Reduced oxygen carrying capacity of blood, or reduced numbers of red blood cells or their haemoglobin content or both. Diagnosed by a simple blood test for Haemoglobin levels.


Haemoglobin men 13.5 18g/dL women 11.5 16.5g/dL


Haematocrit value Percentage of the blood which is red cells, usually about 45%



Non specific symptoms





Hypoxic cerebral effects





anorexia and dyspepsia


Hypoxia effects

shortness of breath on exertion

tingling in extremities




ischaemic conditions made worse



pallor of skin, nail beds, mucus membranes


cardiac failure


Signs of iron deficiency

Brittle spoon shaped nails

angular stromatitis




Anaemia can be caused basically in one of three ways, secondary to decreased erythropoiesis, increased haemolysis or secondary to blood loss


Decreased production

Deficiency of erythropoetic agents; iron, vit B12, folic acid, vit C, thyroxine, copper

Inadequate production - renal failure

Hypoplastic or aplastic



Excessive red cell breakdown haemolysis

May be raised serum bilirubin

May be caused by any haemolytic disease


Blood loss

Any cause of chronic haemorrhage


Iron deficiency anaemia



Clinical features



Megaloblastic anaemia


Pernicious anaemia



Clinical features



Aplastic anaemia



Clinical features

Treatment principles


Haemolytic anaemias


Hereditary spherocytosis

G6PD deficiency


Mechanical haemolytic anaemia

Haemolytic disease of the newborn


Sickle cell disease


Clinical features


Treatment principles


Other forms of anaemia

Sideroblastic anaemia

Anaemia in renal disease

Anaemia of chronic disease

Cigarette smoking






























Classification microcytic normocytic macrocytic


Microcytic - Iron deficiency


blood loss, low iron diet, malabsorption, increased iron demand eg. growth or pregnancy


Cell changes microcytic, hypochromic, variation in shape and size of RBCs



Correct underlying cause

Iron supplement e.g. ferrous sulphate, 600 mg/day, (120g ferrous iron)

With good treatment Hb should rise by 1g/week

Full recovery and replacement of iron stores may take up to 6 months



Failure of production by bone marrow


Anaemia due to blood loss

Causes menorrhagia peptic ulcer haemorrhoids GI cancer colitis hook worm


Treatment the cause, erythropoietic (haematinic) factors


Anaemic of chronic disease Decreased release of iron from bone marrow to developing erythrocytes


Macrocytic Vit B12 and foliate are both required for DNA synthesis


Pernicious anaemia

B12 malabsorption Usually in elderly Post gastrectomy, lack of intrinsic factor


Cell changes abnormal macrocytic


Treatment oral B12 and diet B12 injections


Folic acid deficiency

Macrocytic as in pernicious anaemia Give 5mg folic acid/day ? prophylactic folic acid in pregnancy

Found in green vegetables and offal, (liver and kidney)


Macrocytosis of pregnancy Possibly results from shortage of folic acid


Macrocytic anaemia also found in, newborn alcoholics liver diseasehypothyroidism aplasic anaemia






Specific nursing management in anaemia


Possible factors

Diet Assess and plan the diet with patient and dietitian to compensate for deficiencies.


Gastric Lack of hydrochloric acid or intrinsic factor, by-pass stomach by using injections.


Blood loss Assess site and degree, arrest cause and take steps to return the HB to normal.


Pregnancy Consider the periconceptual period as well as pregnancy. Give advice pregnancy prevention.


Systemic disease Correction and care while ill.

Poor financial circumstances

Ignorance of dietary needs

Childhood and pregnancy, Dietary demands are greater.



Treatment of cause

Care during iron injections, care of blood transfusions, ensure medication compliance.


Observations Bowel habits, type/colour occult blood urine observation/tests menstrual patterns, length severity blood tests.


Breathlessness Depends on severity, bed rest and positioning, monitor respiratory rate, observe for cyanosis, oxygen if required.


Tachycardia/tiredness Record pulse rate, planned rest periods.


Diet Record what patient actually eats, weight charts.


General measures ADLs, care of the mouth, finger nails, psychological, sociological



























1. Which hormone stimulates the bone marrow to produce more red blood cells?

(chose 1 answer)

a. Thyroid hormone

b. Erythropoietin

c. Renin

d. Angiotensinogen


2. In iron deficiency anaemia you would expect to find;

(chose 1 answer)

a. Macrocytic hyperchromic red cells

b. Macrocytic normochromic red cells

c. Microcytic hyperchromic red cells

d. Microcytic hypochromic red cells


3. Which of the following statements about aplastic anaemia is true? (chose 2 answers)

a. There is a reduction in white cells but never red cells

b. There is a reduction in red cells but never in white cells

c. The numbers of thrombocytes are not reduced

d. There are reduced numbers of red and white cells in the blood

e. infection represents a life-threatening risk to these patients


4. The most common form of anaemia in the world is;

(chose 1 answer)

a. Aplastic

b. Sickle cell

c. Thalassaemia

d. Iron deficiency

e. Pernicious


5. Which form of anaemia has an autoimmune aetiology? (chose 1 answer)

a. Sickle cell anaemia

b. Macrocytosis of pregnancy

c. Pernicious anaemia

d. Iron deficiency anaemia


6. If a healthy person moves to live at high altitude, which of the following will happen?

(chose 2 answers)

a. The amount of erythropoietin in the blood will be reduced

b. The amount of erythropoietin in the blood will be increased

c. Red cell count will in crease

d. Red cell count will stay the same

e. Red cell size will increase

f. Oxygen carrying capacity of the blood will be reduced


7. If which of the following might the levels of bilirubin in the blood be increased

(chose 2 answers)

a. Iron deficiency anaemia

b. Pernicious anaemia

c. Chornic haemorrhage

d. Spherocytosis

e. Anaemia of renal disease

f. G6PD deficiency


8. Which of the following conditions may complicate long term anaemia

(chose 2 answers)

a. Renal failure

b. Colorectal carcinoma

c. Cardiomegaly

d. Left ventricular failure

e. Myocardial infarction