Anemia PDF

 Anemia At the end of this lecture, the student will be able to: - Define anemia. - Describe Pathophysiology of anemia. - Explain causes of anemia. - Describe clinical manifestation of anemia. - Identify diagnostic test of anemia. - Explain types of anemia. - Management of...

 Anemia At the end of this lecture, the student will be able to: - Define anemia. - Describe Pathophysiology of anemia. - Explain causes of anemia. - Describe clinical manifestation of anemia. - Identify diagnostic test of anemia. - Explain types of anemia. - Management of patient with anemia. Definition of anemia Definition of anemia: Anemia is a deficiency in the number of red blood cells (RBCs), hemoglobin, and/ or the volume of packed RBCs (hematocrit). Anemia is not a specific disease state but a sign of an underlying disorder. It is by far the most common hematologic condition Pathophysiology of anemia A decrease in the number of RBCs can be traced to three different conditions: (1) impaired production of RBCs, as in aplastic anemia and nutrition deficiencies; (2) increased destruction of RBCs, as in hemolytic or sickle cell anemia; or (3) massive or chronic blood loss. Some anemia's are related to genetic problems in certain cultures. Causes of anemia 1. Dietary deficiencies: Iron, folic acid, and vitamin B12 are all essential to the production of healthy RBCs. A deficiency of any of these nutrients can cause anemia. Pernicious anemia is associated with a lack of intrinsic factor in stomach secretions, which is necessary for absorption of vitamin B12. Cont. 2.Hemolysis: Hemolysis is the destruction, or lysis, of RBCs. Destruction of RBCs leads to a type of anemia called hemolytic anemia. This may be a congenital disorder or it may be caused by exposure to certain toxins. Cont. 3.Other causes. Thalassemia anemia is a hereditary anemia found in persons from Southeast Asia, Africa, Italy, and the Mediterranean islands. People with thalassemia do not synthesize hemoglobin normally. Those with chronic disease also develop anemia.  Most common clinical manifestations of anemia  Hemoglobin (Hgb) levels are often used to determine the severity of anemia. Mild states of anemia (Hgb 10 to 12 g/dL [100 to 120 g/L]) may exist without causing symptoms. In moderate anemia (Hgb 6 to 10 g/dL [60 to 100 g/L]) In severe anemia (Hgb less than 6 g/dL [60 g/L]).  Slight tachycardia on exertion and fatigue.  Dyspnea. - Chest pain. And - Muscle pain. The pale hand of a woman with severe anemia (right) in comparison to the normal hand of her husband (left). Diagnostic tests of anemia:  A complete blood cell count (CBC) is done to determine the number of RBCs and WBCs per cubic millimeter.  Hemoglobin and hematocrit levels are below normal in anemia.  Serum iron, ferritin, and total iron binding capacity measurements are done to diagnose iron deficiency anemia.  Serum folate is measured if folic acid deficiency is suspected.  A bone marrow biopsy and analysis may also be done. Classification of anemia  A- Hypo proliferative (Resulting from defective RBC production): Causes of hypo proliferative anemia: Inadequate production of RBCs may result from marrow damage due to medications or chemicals (eg, chloramphenicol, benzene) or from a lack of factors necessary for RBC formation or decreased erythropoietin production (eg, from renal dysfunction) cancer/inflammation, it include:  1. Iron deficiency. 2. Vitamin B12 deficiency (megaloblastic). 3.Folate deficiency. B- Bleeding (Resulting from RBC loss): 1. Bleeding from gastrointestinal tract. 2. Menorrhagia (excessive menstrual flow). 3. Epistaxis (nosebleed). 4. Trauma. C- Hemolytic (Resulting from RBC destruction):  Causes of hemolytic anemia: Hypersplenism (hemolysis), drug-induced anemia, and autoimmune anemia, it includes:  1. Sickle cell anemia: RBCs become rigid, sticky and are shaped like sickles or crescent moons. These irregularly cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body.  2. Thalassemia Hypo proliferative anemia (Iron deficiency anemia)  IRON DEFICIENCY ANEMIA Definition: Is a condition in which the intake of dietary iron is inadequate for hemoglobin synthesis. Iron deficiency anemia is the most common type of anemia in all age groups, and it is the most common anemia in the world. Causes of iron deficiency , - The most common cause of iron deficiency in men and postmenopausal women is bleeding (from ulcers, gastritis, inflammatory bowel disease, or gastrointestinal tumors, menorrhagia (excessive menstrual bleeding) and pregnancy with inadequate iron supplementation), Cont - Chronic alcoholism often have chronic blood loss from the gastrointestinal tract. - Inadequate iron stores, inadequate intake of iron (seen with vegetarian diets), iron malabsorption, as is seen after gastrectomy or with celiac disease. Clinical manifestations  In the early course of iron-deficiency anemia the patient may not have any symptoms.  As the disease becomes chronic, any of the general manifestations of anemia may develop.  In severe deficiency or prolonged, they may also have as smooth, sore tongue, brittle nails.  An ulceration of the corner of the mouth, these signs subside after iron-replacement therapy Assessment and diagnostic findings - Laboratory investigation: - CBC. - Hemoglobin values. - Hematocrit. - Ferritin level. - Endoscopy and colonoscopy may be used to detect GI bleeding. - A bone marrow biopsy may be done  Management  Medical management:  Several oral iron preparations—ferrous sulfate, or ferrous gluconate.  In some cases, oral iron is poorly absorbed, poorly tolerated due to gastrointestinal toxicities (eg, nausea, abdominal discomfort, constipation), or iron supplementation is needed in large amounts. In these situations, intravenous or intramuscular administration of iron dextrin may be needed. Nursing management Preventive education is important, because iron deficiency anemia is common in menstruating and pregnant women. Food sources high in iron include organ meats (beef or calf’s liver, chicken liver), other meats, beans (black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses. Cont.  Taking iron-rich foods with a source of vitamin C enhances the absorption of iron.  Nutritional counseling can be provided for those whose usual diet is inadequate. Patients with a history of eating fad diets or strict vegetarian diets are counseled that such diets often contain inadequate amounts of absorbable iron.  The nurse encourages patients to continue iron therapy as long as it is prescribed, although they may no longer feel fatigued.  Guidelines for taking iron supplements  Take iron on an empty stomach (1 hour before or 2 hours after a meal). Iron absorption is reduced with food, especially dairy products.  To prevent gastrointestinal distress, the following schedule may work better if more than one tablet a day is prescribed: Start with only one tablet per day for a few days, then increase to two tablets per day, then three tablets per day. This method permits the body to adjust gradually to the iron. Cont. - 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. - To prevent staining the teeth with a liquid preparation, use a straw or place a spoon at the back of the mouth to take the supplement. Rinse the mouth thoroughly afterward.  Complications: - Angina or symptoms of heart failure. - Parenthesis. - Confusion. Feed back Anemia is a common condition. What happens when a person has anemia?  A.The body produces too much iron  B. The blood does not have enough red blood cells  C. The blood becomes thick  D. Too many white blood cells are produced What is the most common cause of anemia?  A. Too little sleep  B. Too much sugar  C. Too little iron in the blood  D. Exposure to X-ray radiation Cont. Which of these groups is the most likely to have anemia?  A. Men  B. Women  C. Teenagers  D. Older adults How does anemia affect the body?  A. The blood doesn't deliver enough oxygen to the body  B. Blood becomes thin  C. Tissues retain fluids  D. None of the above cont Which of these are signs of anemia?  A. Pale gums  B. Dark circles under the eyes  C. Bleeding  D. Numbness in hands and feet How does iron-deficiency anemia affect children and teens?  A. More fatigue  B. Increased irritability  C. Aggravates hyperactivity  D. A and B Cont. Anemia can contribute to which of these among older adults?  A. More falls  B. High blood pressure  C. Diminished eyesight  D. Diabetes