1. ANEMIA

2. Definition
A decrease in the number of RBCs, the quantity of Hgb, and/or the volume of PRBCs (which is measured by Hct).
It is not a disease, it is a symptom of a disease or condition
Can lead to tissue hypoxia
How do you know if someone has hypoxia?

3. Etiologies Inadequate production of RBCs
Premature or excessive destruction of RBCs
Acute or chronic blood loss
Nutrition deficits
Hereditary factors
Chronic diseases

4. Types of Anemias Hypoproliferative—Inadequate production of RBCs
Iron deficiency, aplastic anemia, B-12 deficiency, folic acid deficiency, renal dz, chronic inflammation, cancer, chemotherapy induced
Hemolytic—Increased RBC destruction (usually hereditary)
Thalassemia, G6PD
Blood loss—Usually caused by trauma or an underlying condition or disease—can be slow or fast
Acute: injury, PUD
Chronic: metorrhagia, colon cancer, PUD

5. General Manifestations of Anemia
Deficient oxygenation of tissues results in:
Pallor
Complaints of feeling cold
Fatigue, shortness of breath
Dizziness, headache, light-headedness, slowing of thought processes, irritability, restlessness, depression
Increased cardiac workload manifested as tachycardia, palpitations, chest pain, and even CHF in those patients with weak myocardium.

6. Specific Manifestations and Complications
Glossitis, chelitis, spoon-shaped nails, petechiae, chronic leg ulcers
Tingling, numbness, confusion, ataxia
Joint pain
Mental retardation
Hepatomegaly, splenomegaly
Sudden hemorrhage, tachycardia, hypotension, murmurs, angina
Injury from falls (bone deformities, fractures, fainting)

7. General Labs CBC (RBC and indices; H & H)
Hgb electrophoresis (identifies abnormal forms of hemoglobin)
Serum iron
Serum ferritin Iron deficiency
Iron-binding capacity
Microscopic analysis—tells size/shape/color
Schilling test or serum gastrin—B-12 deficiency
Bone marrow examination

8. Microscopic Analysis Hemoglobin & Hematocrit
Males—14-18 g/dL; 42-52%
Females—12-16 g/dL; 37-47%
NB—14-24; 44-64
2-6 mos 10-17; 35-50
RBC (values are approximate):
males 4-6
females 4-5.5
Newborns 5-7
2-6 months

9. RBC Indices MCV—size MCH—average amount of Hgb in a cell
Macrocytic (H): B12 or folic acid deficiency
Microcytic (L): iron deficiency or Thalassemia
MCH—average amount of Hgb in a cell
Follows values for size
MCHC—color (has to do with concentration)
Hypochromic (L): iron deficiency or Thalassemia
Normochromic (may read as H due to abnormal shape of cell): hemolytic anemia
RDW—has to do with identifying a wide variation of sizes in the cells, indicating abnormal blood conditions

10. Treatments Depends on type of anemia identified
Pharmacologic therapy—iron, folic acid, vitamin B-12
Improved nutrition—eggs, red meat, dark green leafies, dried fruit, fish, seafood, iron-fortified cereals and grains, bean family
Blood transfusions
Transplants

11. Nursing Assessment
Ask about SOB, fatigue, weakness dizziness, syncope, palpitations, bleeding, menstrual hx, meds, chronic diseases, diet, ETOH and cigarettes
Look at general appearance, skin color, VS, heart and lung sounds, pulses, cap refill, abdominal tenderness, pain, bleeding, bruising

12. Nursing Diagnoses Activity Intolerance Altered Oral Mucous Membranes
Self-Care Deficit
Decreased Cardiac Output
Fatigue
Deficient fluid volume
Impaired gas exchange
Risk for injury
Impaired physical mobility
Ineffective tissue perfusion
Imbalanced nutrition

13. Nursing Management
Direct general management toward addressing the cause of anemia and replacing blood loss as needed to sustain adequate oxygenation
Promote optimal activity and protect from injury
Reduce activities and stimuli that cause tachycardia and increase cardiac output
Provide for nutritional needs
Provide teaching

14. Client Education Organize activities with rest periods
Identify situations that cause palpitations, dyspnea
Explain the need to ensure adequate oxygenation
Drink at least 2-3 liters of fluid a day
Instruct the client to report signs of fluid retention, paresthesias, poor coordination, ataxia and confusion
Discuss dietary requirements and meds
Encourage a well balanced diet
Advise the client to avoid alcoholic beverages and spicy foods
Explain the need for ongoing lab tests and treatment

15. Specific Anemias Iron deficiency Vit B-12 deficiency
Folic acid deficiency Hypoproliferative
Anemia of chronic dz (renal, cancer, inflammation)
Aplastic
Thalassemia Hemolytic
Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)

16. Fe Deficiency Most common Usually from inadequate diet or blood loss
Smooth, sore tongue
Brittle nails
Angular cheilosis
Pica
Low ferritin, microcytic RBCs

17. Ferrous Sulfate
Action: Replaces iron stores needed for RBC development, energy, and O2 transport
Dosage: po mg/d; IV 125 mg in 100 mL over 1h; requires IV push test dose first.
SE: Nausea, constipation, epigastric pain, black stools
Nursing: If giving IV, give IVP test dose first to assess for reactions. If giving IM, give Z-track in large muscle.
Education: (Related to po route only) Take tabs whole, between meals with juice. If upset occurs, take after meals. Do not take with antacids or milk. Drink liquid through straw. Store in tight, light resistant container. Stools will turn black. Do not substitute one type with another. Take 1h before lying down. Eat iron-rich foods.