Understanding Anemia and Its Types

Anemia

• Anemia is a condition where hemoglobin levels are lower than normal, resulting in fewer red blood cells (RBCs) and reduced oxygen delivery to tissues.
• It's not a disease but a symptom of an underlying issue, and it's the most common hematologic condition.

Classification of Anemia

• Hypo-proliferative: Anemia caused by inadequate RBC production. Bone marrow doesn't produce enough RBCs due to factors like medication, chemical damage, or insufficient production factors (e.g., iron, vitamin B12).
• Bleeding: Anemia resulting from blood loss. RBCs are lost, leading to reduced RBC counts.
• Hemolytic: Anemia resulting from RBC destruction. RBCs are destroyed prematurely, releasing hemoglobin into the plasma. This leads to elevated bilirubin levels and tissue hypoxia, stimulating erythropoietin production and increasing reticulocyte count (as the bone marrow responds). Hemolysis can be caused by issues within the RBCs themselves (like sickle cell disease), issues within the plasma, or direct trauma to the RBCs in the circulation.

Iron Deficiency Anemia

• Occurs due to insufficient dietary iron for hemoglobin production.
• Causes:
  • Bleeding (ulcers, gastritis, inflammatory bowel disease, GI tumors, heavy periods, pregnancy without iron supplementation)
  • Chronic alcoholism
  • Iron malabsorption (after surgery, with celiac/inflammatory bowel disease, or from medications like proton pump inhibitors/H2 blockers)
  • Inadequate iron intake (vegetarian diets), or blood loss (like hookworm).
• Clinical Manifestations:
  • Weakness, fatigue, pallor, tachycardia, palpitations, dyspnea, dizziness, nausea, vomiting, melena, diarrhea, anorexia, glossitis
  • Pica (cravings for unusual substances like ice, starch or dirt)
  • Severe/prolonged deficiency can lead to a smooth red tongue, brittle/ridged nails, angular cheilosis
• Assessment & Diagnostics:
  • Bone marrow aspiration
  • Low levels of hematocrit, RBCs, hemoglobin, and ferritin.
• Medical Management:
  • Identify the cause of deficiency.
  • Oral iron supplements (ferrous sulfate, ferrous gluconate) taken 1-2 hours before meals to improve absorption OR slowly increased doses.
  • Vitamin C enhances iron absorption.
  • Dietary changes to include high-iron foods (organ meats, beans, leafy greens).
  • IV or IM iron dextran if oral is poor absorbed/tolerated.
  • Possible longer treatment (6-12 months) needed to replenish iron stores

Sickle Cell Anemia

• A hereditary disease, often inherited through consanguineous marriages.

• Characterized by a defective hemoglobin (HbS) gene, which causes abnormal hemoglobin formation.

• HbS crystallizes at low oxygen tension, deforming RBCs into rigid, sickle shapes.

• Sickle Cell Crisis: Intermittent episodes related to micro-circulation blockade. Types include:

  • Acute vaso-occlusive crisis: Micro-circulation blockages causing tissue hypoxia, inflammation, and necrosis.
  • Plastic crisis: Occurs from viral (parvovirus) infections when the bone marrow can't compensate for the rapid fall in hemoglobin leading to no reticulocytes.
  • Sequestration crisis: Sickled cells pool in organs (spleen in children; liver /lungs in adults, which causes organ damage.)

• Acute Chest Syndrome: A serious complication of SCD, marked by fever, respiratory distress (tachycardia, cough, wheezing). Often caused by infections or pulmonary issues.

• Complications: Infection, stroke, kidney injury, impotence, heart failure, and pulmonary hypertension.

• Risk factors for crisis: Dehydration, cold, stress, strenuous activity, infection, low oxygen.

Thalassemia

• A group of inherited anemias characterized by:
  • Hypochromia (low hemoglobin content)
  • Microcytosis (small RBCs)
  • Hemolysis
  • Variable degrees of anemia
• Defective hemoglobin synthesis (reduced production of globulin chains). This leads to increased rigidity and premature destruction of RBCs.
• Classified as Alpha and Beta Thalassemia, based on the diminished globulin chain.
• Thalassemia Major: Severe anemia and ineffective erythropoiesis, often fatal before adulthood if untreated. Requires early and regular blood transfusion therapy to facilitate growth and development.
• Management: Blood transfusions and iron chelation therapy. Preconception counseling is important for couples.

Other Medical Management

• Peripheral Blood Stem Cell Transplant (PBSCT): A possible cure for SCD, but limited availability due to lack of compatible donors or existing organ damage.
• Hydroxyurea: Chemotherapy agent which increases fetal hemoglobin levels, reducing sickling and painful crises.
• Folic Acid: Daily supplementation is often needed to support erythropoiesis.
• Transfusion Therapy: Effective in reducing/treating sickle cell crisis and preventing complications like strokes and heart failure but with associated risks (e.g., infection, iron overload).
• Pain Management: Aspirin, NSAIDs, and parenteral opioids are used for pain relief.
• Hydration: Maintained through oral hydration or IV fluids as part of supportive therapy during a crisis.
• Treatment of infections is critical.

Nursing Management

• Managing Pain, Fatigue, Infection and Deficient Knowledge: Assessing patients for symptoms, administering meds, managing fluids, infection control measures, and patient education.
• Potential Complications: Close monitoring and treatment of possible complications from anemia(e.g., infection, stroke, heart failure).