ANEMIA

-is a condition in which hemoglobin concentration is lower than normal, reflects the
presence of fewer than normal erythrocytes within the circulation. As a result, the
amount of oxygen delivered to body tissues is also diminished.
-it is not a disease but a sign of an underlying disorder.
CLASSIFICATION OF ANEMIAS
-a physiologic approach classifies anemia according to whether the deficiency in
erythrocytes is caused by a defect in their production (hypoproliferative anemia), by
their destruction (hemolytic anemia), or by their loss (bleeding).
HYPOPROLIFERATIVE ANEMIAS
-the marrow cannot produce adequate number of erythrocytes. Decrease
erythrocytes production is reflected by an inappropriately normal or low reticulocyte
count. Inadequate production of erythrocytes may result from marrow damage due
to medications (chloramphenicol) or chemicals (benzene) or from a lack of factors
(iron, vit B12, folic acid, and erythropoietin) necessary for erythrocyte formation.
HEMOLYTIC ANEMIAS
-premature destruction of erythrocytes results in the liberation of hemoglobin from
the erythrocytes into the plasma. The increased erythrocyte destruction leads to
tissue hypoxia, which in turn stimulates erythropoietin production. This increased
production is reflected in an increased reticulocytes count as the bone marrow
responds to the loss of erythrocytes. The released hemoglobin is converted in large
part to bilirubin, therefore the bilirubin concentration arises.

HYPOPROLIFERATIVE ANEMIAS
*IRON DEFICIENCY ANEMIA
-typically results when the intake of dietary iron is inadequate for hemoglobin
synthesis.
-common type of anemia
-inadequate iron stores can result from inadequate intake of iron (seen with
vegetarian diets) or from blood loss (from intestinal bookworm).
COMMON CAUSE: in men and menopausal women is bleeding (from ulcers, gastritis,
inflammatory bowel disease, or GI tumors)
-premenopausal women is menorrhagia (excessive menstrual bleeding) and
pregnancy with inadequate iron supplementation.
-patients with chronic alcoholism often have chronic blood loss from the GI tract,
which causes iron loss and eventual anemia.

-other causes include iron malabsorption, as is seen after gastrectomy or with celiac
disease.
CLINICAL MANIFESTATION
-severe or prolonged anemia
-smooth, sore tongue
-brittle and ridged nails;
-angular cheilosis (an ulceration of the corner of the mouth)
ASSESSMENT AND DIAGNOSTIC FINDINGS
-BONE MARROW ASPIRATION
-have a low serum iron level and an elevated TIBC, elevated ferritin level (infection
and inflammatory conditions
-low hemoglobin and hematocrit
-the most reliable are the ferritin and hemoglobin value
MEDICAL MANAGEMENT
-anemia may be a sign of a curable GI cancer or of uterine fibroid tumors.
-Stool specimen should be tested for occult blood
>50 y/o and above should have periodic colonoscopy, endoscopy, or xray
examination of the GI tract to detect ulcerations, gastritis, polyps, or cancer.
-ferrous sulfate, ferrous gluconate, and ferrous fumarate
-should continue taking iron for as long as 6 to 12 mos. Vitamin C facilitates
the absorption of iron.
-IV or IM administration of IRON DEXTRAN
BEFORE PARENTERAL ADMINISTRATION OF A FULL DOSE, a small test dose
shoud be administered parenterally to avoid the risk of anaphylaxis with either IV or
IM injections. If no signs of allergic reaction have occurred after 30 minutes, the
remaining dose of iron may be administered.
NURSING MANAGEMENT
-preventive education is important, common in menstruating and pregnant women.
-food sources high in iron include organ meats (liver), beans, green leafy
vegetables, raisins, and molasses
-with a source of Vitamin C (orange juice) enhances the absorption of Iron
-IRON IS BEST ABSORBED ON AN EMPTY STOMACH, take an hour before
meals + STOOL SOFTENER

-liquid forms of iron that cause less GI distress are available but can stain the teeth,
the patient should take this medication through a straw, rinse the mouth with water,
and to practice with good oral hygiene
SIDEEFFECTS: constipation, cramping, nausea, and vomiting
PATIENT EDUCATION
-take iron on an empty stomach (1 hour before or 2 hours after a meal)
-increase the intake of Vit C
-eat foods high in fiber to minimize problem with constipation
-remember the stools will become dark in color
-to prevent staining the teeth, use a straw or place spoon at the back of the mouth
and rinse the mouth thoroughly.
APLASTIC ANEMIA
-is a rare disease caused by a decrease in or damage to marrow stem cells, damage
to the microenvironment within the marrow, and replacement of the marrow with
fat.
ETIOLOGY: hypothetisized that the bodys T cells mediate an inappropriate attack
against bone marrow resulting in bone marrow aplasia (markedly reduced
hematopoiesis)
-severe anemia, significant neutropenia and thrombocytopenia (a deficiency of
platelets) are also seen
PATHOPHYSIOLOGY
-Aplastic anemia can be congenital or acquired, but most cases are idiopathic
(without apparent cause). Infections and pregnancy can trigger it or may be caused
by certain medications, chemicals, or radiation damage. Agents that regularly
produce marrow aplasia include benzene and benzene derivatives (airplane glue).
Certain toxic materials such asa inorganic arsenic and several pepticides.
CLINICAL MANIFESTATIONS
-infections, fatigue, pallor dyspnea
-purpura (bruising) may develop later
-if there is repeated throat infections, cervical lymphadenopathy
-retinal hemorrhages are common
ASSESSMENT AND DIAGNOSTIC FINDINGS
-aplastic anemia occurs when a medication or chemical is ingested in toxic amounts

-BONE MARROW ASPIRATE shows an extremely hypoplastic or even aplastic (very

few to no cells) marrow replace with fat.
MEDICAL MANAGEMENT
-the lymphocytes of patients with a plastic anemia destroy the stem cells and
consequently impair the production of erythrocytes, leukocytes, and platelets
-younger than 60 y/o, bone marrow transplant or peripheral blood stem cell
transplant
-can be manaed with a combination of ANTITHYMOCYTE GLOBULIN (ATG), a
purified gamma globulin solution and CYCLOSPORINE
SIDE EFFECT: fever and chills, sudden onset of a rash or bronchospasm
may henald anaphylaxis and requires prompt management
NURSING MANAGEMENT
-vulnerable to problems related to erythrocyte, leukocyte, and platelet deficiencies.
-assess carefully for signs of infection and bleeding
MEGALOBLASTIC ANEMIA
-caused by deficiencies of Vitamin B12 or folic acid, identical bone marrow and
peripheral blood changes occur because both vitamins are essential for normal DNA
synthesis
-the erythrocytes that are produced are abnormally large and are called
MEGALOBLASTIC red cells.
PATHOPHYSIOLOGY
*FOLIC ACID DEFIECIENCY is stored as compounds referred to as folates. The folate
stores in the body are much smaller than those of B12 and they are quickly
depleted when the dietary intake of folate is deficient (within 4 mos) Folate is found
in green vegetables and liver. Folate deficiency occurs in people who rarely eat
uncooked vegetables. Alcohol increases folic acid requirements and at the same
time patients with alcoholism