Anaemia

 

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%

 

Symptoms

Non specific symptoms

tiredness

fatigue

weakness

 

Hypoxic cerebral effects

fainting

dizziness

headache

insomnia

anorexia and dyspepsia

 

Hypoxia effects

shortness of breath on exertion

tingling in extremities

angina

amenorrhoea

palpitations

ischaemic conditions made worse

 

Signs

pallor of skin, nail beds, mucus membranes

tachycardia

cardiac failure

 

Signs of iron deficiency

Brittle spoon shaped nails

angular stromatitis

glossitis

 

Aetiology

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

 

Haemolytic

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

Aetiology

Pathophysiology

Clinical features

Treatment

 

Megaloblastic anaemia

 

Pernicious anaemia

Aetiology

Pathophysiology

Clinical features

Treatment

 

Aplastic anaemia

Aetiology

Pathophysiology

Clinical features

Treatment principles

 

Haemolytic anaemias

Pathophysiology

Hereditary spherocytosis

G6PD deficiency

Thalassaemia

Mechanical haemolytic anaemia

Haemolytic disease of the newborn

 

Sickle cell disease

Pathophysiology

Clinical features

Epidemiology

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

Causes

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

 

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

 

Treatment

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

 

Normocytic

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