
•Susceptibilitytoinfection
•Fatigue
•Delayedgrowthanddevelopmentin
children
•Episodesofseverepain,especiallyinthe
joints,abdomen,andlimbs

24. TREATMENT
administration of oxygen
pain-relieving drugs
oral and intravenous fluids : reduce pain and prevent
complications
blood transfusions
folic acid supplements
antibiotics
bone marrow transplant
cancer drug: hydroxyurea (Droxia, Hydrea)

25. 2. Aplastic Anemia:
mostrareformsofanemia.
twotosixpeoplepermillionhavethistypeofanemia.
resultsfromanunexplainedfailureofthebonemarrow
toproducealltypesofbloodcells.
foundinadolescentsandyoungadults.
Symptomscanincludebleedinginthemucous
membranes.
Chemicalssuchasbenzeneandcertainpesticides

26. TREATMENT
bloodtransfusionstoboostlevelsofredblood
cells.
bonemarrowtransplantifbonemarrowis
diseasedandcan'tmakehealthybloodcells.

27. 3. Hemolytic Anemia:
prematuredestructionofredbloodcells.
antibodiesproducedbytheimmunesystemdamagered
bloodcells.
Toxicmaterials:lead,copper,andbenzene(causes)
Hemolyticanemiacanbeacquiredorinherited
Sicklecelldiseaseandthalassemiaarebothinherited
typesofhemolyticanemia.
Treatment:
»BloodTransfusion

28. TREATMENT
•avoidingsuspectmedications,treatingrelatedinfections
andtakingdrugsthatsuppressimmunesystem,which
maybeattackingredbloodcells.
•dependingontheseverityofanemia,ablood
transfusionorplasmapheresismaybenecessary.
•Plasmapheresisisatypeofblood-filteringprocedure.In
certaincases,removalofthespleencanbehelpful.

29. 4. VITAMIN DEFICIENCY
ANEMIAS:
VitaminB-12isalsoessentialinhemoglobinproduction.
Normally,achemicalsecretedbythestomachhelpsthebody
absorbsthisvitamin.However,somepeoplecan'treadilyabsorb
B-12.TheresultisB-12deficiency(perniciousanemia).
symptomsdevelopgraduallythisconditionmaynotbe
immediatelyrecognized.

30. Thosewiththyroiddiseaseordiabetesmellitus
areatincreasedriskforthistypeofanemia.The
conditionoccursmostoftenin40-to80-year-
oldnorthernEuropeanswithfairskin.
Alackoffolicacid,anotheroneoftheB
vitamins,canalsoleadtoanemia.Folicacid
deficiencyisaparticularproblemfor
alcoholics.

31. SYMPTOMS
•Atingling,"pinsandneedles"sensationin
thehandsorfeet
•Lostsenseoftouch
•Awobblygaitanddifficultywalking
•Clumsinessandstiffnessofthearmsand
legs
•Dementia
•Hallucinations,schizophrenia.

32. TREATMENT
dietarysupplementsandincreasingthesenutrientsin
yourdiet.
IfdigestivesystemhastroubleabsorbingvitaminB-12
fromthefoodeat:vitaminB-12injectionscanbe
given.

33. 5. THALASSEMIA:
•defectsinthegenesproducinghemoglobin.
•2majorforms:thalassemiaminorandthalassemia
major
•Asitsnameimplies,thalassemiaminorismildand
thosesufferingfromthisconditiongoontoliveafull
life.Treatmentisoftenunnecessary.
•ThalassemiamajorisalsocalledCooley'sanemia,
namedafterthedoctorwhofirstdescribeditin1925.
Thalassemiamajorcanbeserious,butitisveryrare.
•Transfusionsorbonemarrowtransplantsareusually
required.

34. Treatment
•blood transfusions
•folic acid supplements
•removal of the spleen (splenectomy)
•bone marrow transplantation

35. 6. Heinz body anemia:
Hemolyticanemiaresultingfromoxidationofglobin
andformationofHeinzbodies
whichareseeninbloodsmearsasdark
refractileintracytoplasmicbodiesandstain
withnewmethyleneblue.
Somecommoncausesareingestionofonionsandplants
intheBrassicaeaefamily,phenazopyridine,methylene
blueandacetaminophen(paracetamol).
HinzbodyforminthecytoplasmoftheRBC'Sand
appearslikesmalldarkdotsunderthemicroscope.

36. 6. Refractory anemia:
•Anyofvariousanemicconditionsthatarenot
successfullytreatedbyanymeansotherthanblood
transfusions(andthatarenotassociatedwithanother
primarydisease).

37. 7. Iron Deficiency Anemia:
•Thebodyneedsirontoproducethehemoglobin
necessaryforredbloodcellproduction.Ingeneral,most
peopleneedjust1milligramofirondaily.Menstruating
womenneeddoublethatdose.

38. Symptoms:
•Ahungerforstrangesubstancessuchas
paper,ice,ordirt(aconditioncalledpica)
•Upwardcurvatureofthenails,referredtoas
koilonychias
•Sorenessofthemouthwithcracksatthe
corners

39. ANAEMIA SYMPTOMS
ChronicLead
Poisoning
Ablue-blacklineonthegumsreferredtoasa
leadline
Abdominalpain
Constipation
Vomiting
ChronicRed
Blood Cell
Destruction
Jaundice(yellowskinandeyes)
Brownorredurine
Legulcers
Failuretothriveininfancy
Symptomsofgallstones
SuddenRed
Blood Cell
Destruction
Abdominalpain
Brownorredurine
Jaundice(yellowskin)
Smallbruisesundertheskin
Seizures
Symptomsofkidneyfailure

40. •Other common symptoms
of anemia:
Extreme fatigue
Pale skin
Weakness
Shortness of breath
Chest pain
Frequent infections
Headache
Dizziness or light-headedness

41. Cold hands and feet
Inflammation or soreness of tongue
Brittle nails
Fast heartbeat
Unusual cravings for non-nutritive substances,
such as ice, dirt or starch
Poor appetite, especially in infants and children
with iron deficiency anemia.
An uncomfortable tingling or crawling feeling
in your legs (restless legs syndrome)

42. DIAGNOSTIC TESTS FOR ANAEMIA:
Physicalexamination:
•Completebloodcount(CBC)
•Irontests:whichmeasuretheamountofironinblood.
•AReticulocytecounttoseehowwelltreatmentis
working.Reticulocytesareimmatureredbloodcells
producedbythebonemarrowandreleasedintothe
bloodstream.Whenreticulocytecountsincrease,it
usuallymeansthatironreplacementtreatmentis
effective.

43. •Aferritinleveltest,whichreflectshowmuch
ironmaybestoredinthebody.
•Atesttodeterminethesizeandshapeofyour
redbloodcells.Someofredbloodcellsmay
alsobeexaminedforunusualsize,shapeand
color.

44. TREATMENT:
•Anemiatreatmentdependsonthecause.
Iron deficiency anemia:
•Thisformofanemiaistreatedwithchangesindietand
ironsupplements.
•Iftheunderlyingcauseofirondeficiencyislossof
blood—otherthanfrommenstruation—thesourceof
thebleedingmustbelocatedandstopped.Thismay
involvesurgery.

45. ORAL IRON THERAPY:
•Anincreaseinhemoglobinof1gperdlafteronemonth
oftreatmentshowsanadequateresponsetotreatment
andconfirmsthediagnosis.
•Inadults,therapyshouldbecontinuedforthreemonths
aftertheanemiaiscorrectedtoallowironstoresto
becomereplenished.

46. Prematureneonates 2to4mgelementaliron/kg/day
dividedevery12to24hours
(maximumdailydose=15mg).
Infantsandchildrenless
than12years
Prophylaxis:1to2mgelemental
iron/kg/day(maximum15mg)in
1to2divideddoses.
Mildtomoderateiron
deficiencyanemia
3mgelementaliron/kg/dayin1
to2divideddoses.
Severeirondeficiency
anemia
4to6mgelementaliron/kg/day
in3divideddoses
UsualPediatricDoseforIronDeficiencyAnemia:

47. SIDEEFEECTOFORALIRON
THERAPY:
oAdherencetooralirontherapycanbeabarrierto
treatmentbecauseofGIadverseeffectssuchas
epigastricdiscomfort,nausea,diarrhea,and
constipation.
oTheseeffectsmaybereducedwhenironistakenwith
meals,butabsorptionmaydecreaseby40percent.

48. oMedicationssuchasprotonpumpinhibitors
andfactorsthatinducegastricacidhyposecretion
(e.g.,chronicatrophicgastritis,recent
gastrectomyorvagotomy)areassociatedwith
reducedabsorptionofdietaryironandiron
tablets.
oSideeffectsaredose-dependent,andthedose
maybeadjusted.

49. Foods and drugs that impair iron
absorption:
Takingoralironwithfoodreducesabsorption
Caffeinatedbeverages(especiallytea)
Calciumcontainingfoodsandbeverages
Calciumsupplements
Antacids
H-2receptorblockers
Protonpumpinhibitors

50. Factors that affect the absorption of iron supplements:
Theamountofironabsorbeddecreasesasdosesget
larger.Forthisreason,itisrecommendedthatmost
peopletaketheirprescribeddailyironsupplementin
twoorthreeequallyspaceddoses.
Oralironsupplementsmustdissolverapidlyinthe
stomachsothattheironcanbeabsorbedinthe
duodenumorupperjejunum.Enteric-coated
preparationsandlong-actingsupplementsmaybe
ineffective,sincetheydonotdissolveinthestomach.

51. •Ascorbicacidisanenhancerofironabsorptionand
canreversetheinhibitingeffectsofsubstancessuchas
teaandcalcium.
•Ascorbicacidfacilitatesironabsorptionbyforminga
chelatewithferricironatacidpHthatremainssoluble
atthealkalinepHoftheduodenum.
•Tominimizesideeffects,ironsupplementsareoften
takenwithfood.Thismaydecreaseironabsorptionby
asmuchas40-66%.
•Foodanddruginteractionsmayreducetheefficacyof
oraliron

52. Ways to Minimize Adverse
Effects of Oral Iron:
Startwithhalftherecommendeddoseand
graduallyincreasetothefulldose.
Takeironsupplementswithfoodtoalleviate
gastrointestinaldistress(thismaydecreaseiron
absorptionbyasmuchas40-66%).
Changetoadifferentironpreparation.
Takethesupplementindivideddoses.
Concomitantuseofastoolsoftener,suchas
docusate,mayhelpalleviateconstipation.

53. Parenteral Iron Therapy:
•Parenteraltherapymaybeusedinpatientswhocannot
tolerateorabsorboralpreparations,suchasthosewho
haveundergonegastrectomy,gastrojejunostomy,
bariatricsurgery,orothersmallbowelsurgeries.

54. Themostcommonindicationsfor
intravenoustherapyinclude:
•GIeffects,worseningsymptomsof
inflammatoryboweldisease,unresolved
bleeding,renalfailure–inducedanemiatreated
witherythropoietin,andinsufficientabsorption
inpatientswithceliacdisease.

55. Prevention:
Chooseavitamin-richdiet:
•Manytypesofanemiacan'tbeprevented.However,you
canhelpavoidirondeficiencyanemiaandvitamin
deficiencyanemiasbychoosingadietthatincludesa
varietyofvitaminsandnutrients,including:

56. •Iron:
•Iron-richfoodsincludebeefandothermeats,
beans,lentils,iron-fortifiedcereals,darkgreen
leafyvegetables,anddriedfruit.

57. •Folate:
•Thisnutrient,anditssyntheticformfolicacid,canbe
foundincitrusfruitsandjuices,bananas,darkgreen
leafyvegetables,legumes,andfortifiedbreads,cereals
andpasta.

58. Vitamin
•Thisvitaminisfoundnaturallyinmeatanddairy
products.It'salsoaddedtosomecerealsandsoy
products,suchassoymilk.
•

59. •Vitamin C:
•FoodscontainingvitaminC—suchascitrusfruits,
melonsandberries—helpincreaseironabsorption.

60. NURSING CARE PLAN FOR ANEMIA:
DIAGNOSIS:
RiskforInfectionrelatedtodecreased
immunity,invasiveprocedures
Goal:
•Reduce risk factors for infection

61. Control of infection:
•Cleanuptheenvironmentafteruseforotherpatients.
•Limitvisitorwhennecessaryandrecommendedfor
adequaterest.
•Instructpatient’sfamilytowashtheirhandsbeforeand
aftercontactwiththeclient.
•Useanti-microbesoapforhandwashing.
•Makehandwashingbeforeandafternursingactions.

62. •Useclothesandglovesasaprotectivedevice.
•Maintainasepticenvironmentduringthe
installationofequipment.
•Performwoundcare,anddresinginfusion,
cathetereverydayifany.
•Increaseintakeofnutrients,andadequatefluid.
•Giveantibioticsaccordingtotheprogram.

63. Protection of infection:
Monitorsignsandsymptomsofsystemicand
localinfections.

Monitorsusceptibilitytoinfection.
Maintainaseptictechniqueforeachaction.
Inspectionoftheskinandmucousmebran
redness,heat.

64. •Monitorchangesinenergylevels.
•Encourageclientstoimprovemobilityand
exercise.
•Instructtheclienttotakeantibioticsaccordingto
theprogram.
•Teachfamily/clientaboutthesignsand
symptomsofinfectionandreportsuspected
infection.

65. Activityintolerancerelatedtotissuehypoxia
associatedwithanemiaresultingfrom:
decreasedproductionofRBCsresultingfromadecreased
intakeandabsorptionofvitaminsandmineralsandan
inabilityofthelivertostorevitaminsandminerals
Or
excessiveRBCdestructionresultingfromhypersplenism
(ifvenouscongestionhasresultedinsplenomegaly,the
spleenwilldestroyRBCsfasterthanusual)

66. INTERVENTION:
Assessforsignsandsymptomsof
activityintolerance:
fatigueorweakness
exertionaldyspnea,chestpain,diaphoresis,ordizziness
abnormalheartrateresponsetoactivity(e.g.increasein
rateof20beats/minuteaboverestingrate,ratenot
returningtopreactivitylevelwithin3minutesafter
stoppingactivity,changefromregulartoirregularrate)
asignificantchange(15-20mmHg)inbloodpressure
withactivity.

67. •Implementmeasurestoimproveactivity
tolerance:
Performactionstopromoterestand/or
conserveenergy
Maintainactivityrestrictionsasordered
Minimizeenvironmentalactivityandnoise
Organizenursingcaretoallowforperiodsof
uninterruptedrest
Limitthenumberofvisitorsandtheirlengthof
stay
Assistclientwithself-careactivitiesasneeded

68. •keepsuppliesandpersonalarticleswithineasyreach
•Instructclientinenergy-savingtechniques(e.g.using
showerchairwhenshowering,sittingtobrushteethor
combhair)
•Implementmeasurestoreducefearandanxiety(e.g.
assureclientthatstaffarenearby,Explainalltestsand
procedures,encourageverbalizationoffearandanxiety)

69. •Implementmeasurestopromotesleep(e.g.elevatehead
ofbedandsupportarmsonpillowstofacilitate
breathing;maintainoxygentherapyduringsleep;
discourageintakeoffluidshighincaffeine,especiallyin
theevening;encouragerelaxingdiversionalactivitiesin
theevening)
•Implementmeasurestoreducediscomfort
•Discouragesmokingandexcessiveintakeofbeverages
highincaffeinesuchascoffee,tea,andcolas(nicotine
andcaffeinecanincreasecardiacworkloadand
myocardialoxygenutilization,therebydecreasing
oxygenavailability)

70. •Performactionstoimprovebreathingpatterninorderto
decreasedyspneaandimprovetissueoxygenation
•Maintainoxygentherapyasordered
•Performactionstoimprovenutritionalstatus
•Performactionstotreatanemia(e.g.administer
prescribediron,folicacid,and/orvitaminB
12;
administerpackedredbloodcellsifordered)
•Increaseclient'sactivitygraduallyasallowedand
tolerated.

71. Instruct client to:
•Reportadecreasedtoleranceforactivity
•Stopanyactivitythatcauseschestpain,a
markedincreaseinshortnessofbreath,dizziness,
orextremefatigueorweakness.
•Consultphysicianifsignsandsymptomsof
activityintolerancepersistorworsen.
•

72. RESEARCH ABSTRACT:
•PremalathaT*,ValarmathiS,ParameshwariSrijayanthet.al.
conductedastudyon“PrevalenceofAnemiaandits
AssociatedFactorsamongAdolescentSchoolGirlsin
Chennai,TamilNadu,INDIA”
•Anemiaisamajorpublichealthproblembutmostlyignored
whetherthecountryisdevelopingordeveloped.Indeveloping
countriesitservesasaprimarycausefor40%ofmaternaldeath
eitherdirectlyorindirectly

73. •.WorldHealthreportof2002identifiedanemiaasoneamongthetop10risks
forinfantmortality,maternalmortalityandpretermbirth.Duringadolescence
anemiaismoreprevalentinbothsexesduetogrowthspurtespeciallyingirls
wheretheyareexposedtoriskofonsetofmenarche.Prevalenceofanemiais
veryhighinvulnerablegroupseveninhighersocioeconomicstatus.This
stressestheneedtoinvestigatethefactorsassociatedwiththeprevalenceof
anemia.Preventionofanemiaiseffectivewhenthestrategyisfocusedright
fromadolescencefortheirfuturereproductivelifeandthiswillcontributeto
achieveMillenniumDevelopmentGoals(MDG).
•Objectiveofthestudy:Toestimatetheprevalenceofirondeficiencyanemia
amongadolescentschoolgirlsintheagegroupof13-17yearsinChennaiand
tostudytheassociatedfactors.Studyapproach:Across-sectionalsurveywas
executedamong400femaleschoolstudentsintheagegroupof13-17yearsin
Chennai.Sociodemographicdetails,anthropometricmeasurementswere
obtained.Haemoglobinwasestimatedusingcyanmethod.Statisticalanalysis
wasdoneusingIBMSPSS(StatisticalPackagefortheSocialSciences).

74. •Studyresults:Theprevalenceofanemiawasfoundtobe78.75%among
schoolstudents.Chi-squarestatisticsshowssignificantassociation(p<0.05)of
anemiaiswithtypeoffamily,socioeconomicstatusanddiet.Inthisstudym
42.5%ofgirlswithBMI<18werefoundtobeanemic.Lineartrendpredicts
decreaseinHemoglobinwithageasafactorifsamedietarypatternisfollowed
overtheyears.Conclusionsandrecommendations:Ahighprevalenceof
anemiaisfoundinfemalestudentsfromnuclearfamiliesandwhosemothers’
educationislow.Thisstudypredictsthathemoglobinleveltendstodecreaseas
ageprogressesespeciallyintheirmaternallifethatgivesanalarmingeffecton
infantandmaternalmortalityrates.Healthprogramsforhousewivesshould
insisttheutilizationofeasilyavailableandaffordableironrichdiet,forming
kitchengardenetc.Schoolhealthprograms,antenatalprogramsshouldfocuson
anemia,targetingonindividual’sbenefit.
•Strategiesonanemiapreventioncanbeformedatprimaryhealthcarelevel.Iron
fortificationofcommonlyreachablevehicleslikesalt,sugarcanbeemphasized
whichdoesnotdemandtheindividualco-operation.Communityawareness
shouldbeincreasedinoverallnutritionalstatusofwomen.
•
•

77. •Anemiaisnotadiseasebut,aconditioncausedby
variousunderlyingpathologicprocesses.Aproper
historyandphysicalexaminationismoreimportantinan
easywayofapproachingachildwithanemia.Labexams
leadstodefinitivecauseofanemia.Allcasesofanemia
arenotnecessarytobetransfused

78. Bibliography
BOOKS:
WilsonDavid,Wong’sEssentialOfPaediatric
Nursing,8
th
Edition,PublishedByElsevier
MarlowDorothyr,TextBookOfPaediatric
Nursing,6
th
Edition,PublishedByElsevier
PaulKVinod,BaggaArvind.EssentialPediatrics.8
th
Edition.NewDelhi(INDIA).CBSPublisher;2009.

79. GuptaPiyush;“EssentialPediatricNursing”.A.P.Jain
&CO.NewDelhi,1
st
edition;
GhaiOP“EssentialPediatrics”,8
th
edition,CBS
publishers,Pp-507-509
SharmaRimple.EssentialofPaediatricNursing.1
st
Edition.LudhianaPunjab.JaypeePublisher;2013.p
503-508

80. INTERNET/JOURNAL:
http://en.wikipedia.org/wiki/anemia
http://www.anemiadaassociation.org
PremalathaT,ValarmathiS,SrijayanthP,SundarJS,
KalpanaS(2012)PrevalenceofAnemiaandits
AssociatedFactorsamongAdolescentSchoolGirlsin
Chennai,TamilNadu,INDIA.epidemiol2:118.doi
:10.4172/2161-1165.