Anemia ppt

1. Introduction Anemia is one of the most underdiagnosed conditions and, if left untreated, can have many serious implications such as cardiovascular disease and compromised immune functions

2. Introduction According to WHO estimates, India is one of the countries in the world that has highest prevalence of anemia . The bliss of motherhood thrives under the looming presence of anemia in India.

3. Definition Anaemia ( from Greek word anaimia , meaning lack of blood ) is a decrease in number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood.

4. Definition

5. Anemia cases in India on rise: NFHS 3 report Adolescence in India goes hand in hand with iron-deficiency anemia , medically known as IDA While 56 % of adolescent girls are anemic , boys too are falling prey to the disease. Around 30 % of adolescent boys are suffering from anemia . The Hb count in most of the adolescent girls in India is less than the standard 12 g/decilitre, the standard accepted worldwide. the disease troubles 59 % cases of pregnancy while 63 % of lactating women are anemic . States like Bihar and Rajasthan register 60 % of pregnant women to be anemic .

6. Shall we learn some basics about our blood cells?

7. Red blood cell cytoplasm is rich in Hb mature red blood cells are flexible biconcave disks that lack a cell nucleus 2.4 million new erythrocytes are produced per second. develop in the bone marrow and circulate for about 100–120 days in the body before their components are recycled by macrophages.

8. RBC women have about 4 to 5 million erythrocytes per microliter (cubic millimeter ) of blood and men about 5 to 6 million; people living at high altitudes with low oxygen tension will have more Each RBC contains approx. 270 million of Hb biomolecules , each carrying 4 heme groups. RBCs of an average adult human male store collectively about 2.5 grams of iron , representing about 65% of the total iron contained in the body

9. RBC

10. RBC

11. Just for GK…….. Do u know???? The only known vertebrates without RBC are the crocodile icefishes . They live in very oxygen rich cold water and transport oxygen freely dissolved in their blood.

12. RBC production

13. Immature RBC about 1% of the red cells develop and mature in the red bone marrow then circulate for about a day in the blood stream before developing into mature red blood cells. do not have a cell nucleus. Reticulocytes

14. MCV measure of the average RBC size allows classification 10 x HCT (%) ─────────────── RBC count (millions/mm 3 ).. MCV

15. MCV The normal range for MCV 80-99 fL.

16. Mean corpuscular hemoglobin concentration (MCHC) measure of the concentration of Hb in a given volume of packed RBCs. 32 to 36 g/dl MCHC Hb ──── HCT

17. Mean corpuscular hemoglobin MCH mean cell Hb average mass of hemoglobin per red blood cell MCH = Hb / RBC 27 to 31 picograms /cell

18. The burden of anemia among women in India M E Bentley and P L Griffiths Objective : to investigate the prevalence and determinants of anemia among women in Andhra Pradesh. Subjects :A total of 4032 ever-married women aged 15–49 from 3872 households. Results: In all 32.4% of women had mild ,14.19% had moderate , and 2.2% had severe anemia . Protective factors include Muslim religion, reported consumption of alcohol or pulses, and high socioeconomic status, particularly in urban areas. Poor urban women had the highest rates and odds of being anemic . Fifty-two percent of thin, 50% of normal BMI, and 41% of overweight women were anemic . Conclusion :New program strategies are needed, particularly those that improve the overall nutrition status of women of reproductive ages. This will require tailored programs across socio-economic groups and within both rural and urban areas, but particularly among the urban and rural poor.

19. Causes

20. Causes

21. Classification

22. Classification If the cells are smaller than normal (under 80 fl ), the anemia is said to be microcytic ; if they are normal size (80–100 fl), normocytic ; if they are larger than normal (over 100 fl), the anemia is classified as macrocytic .

23. Microcytic anemia a result of hemoglobin synthesis failure/insufficiency, Heme synthesis defect Iron deficiency anemia Anemia of chronic disease (more commonly presenting as normocytic anemia ) Globin synthesis defect alpha-, and beta- thalassemia HbE syndrome HbC syndrome and various other unstable hemoglobin diseases Sideroblastic defect Hereditary sideroblastic anemia Acquired sideroblastic anemia , including lead toxicity Reversible sideroblastic anemia

24. Microcytic anemia

25. Iron deficiency anemia Iron is an essential part of Hb low iron levels result in decreased incorporation of hemoglobin into red blood cells hypochromic (paler than usual) and microcytic (smaller than usual) Causes insufficient dietary intake absorption of Iron losses due to diseases. bleeding lesions of the gastrointestinal tract parasitic infestation

26. Anemia of chronic diseases crohn’s disease SLE rheumatoid arthritis, ulcerative colitis Cancer, particularly lymphoma and Hodgkin’s disease CKD Liver cirrhosis Long-term infections, such as bacterial endocarditis , osteomyelitis (bone infection), HIV/AIDS, hepatitis B or hepatitis C.

27. Anemia of chronic diseases Any long-term medical condition . The exact mechanism of this process in unknown, chronic infection or a cancer people with chronic (long-standing) kidney disease.

28. Anemia of chronic diseases

29. Thalassemia

30. Thalassemia Major Intermedia Minor

31. Macrocytic anemia Megaloblastic anemia , the most common cause of macrocytic anemia due to a deficiency of either vitamin B12 , folic acid (or both). Causes gastric bypass surgery Hypothyroidism Alcoholism Drugs that affect DNA Leukemia The anticonvulsant drug dilantin

32. Normocytic anemia overall hemoglobin levels are decreased, but the red blood cell size(MCV) remains normal. Causes Acute blood loss Anemia of chronic disease Hemolytic anemia Aplastic anemia

33. Aplastic anemia decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat. It results in bone marrow aplasia (markedly reduced hematopoiesis ) CAUSES congenital or acquired Idiopathic Infections and pregnancy certain medications, chemicals, or radiation damage

34. Substances Associated With Aplastic Anemia Analgesics Antiseizure agents ( mephenytoin , triethadione *) Antihistamines Antimicrobials* Antineoplastic agents ( alkylating agents, antitumor antibiotics, antimetabolites ) Antithyroid medications Benzene* Chloramphenicol * Gold compounds* Heavy metals Hypoglycemic agents Insecticides Organic arsenicals* Phenylbutazone * Phenothiazines Sulfonamides * Sedatives

35. Hyperanemia severe form of anemia hematocrit is below 10%

36. Refractory anemia not respond to treatment. often seen secondary to myelodysplastic syndromes.

37. Sickle cell anemia autosomal recessive RBC that assume an abnormal, rigid, sickle shape Sickling decreases the cells' flexibility and results in a risk of various complications. The sickling occurs because of a mutation in the hemoglobin gene

38. Sickle cell anemia

39. WHO Grading of anemia Grade 1 (Mild Anemia ): 10 g/dl Grade 2 (Moderate Anemia ): 7-10 g/dl Grade 3 (Severe Anemia ): below 7 g/dl

40. Koilonychia

41. Angular cheilitis

42. Splenomegaly

43. Pica

44. Pallor

45. Anemic eyes

46. ANEMIA SYMPTOMS

47. Anemic woman

48. the signs that may indicate anemia Change in stool color rapid heart rate low blood pressure rapid breathing pale or cold skin yellow skin called jaundice if anemia is due to red blood cell breakdown heart murmur enlargement of the spleen with certain causes of anemia

49. Anemia Diagnosis complete blood count. thorough evaluation of the patient Physical examination and medical history

50. Lab tests for anemia 1.CBC 2.Stool hemoglobin test 3.Peripheral blood smear 4.Iron level 5.Transferrin level 6.Ferritin 7.Folate 8.Vitamin B12 9.Bilirubin 10.Lead level 11.Hemoglobin electrophoresis 12.Reticulocyte count 13.LFT 14.RFT 15.Bone marrow biopsy

51. cause and the severity iron supplements investigations hospitalization and transfusion of red blood cells

52. Medications Iron Vitamin supplements epoetin alfa ( Procrit or Epogen ) injection Stopping a medication that may be the cause of anemia

53. Anemia Prevention eating a healthy diet and limiting alcohol use. seeing a doctor regularly and when problems arise routine blood work

54. Anemia Prognosis cause of the anemia and how severe it is age makes almost any medical problem worse

55. NURSING PROCESS : Assessment

56. NURSING DIAGNOSES Activity intolerance related to weakness, fatigue, and general malaise Imbalanced nutrition, less than body requirements, related to inadequate intake of essential nutrients Ineffective tissue perfusion related to inadequate blood volume or HCT Noncompliance with prescribed therapy

57. Nursing Interventions MANAGING FATIGUE Assist the patient to prioritize activities and to establish a balance between activity and rest that is realistic and feasible from the patient’s perspective. Patients with chronic anemia need to maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.

58. Nursing Interventions MAINTAINING ADEQUATE NUTRITION A healthy diet should be encouraged. Because alcohol interferes with the utilization of essential nutrients, the nurse should advise the patient to avoid alcoholic beverages or to limit their intake and should provide the rationale for this recommendation. Dietary teaching sessions should be individualized, including cultural aspects related to food preferences and food preparation.

59. Nursing Interventions MAINTAINING ADEQUATE PERFUSION Lost volume is replaced with transfusions or intravenous fluids, based on the symptoms and the laboratory findings. Supplemental oxygen may be necessary, but it is rarely needed on a long-term basis unless there is underlying severe cardiac or pulmonary disease as well. The nurse monitors vital signs closely; other medications, such as antihypertensive agents, may need to be adjusted or withheld.

60. Nursing Interventions PROMOTING COMPLIANCE WITH PRESCRIBED THERAPY Patients need to understand the purpose of the medication, how to take the medication and over what time period, and how to manage any side effects of therapy. To enhance compliance, the nurse can assist patients in developing ways to incorporate the therapeutic plan into their lives, rather than merely giving the patient a list of instructions.

61. PATIENT EDUCATION Taking Iron Supplements Take iron on an empty stomach (1 hour before or 2 hours after a meal). Start with only one tablet per day for a few days, then increase to two tablets per day, then three tablets per day Increase the intake of vitamin C (citrus fruits and juices, strawberries,tomatoes , broccoli), to enhance iron absorption. Eat foods high in fiber to minimize problems with constipation. Remember that stools will become dark in color .

62. Nursing Interventions MONITORING AND MANAGING POTENTIAL COMPLICATIONS assessfor signs and symptoms of heart failure. A serial record of body weights can be more useful than a record of dietary intake and output, because the intake and output measurements may not be accurate. In the case of fluid retention resulting from congestive heart failure, diuretics may be required. In megaloblastic forms of anemia , the significant potential complications are neurologic. A neurologic assessment should be performed for patients with known or suspected megaloblastic anemia .

63. Nursing Interventions Measure temperature of bath water with thermometer because anemia may cause poor circulation. Provide blankets and warm clothing to increase comfort and aid circulation. Notify physician if excessive vomiting, coughing or straining at stools occurs so that medication can be prescribed to alleviate symptom. Avoid aspirin-containing products to prevent bleeding. Avoid forceful blowing.

64. Nursing Interventions Avoid contact on gingival when brushing and flossing teeth. Avoid situations in which trauma may occur, such as shaving with straight-edge razor, ambulating after taking medication that may cause orthostasis , or using sharp utensils Avoid purseful sexual intercourse and use adequate lubrication.

65. Nursing Interventions Use of stool softeners or laxative to avoid PRN to avoid straining. Ascorbic acid (Vitamin C) promotes iron absorption, thus iron preparations should be taken with orange juice. Bowel movements will be black from excess iron excretion. Iron supplements usually given for at least 6 months to restore body stores.

66. Nursing interventions Keep skin clean and bedclothes dry. Encourage diet high in protein, vitamins, and minerals. Encourage cool, bland foods; flavored ices and ice cream are well tolerated. Monitor Hb / Hct and assess whether other factors (e.g., nutritional deficiencies, fluid and electrolyte disorders, depression, etc.) are contributing to symptomatology . Assess activity schedule and suggest daily activities that allow for rest periods. Transfuse whole blood and packed red blood cells as ordered by physician.

67. Nursing interventions Avoid rectal thermometers, suppositories, and enemas. Avoid heating pads or hot water bottles. Iron salts are gastric irritants and should always be taken following meals. Iron preparation taken on empty stomach cause dyspepsia, abdominal discomfort, and diarrhea Liquid iron preparations should be well diluted and taken through a straw (undiluted liquid iron stains teeth).