Anaemia By Dr.

Hanan Said Ali

Objectives

Identify the components of blood. Enumerates what does blood do. Define the anaemia. Discus the etiologic classification of anaemia.

Objectives Cont.
Identify the clinical manifestations, Aetiology, Diagnosis, Treatment, Nursing care for: Iron deficiency anaemia. Megaloblastic or Macrocytic Anaemia: Cobalamin(vitamin B12) Folic acid deficiency A plastic Anaemia Haemolytic Anaemia Haemolytic Anaemia

Hematology
Study of blood and blood forming tissues Key components of hematologic system are:
Blood Blood forming tissues

Bone marrow Spleen Lymph system

What Does Blood Do?

Transportation
Oxygen Nutrients Hormones Waste Products

Regulation
Fluid, electrolyte Acid-Base balance

Protection
Coagulation Fight Infections

Components of Blood
Plasma
55%

Blood Cells
45% Three types
Erythrocytes/RBCs Leukocytes/WBCs Thrombocytes/Platelets

Erythrocytes/Red Blood Cells

Composed of hemoglobin Erythropoiesis
= RBC production
Stimulated by hypoxia Controlled by erythropoietin
Hormone synthesized in kidney

Hemolysis
= destruction of RBCs Releases bilirubin into blood stream Normal lifespan of RBC = 120 days

Leukocytes/White Blood Cells

5 types
Basophils Eosinophils Neutrophils Monocytes Lymphocytes

Thrombocytes/Platelets
Must be present for clotting to occur Involved in homeostasis

Anaemia
Definition The term of anaemia refers to a deficiency in the number of circulating red blood cells available for oxygen transport
What is the etiologic classification of anaemia ? 1- Iron deficiency anaemia When the stored iron is not replaced, haemoglobin production is reduced leads to iron- deficiency anaemia

Anaemia Cont.

Iron deficiency anaemia Cont.

Aetiology
Inadequate dietary intake, malabsorption. Blood loss of haemolysis Gastrointestinal blood loss e.g. Peptic ulcer, gastritis, oesophagitis. Menstrual bleeding....45 ml.....loss of 22mg of iron Pregnancy...diversion of iron to the foetus

Iron deficiency anaemia Cont.

Clinical manifestation In early course , the client may be free of symptoms Mild.... Pallor , fatigue and exertion dyspnea.
Sever.....
Nail become brittle and concave and longitudinal ridges. Glossitis (inflammation of tongue), bright- red . Cheilosis (inflammation of lips- The corners of mouth may be cracked, reddened and painful. Headache, paresthesia. Burning sensation of the tongue result to lack of iron

in tissues.

Iron deficiency anaemia Cont.

Management Diagnosis
Peripheral blood smears (CBC) Low serum iron levels, and elevated serum iron- binding capacity. Absent iron stores in the bone marrow. endoscopy, or colonoscopy to detect GI bleeding. Treatment Increasing the intake of iron. Administer nutrients for erythroporesesis

Iron deficiency anaemia Cont.

Role of nutrients for erythroporesesis
Cobalamin (Vit B12) has role in RBC maturation found in red meat especially liver. Folic acid has role in RBC maturation in leaves, fish. Vitamin B6 has role in haemoglobin synthesis found in eggs, whole grain and bread, potatoes.

Amino acids has role in synthesis of nucleoproteins found in eggs, meat, milk, milk products
Vitamin C has role in conversion of folic acid to its active forms aids in absorption.

Iron deficiency anaemia Cont.

Medical therapy Oral iron supplements (ferrous sulphate) It should be taken after meals and with orange juice Told the client that the stool will be black. Parenteral iron is administered by IM or IV

Megaloblastic or Macrocytic Anaemia

It characterized by morphological changes caused by defective DNA synthesis and abnormal RBC matured.
The common forms of mgaloblastic anaemia: 1- Cobalamin(vitamin B12) o Result from dietary deficiency. o Deficiency of gastric intrinsic factors. o Intestinal malabsorption and increased requirement.

Megaloblastic or Macrocytic Anaemia Cobalamin(vitamin B12)

Symptoms a. General symptoms of anaemia . b. GIT manifestation a a sore tongue, anorexia, nausea, vomiting and abdominal pain.

c. Neurovascular manifestation as weakness, parethesias of the feet and hands, muscle weakness, impaired thought process ranging from confusion to dementia

Megaloblastic or Macrocytic Anaemia Cobalamin(vitamin B12)

Diagnosis Abnormal Schilling test result which demonstrates, the inability to absorb vitamin B12. Treatment I. Parenteral administration of vitamin B12 once/month.
I. The nurse should ensure that injuries are not sustained because of the diminished sensation to heat and pain due to neurologic impairment. Protect client from burn and trauma.

I.

II. Evaluate skin for redness.

Megaloblastic or Macrocytic Anaemia Folic acid deficiency

Folic acid required for DNA synthesis leading to RBC formation and maturation. Daily requirement of folic acid 100 to 200 mg. Causes
Poor nutrition (Lack of vegetable, yeast, nuts, grains. Malabsorption syndrome. Drugs that impede the absorption and use of F acid (oral contraceptives ,anti seizure agents). Alcohol abuse and anorexia. Haemodialysis client because of folic aid is dialyzable. Pregnancy, and increased requirement & malnutrition.

Megaloblastic or Macrocytic Anaemia Folic acid deficiency

Clinical manifestation
Similar to cobalamin deficiency except the absence of neurologic problem, this lack of neurologic involvement differentiate folic acid deficiency from vit. B12.

Diagnosis
Low serum folate level.

Treatment
Anaemia caused by a dietary deficiency can be treated with 1 mg of folic acid for 3- month period. Diet ... Orange, meat, eggs, cabbage, citrus fruits .

A plastic Anaemia
Related to reduced or impaired erythrocyte production (fatty bone marrow). Aetiology It can be divided into the major groups: 1- Congenital Caused by chromosomal alterations. 2- Acquired as a result of exposure to: Ionizing radiation, chemical agents (DDT, alcohol) Viral and bacterial infection(hepatitis, miliary TB)

A plastic Anaemia
Aetiology Cont. Prescribed medication(alkalating agents, antimicrobial) Pregnancy. Idiopathic Pathophysiology
It caused by depression of activity of all blood-producing elements { There is decrease in white blood cells(Leukopoenia), Platelets(Thrombocytopoenia), and decrease in the formation of RBC, which lead to

anaemia.

A plastic Anaemia Cont.

Clinical Manifestation Pallor of skin and mucous membranes. Cardiovascular (fatigue, and dyspnea on exertion, palpitation) Cerebral responses Infection of skin and mucous membrane. Haemorrhagic symptoms(bleeding tendencies into the skin and mucous membranes, nose, gums, vagina and rectum

A plastic Anaemia Cont.

Management.
1. The CBC characteristically reveals a pancytopoenia (a marked decrease in the numbering of cell types) 2. The reticulocyte count is low . 3. Bone marrow examination and biopsy

Treatment Bone marrow transplantation from a donor with identical human leukocyte antigen for person younger than 40 years.

A plastic Anaemia Cont.

The remainder of persons are treated with immunosuppressive therapy.

Nursing care Is based on careful assessment and management of complications of pancytopoenia by:
o Private room. o Protective isolation o Provide and instruct the client on meticulous hygiene. o Assessment and maintenance of oral care regimen.

o Monitor invasive lines for sign of infection.

A plastic Anaemia Cont.

Nursing Care Cont. o Avoid bladder catheterization. o Instruct family and visitors on careful hand washing. o Nursing intervention for preventing bleeding......... Teaching the person with a plastic anaemia include: Prevent infection. Prevent haemorrhage. Prevent fatigue.

Haemolytic Anaemia
Definition
Premature destruction of erythrocyte occurring at such a rate that the bone marrow is unable to compensate for the loss of cells.

Haemolysis can occur either extra vascular or intravascular.

In extra vascular, the spleen removes erythrocytes from circulation at much more rapid rate. In Intravascular it is secondary to the erythrocyte lysing and spilling the cell contents into the spleen

Haemolytic Anaemia Cont.

Aetiology
The causes may be acquired form or hereditary forms Acquired forms Immune system-mediated haemolysis is caused or associated with transfusion reactions, haemolytic disease of the newborn Traumatic haemolysis is caused by presence of prosthetic heart valves; structural abnormalities of the heart; haemodialysis. Infectious haemolysis are due to bacterial infection (cholera, typhoid)

Haemolytic Anaemia Cont.

Toxic (chemical) haemolysis occurs as the result of exposure to toxic chemical agents; haemodialysis or uraemia. Physical haemolysis are due to burns and radiation. Hypophosphatemic haemolysis are due to hypophosphatemia (phosphate deficiency in plasma. Hereditary Form Structural defect i.e., plasma membrane defect, destruction due to fragility of the erythrocyte. Enzyme deficiency i.e., deficiency of glycol tic enzymes

Haemolytic Anaemia Cont.

Clinical Manifestation
Ischemia occurs when red cells clump in the capillary beds, causing cyanosis, pain and paresthesia. Haemoglobinuria. Management Diagnosis The presence of the antibody or complement on the RBCs (direct Coombs test) or in the serum(indirect Coombs test) Decreased Hct. Increased reticulocyte and bilirubin

Anaemia caused by blood loss

Anaemia resulting from blood loss may be caused by either acute or chronic. Aetiology /Pathophysiology
I. Trauma II. Complications of surgery III. Diseases that disrupt vascular integrity. There are two clinical concerns in such situation

First
There is sudden reduction in the total blood volume that can lead to hypovolaemic shock.

Haemolytic Anaemia Cont.

Treatment
Mild cases require no treatment. Supportive care includes: Administering corticosteroids and blood products. Removing the spleen.

Nursing Management
Teach the client about drug therapy. Preparing the client for surgery.

Anaemia caused by blood loss Cont.

Second If the acute loss is more gradual, the body maintains its blood volume by slowly increasing the plasma volume. Consequently, the circulating fluid volume is preserved. But the number of RBCs available to carry oxygen is significantly diminished.

Anaemia caused by blood loss Cont.

Clinical Manifestation
Clinical manifestation of acute blood loss according to varying degrees of blood volume loss as follows:
Volume loss Clinical manifestation

10%

None

20%
30% 40%

No detectable signs or symptoms at rest, tachycardia with exercise and slight postural hypertension.
Normal supine blood pressure and pulse at rest , postural hypertension and tachycardia with exercise. Blood pressure, central venous pressure, and cardiac output below normal at rest, rapid , threading pulse and cold and clammy skin. Shock and potential death

50%

Anaemia caused by blood loss Cont.

Management Replacing blood volume to prevent shock. Identify the source of haemorrhage and stopping blood loss. IV fluid used in emergency includes dextran, albumin, or crystalloid electrolyte solution such as ringer lactate Blood transfusion (packed RBCs) Supplemental iron .

Thank You