Anemia Treatment Overview

Anemia Treatment

• Priority: Ensure adequate tissue oxygenation
• Treatment Based On Cause:
  • Nutritional Deficiencies: Address through dietary counseling
  • Drug Therapy: Necessary for some anemias
  • Severe Cases: May require blood transfusion
• Interprofessional Team:
  • Nurses, physicians, pharmacists, nutritionists, and other healthcare professionals collaborate on patient care.

Surgical Management of Anemia

• Blood Loss Anemia: Identify and repair the source of bleeding to address the underlying cause and stop blood loss.
• Aplastic Anemia: Stem cell (bone marrow) transplantation may be necessary to replace damaged bone marrow with healthy cells.
• Pernicious Anemia: Surgical exploration of the gastrointestinal (GI) tract and pancreas may be required to diagnose and treat conditions like celiac disease or inflammatory bowel disease (IBD) that can contribute to pernicious anemia.
• Thalassemia Major: Splenectomy, the surgical removal of the spleen, can be indicated in some cases to improve red blood cell production and reduce anemia severity.

Iron Supplements

• Used to correct red blood cell (RBC) abnormalities.
• Examples include Ferrous fumarate, Ferrous gluconate, and Ferrous sulfate.
• Monitor hemoglobin and reticulocyte counts.
• Use straw or dropper for liquid forms to prevent tooth staining.
• Side effects include constipation, nausea, and heartburn.
• May cause black or dark green stools.
• IV or IM administration is useful for acute deficiency, chronic GI blood loss, chronic renal failure, or cancers.
• Caution is required for hypersensitivity reactions.

Antianemic Agents

• Used to stimulate RBC, white blood cell (WBC), and platelet production.
• Examples include Folic acid and Vitamin B12 (Cyanocobalamin).
• Folic acid is used in megaloblastic anemia, and is prescribed to women of childbearing age, pregnant women, and patients with folic acid deficiency or sickle cell disease (SCD).
• Vitamin B12 treats B12 deficiency and pernicious anemia.
• Monitor CBC, serum folate, and potassium levels, especially 48 hours after starting therapy.
• Watch for pulmonary edema, particularly in patients with cardiovascular disease.
• Hydroxyurea promotes fetal hemoglobin in SCD, especially in patients experiencing frequent crisis or severe disease.

Erythropoiesis-Stimulating Agents

• Stimulate RBC production in anemia associated with chronic diseases like chronic kidney disease, cancer, and HIV.
• Examples include Darbepoetin alfa, Epoetin alfa, and Methoxy polyethylene glycol-epoetin beta.
• Given subcutaneously up to three times a week in chronic renal failure.
• Monitor hemoglobin, blood pressure (BP), and neurologic status.
• Instruct patients on proper use and disposal of syringes.
• IV iron therapy is needed in conjunction with erythropoietin if patients lack sufficient iron.

Hydroxyurea

• Used to promote fetal hemoglobin production in SCD to reduce painful crises.

Immunosuppressive Therapy

• Corticosteroids are used to treat aplastic anemia by suppressing the immune system.

Androgens

• Stimulate blood cell production in aplastic anemia.

Iron Supplements

• Examples: Ferrous fumarate, Ferrous gluconate, Ferrous sulfate
• Use: Correct red blood cell abnormalities.
• Nursing Considerations:
  • Monitor hemoglobin and reticulocyte count.
  • Use straw or dropper to avoid tooth staining.
  • Advise about dark stools and constipation.
  • Oral side effects: constipation, nausea, heartburn.
  • IV/IM administration is used for acute deficiencies, chronic gastrointestinal blood loss, chronic renal failure or cancers.
  • Caution for hypersensitivity reactions.

Antianemic Agents

• Examples: Folic acid, Vitamin B12.
• Folic Acid: Stimulates red blood cell, white blood cell, and platelet production. Used in megaloblastic anemia. Ordered for women of childbearing age, pregnant women, and patients with folic acid deficiency or sickle cell disease to meet increased blood cell demands.
• Vitamin B12 (Cyanocobalamin): Treats B12 deficiency and pernicious anemia.
  • Monitor: Complete Blood Count (CBC), serum folate, potassium levels (48 hours after starting therapy).
  • Monitor for pulmonary edema (especially in patients with cardiovascular disease).

Hydroxyurea

• Promotes fetal hemoglobin production in sickle cell disease to reduce painful crises.

Erythropoiesis-Stimulating Agents

• Examples: Darbepoetin alfa, Epoetin alfa, Methoxy polyethylene glycol-epoetin beta.
• Use: Stimulates red blood cell production for anemia in chronic diseases like chronic kidney disease, cancer, HIV.
• Nursing Considerations:
  • Administered subcutaneously up to 3 times a week in chronic renal failure.
  • Monitor hemoglobin, blood pressure, and neurological status.
  • Provide instructions for proper syringe use and disposal.
  • IV iron therapy is needed if patients lack sufficient iron stores.

Immunosuppressive Therapy

• Corticosteroids used for aplastic anemia.

Androgens

• Used to stimulate blood cell production in aplastic anemia.

Iron Supplements

• Iron supplements, such as Ferrous fumarate, Ferrous gluconate, and Ferrous sulfate, are used to correct red blood cell (RBC) abnormalities by providing iron.
• When administering iron supplements, monitor hemoglobin and reticulocyte counts.
• Liquid iron should be given with a straw or dropper to prevent teeth staining.
• Patients should be warned about the potential for black or dark green stools, and constipation.
• Oral administration of iron supplements can cause side effects such as constipation, nausea, and heartburn.
• Intravenous (IV) or intramuscular (IM) iron administration is useful for acute iron deficiency, chronic gastrointestinal (GI) blood loss, chronic renal failure, or cancers.
• Caution is advised when administering IV/IM iron, as hypersensitivity reactions may occur.

Antianemic Agents

• Folic acid and Vitamin B12 are examples of antianemic agents.
• Folic acid stimulates RBC, white blood cell (WBC), and platelet production. It is commonly prescribed for women of childbearing age, pregnant women, and those with folic acid deficiency or sickle cell disease (SCD) to meet increased demands for blood cells from the bone marrow.
• Vitamin B12 (Cyanocobalamin) is used to treat Vitamin B12 deficiency and pernicious anemia.
• When administering Vitamin B12, monitor the complete blood count (CBC), serum folate, and potassium levels, especially within 48 hours of starting therapy.
• Be vigilant for pulmonary edema, especially in patients with cardiovascular disease.
• Hydroxyurea is a medication that promotes fetal hemoglobin production in patients with SCD, particularly those experiencing frequent crises or severe disease, to reduce the occurrence of crises.

Erythropoiesis-Stimulating Agents

• Erythropoiesis-stimulating agents, such as Darbepoetin alfa, Epoetin alfa, and Methoxy polyethylene glycol-epoetin beta, stimulate RBC production in patients with anemia due to chronic diseases, such as chronic kidney disease, cancer, or HIV.
• In patients with chronic renal failure, erythropoiesis-stimulating agents are usually administered subcutaneously up to three times per week.
• Monitor hemoglobin, blood pressure (BP), and neurological status closely when administering these agents.
• Proper use and disposal of syringes should be instructed to the patient.
• Intravenous (IV) iron therapy may be required concurrently with erythropoietin if the patient has insufficient iron levels.

Hydroxyurea

• Hydroxyurea is used to promote fetal hemoglobin production in patients with SCD to reduce the occurrence of painful crises.

Immunosuppressive Therapy

• Corticosteroids are used as immunosuppressive therapy in patients with aplastic anemia.

Androgens

• Androgens are used to stimulate blood cell production in patients with aplastic anemia.

Nonpharmacologic Therapy

• Rest and activity balance is essential for anemias due to impaired oxygenation.
• Nutrition is vital for deficiency anemias related to iron, B12, or folic acid.
  • Heme iron is more readily absorbed than nonheme iron.
    • Heme iron sources include: beef, chicken, turkey, oysters, egg yolk
    • Nonheme iron sources include: bran flakes, brown rice, leafy greens, oatmeal, dried fruits
  • Folic acid sources include: green leafy vegetables, broccoli, wheat germ, milk, yeast, kidney beans, eggs
  • Vitamin B12 sources include: liver, milk, cheese, fresh shrimp and oysters, eggs
  • Vitamin C enhances nonheme iron absorption.
  • Tea and coffee inhibit nonheme iron absorption.
• Lifestyle management involves balancing activity with rest to optimize oxygenation and energy.
• A healthy diet is essential to enhance energy levels, even if it cannot fully manage the condition.

Rest and Activity

• Rest and activity balance is crucial for people with anemia due to their impaired oxygenation.

Nutrition

• Proper nutrition is especially vital when dealing with deficiency anemias caused by a lack of iron, vitamin B12, or folic acid.

Iron Sources

• Heme iron, found in animal products, is more easily absorbed than nonheme iron, which is found in both animal and plant sources.
• Heme iron enhances nonheme iron absorption when eaten together.
• Good Heme Iron Sources: Beef, chicken, turkey, oysters, egg yolk, real, loin
• Good Nonheme Iron Sources: Bran flakes, Brown rice, whole-grain breads, dried beans, leafy greens, oatmeal, dried fruits.

Folic Acid Sources

• Good Sources: Green leafy vegetables, broccoli, wheat germ, milk, yeast, kidney beans, eggs, organ meats, asparagus.

Vitamin B12 Sources

• Good Sources: Liver, milk, cheese, fresh shrimp and oysters, organ meats (muscle), eggs.

Absorption Tips

• Vitamin C improves the absorption of nonheme iron.
• Tea and coffee decrease nonheme iron absorption.

Lifestyle Management

• Balancing activity with rest helps improve oxygenation and energy levels.
• Maintain a nutritious diet even if it doesn't completely resolve the anemia. A healthy diet can still boost energy levels.

Blood Transfusion Indications

• Blood transfusions are used to treat significant blood loss, often due to trauma or surgery.
• They are also used in cases of severe anemia, particularly when the individual is experiencing cardiovascular instability.

Types of Blood Transfusions

• Whole Blood: Replaces both red blood cells and blood volume, making it suitable for acute hemorrhage situations.
• Packed Red Blood Cells: Primarily given to individuals with severe anemia who are experiencing complications related to their heart function.

Special Cases

• Aplastic Anemia: This condition necessitates blood transfusions as part of the overall treatment plan.
• Thalassemia: Individuals with this genetic disorder often require lifelong blood transfusions to manage their condition.

Neonatal Anemia Causes

• Blood Loss (Hypovolemia)

  • Prenatal: Placental bleeding (e.g., placenta previa, abruptio placentae), cord malformations, diagnostic procedures like amniocentesis or chorionic villus sampling can cause blood loss.
  • Perinatal: Precipitous delivery resulting in umbilical cord bleeding, birth trauma to the cranium subgaleal bleed or damage to abdominal organs.
  • Postpartum: Hypoxia, shock, or death causing subgaleal bleed.

• Decreased RBC Production

  • Congenital defects: Fanconi anemia, Diamond-Blackfan anemia (rare).
  • Acquired defects: Infections (rubella, syphilis, HIV, bacterial sepsis) impairing bone marrow.
  • Nutritional deficiency: Deficient in B12, folate, vitamin E, or iron (not common at birth).

• Excessive RBC Hemolysis

  • Blood group incompatibilities or RBC disorders (G6PD deficiency (most common), hemoglobinopathies, infections).

• Physiologic Anemia of the Newborn

  • Normal breathing after birth increases oxygenation, decreasing erythropoiesis (RBC production).
  • A combination of decreased erythropoiesis and the decreased lifespan of neonatal RBCs results in a drop in hemoglobin over the first 6–12 weeks.
  • Erythropoietin stimulation and bone marrow activity eventually stabilize hemoglobin levels.