TIME SPECIFIC CONTENT TEACHER AV EVALUATION

OBJECTIVE AND AIDS

LEARNER
ACTIVITY
2min INTRODUCTION
Anemia derived from Greek “anaimia” means ‘lack of blood’. Normal life span of red cells
is 120 days. Old erythrocytes are removed from circulation. Mildly deformed cells are
phagocytosed in spleen, severely injured cells are removed by liver macrophages, and grossly
damaged cells are destroyed in circulation itself. When destruction of erythrocytes exceeds the
normal rate, their life span diminishes and compensatory hyperplasia of erythroid precursors
develops The destruction or dissolution of red blood cells, with release of hemoglobin.
Also called erythrocytolysis, erythrolysis.
1 min Define DEFINITION Teacher Power What is
hemolytic Haemolytic anaemia is a form of anemia due to hemolysis, the abnormal breakdown defines point hemolytic
anemia of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or hemolytic anemia?
elsewhere in the human body (extravascular, but usually in the spleen). anemia
using power
point.
Students
actively
listens and
takes down
INCIDENCE notes.

1Min State the  Hemolytic anemia represents approximately 5% of all anemias. Acute AIHA is Teacher White Which age
incidence of relatively rare, with an incidence of one to three cases per 100,000 population per states the board group are more
hemolytic year. incidence of affected by
anemia  Hemolytic anemias are not specific to any race. However, sickle cell disorders are anemia AIHA?
found primarily in Africans, African Americans, some Arabic peoples, and using white
Aborigines in southern India. board.
Students
 Most cases of hemolytic anemia are not sex specific. However, AIHA is slightly actively
more likely to occur in females than in males. G6PD deficiency is an X-linked listens and
recessive disorder. Therefore, males are usually affected, and females are carriers. takes down
notes
  Hemolytic anemia can occur in persons of any age, hereditary disorders are
usually evident early in life. AIHA is more likely to occur in middle-aged and
older individuals.

TYPES
Elaborate the There are many types of hemolytic anemia. The condition can be inherited or acquired. Teacher Pull What are the
10min
types of elaborates chart types of immune
hemolytic INHERITED HEMOLYTIC ANEMIAS types of hemolytic
anemia With inherited hemolytic anaemia’s, one or more of the genes that control red blood cell hemolytic anemia?
production are faulty. This can lead to problems with the hemoglobin, cell membrane, or anemia
enzymes that maintain healthy red blood cells. using
The abnormal cells may be fragile and break down while moving through the Pull chart.
bloodstream. If this happens, an organ called the spleen may remove the cell debris from Students
the bloodstream. actively
Sickle Cell Anemia listens and
Sickle cell anemia is a serious, inherited disease. In this disease, the body makes abnormal takes down
hemoglobin. This causes the red blood cells to have a sickle, or crescent, shape. note.
Sickle cells don't last as long as healthy red blood cells. They usually die after only about
10 to 20 days. The bone marrow can't make new red blood cells fast enough to replace the
dying ones.
In the United States, sickle cell anemia mainly affects African Americans.
Thalassemia
Thalassemias are inherited blood disorders in which the body doesn't make enough of
certain types of hemoglobin. This causes the body to make fewer healthy red blood cells
than normal.
Thalassemias most often affect people of Southeast Asian, Indian, Chinese, Filipino,
Mediterranean, or African origin or descent.
Hereditary Spherocytosis
In this condition, a defect in the surface membrane (the outer covering) of red blood cells
causes them to have a sphere, or ball-like, shape. These blood cells have a lifespan that's
shorter than normal.
Hereditary spherocytosis (SFER-o-si-to-sis) is the most common cause of hemolytic
anemia among people of Northern European descent.
Hereditary Elliptocytosis (Ovalocytosis)
Like hereditary spherocytosis, this condition also involves a problem with the cell
membrane. In this condition, the red blood cells are elliptic (oval) in shape. They aren't as
flexible as normal red blood cells, and they have a shorter lifespan.
Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
In G6PD deficiency, the red blood cells are missing an important enzyme called G6PD.
G6PD is part of the normal chemistry inside red blood cells.
In G6PD deficiency, if red blood cells come into contact with certain substances in the
bloodstream, the missing enzyme causes the cells to rupture (burst) and die.
Many factors can trigger the breakdown of the red blood cells. Examples include taking
sulfa or antimalarial medicines; being exposed to naphthalene, a substance found in some
moth balls; eating fava beans; or having an infection.
In this condition, the body is missing an enzyme called pyruvate (PI-ru-vate) kinase. Not
having enough of this enzyme causes red blood cells to break down easily.
.
ACQUIRED HEMOLYTIC ANEMIAS
With acquired hemolytic anemias, red blood cells may be normal. However, some other
disease or factor causes the body to destroy red blood cells and remove them from the
bloodstream.
The destruction of the red blood cells occurs in the bloodstream or, more commonly, in
the spleen.

IMMUNE HEMOLYTIC ANEMIA

In immune hemolytic anemia, immune system destroys red blood cells. The three main
types of immune hemolytic anemia are
 Autoimmune
 Alloimmune
 Drug-Induced
Autoimmune hemolytic anemia (AIHA). In this condition, immune system makes
antibodies (proteins) that attack red blood cells.
In some types of AIHA, the antibodies made by the body are called warm antibodies. This
means they're active (that is, they destroy red blood cells) at warm temperatures, such as
body temperature.
In other types of AIHA, the body makes cold-reactive antibodies. These antibodies are
active at cold temperatures.
Cold-reactive antibodies can become active when parts of the body, such as the hands or
feet, are exposed to temperatures lower than 32 to 50 degrees Fahrenheit (0 to 10 degrees
Celsius).

 Alloimmune hemolytic anemia. This type of hemolytic anemia occurs if body

makes antibodies against red blood cells from a blood transfusion. This type of
hemolytic anemia also can occur during pregnancy if a woman has.

 Drug-induced hemolytic anemia. Certain medicines can cause a reaction that

develops into hemolytic anemia. Some medicines, such as penicillin, bind to red
blood cell surfaces and can cause antibodies to develop.
Examples of these medicines include chemotherapy, acetaminophen, quinine and
antimalarial medicines, anti-inflammatory medicines, and levodopa.
Mechanical Hemolytic Anemias
Physical damage to red blood cell membranes can cause them to break down faster than
normal. Damage may be due to:
 Changes in the small blood vessels.
 An artificial heart valve or other device used in blood vessels.
 Hemodialysis.
 A heart-lung bypass machine, which may be used during open-heart surgery.
 Preeclampsia or eclampsia-- Preeclampsia is high blood pressure during
pregnancy. Eclampsia, which follows preeclampsia, is a serious condition that
causes seizures in pregnant women.
 Malignant hypertension - This is a condition in which blood pressure suddenly and
rapidly rises.
 Thrombotic thrombocytopenic purpura -This rare blood disorder causes blood
clots to form in small blood vessels throughout the body.
Blood cell damage also may occur in the limbs as a result of doing strenuous activities,
such as taking part in marathons.

Paroxysmal Nocturnal Hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (HE-mo-GLO-bih-NYU-re-ah), or PNH, is a
disorder in which the red blood cells are faulty due to a lack of certain proteins. The body
destroys these cells more quickly than normal.
 People who have PNH are at increased risk for blood clots in the veins and low levels of
white blood cells and platelets.

Other Causes of Damage to Red Blood Cells

Certain infections and substances also can damage red blood cells and lead to hemolytic
anemia. Examples include malaria and blackwater fever, tick-borne diseases, snake
venom, and toxic chemicals.

ETIOLOGY
5min Recognize the They may be classified according to the means of hemolysis, Teacher Flannel What is foot
etiological ♣ Intrinsic helps to chart strike
factors of ♣ Extrinsic recognize hemolysis?
hemolytic Intrinsic causes the
anemia Hereditary (inherited) hemolytic anemia can be due to : etiological
 Defects of red blood cell membrane production (as in hereditary factors of
spherocytosis and hereditary elliptocytosis) hemolytic
 Defects in hemoglobin production (as in thalassemia, sickle-cell anemia
disease and congenital dyserythropoietic anemia) using
 Defective red cell metabolism (as in glucose-6-phosphate dehydrogenase flannel.
deficiency and pyruvate kinase deficiency) Students
 Paroxysmal nocturnal hemoglobinuria (PNH), sometimes referred to as actively
Marchiafava-Micheli syndrome, is a rare, acquired, potentially life-threatening listens and
disease of the blood characterized by complement-induced intravascular hemolytic takes down
anemia. notes
Extrinsic causes
Acquired hemolytic anemia may be caused by immune-mediated causes, drugs and other
miscellaneous causes.
 Immune-mediated causes could include transient factors as in Mycoplasma
pneumoniae infection (cold agglutinin disease) or permanent factors as
in autoimmune diseases like autoimmune hemolytic anemia (itself more common
in diseases such as systemic lupus erythematosus, rheumatoid arthritis, Hodgkin's
lymphoma, and chronic lymphocytic leukemia).
 Spur cell hemolytic anemia
  Any of the causes of hypersplenism (increased activity of the spleen), such
as portal hypertension.
 Acquired hemolytic anemia is also encountered in burns and as a result of certain
infections (e.g. malaria).
 Lead poisoning resulting from the environment causes non-immune hemolytic
anemia.
 Similarly, poisoning by arsine or stibine also causes hemolytic anemia.
 Runners can suffer hemolytic anemia due to "footstrike hemolysis", owing to the
destruction of red blood cells in feet at foot impact
 Low-grade hemolytic anemia occurs in 70% of prosthetic heart valve recipients,
and severe hemolytic anemia occurs in 3%.

CLINICAL MANIFESTATIONS
list out the  Paleness of the skin Teacher list Power What symptoms
5min clinical outs the point are seen in a
 Fatigue
manifestations  Fever clinical patient with
of  Confusion manifestatio haemolytic
Hemolytic  Light headedness ns of anemia?
anemia  Dizziness hemolytic
 Weakness anemia
 Dark urine using power
 Yellowing of the skin and the whites of the eyes (jaundice) Point.
 Heart murmur Students
 Tachycardia actively
 Splenomegaly listen and
 Hepatomegaly takes down
note

DIAGNOSTIC EVALUATION
Enumerate the  History collection Teacher Leaflet What are the
5Min diagnostic  Physical examination enumerates diagnostic tests
evaluation for  Blood investigations- Complete blood count (CBC) includes red blood cell the for haemolytic
count (RBC), WBC, Differential count, Hemoglobin, and Haematocrit (HCT). diagnostic anemia?
 hemolytic  Urine test- for presence of free hemoglobin and iron. evaluation
anemia  Bone marrow biopsy for
These tests can identify the type of hemolytic anemia: hemolytic
 Absolute reticulocyte count anemia
 Coombs test, direct and indirect using
 Donath-Landsteiner test leaflet.
 Cold agglutinins
 Free hemoglobin in the serum or urine Students
 Hemosiderin in the urine actively
 Platelet count listens and
 Protein electrophoresis - serum takes down
 Pyruvate kinase
 Serum haptoglobin levels
 Serum LDH

MANAGEMENT
GOALS: Teacher chart Which is the
15 Describe the  Reducing or stopping the destruction of red blood cells. describes first line
Min management  Increasing the red blood cell count to an acceptable level. the treatment of
of hemolytic  Treating the underlying cause of the condition. managemen hemolytic
anemia Treatment will depend on the type, cause, and severity of the hemolytic anemia and will t of anemias?
consider the age, overall health and medical history. haemolytic
anemia
PHARMACOLOGICAL MANAGEMENT using chart.
First line treatment Students
 Corticosteroid medicines, such as prednisone 1-2 mg/kg body weight. Once the actively
acute episodes are controlled, the dose may be tapered off but maintenance dose listens and
should be given takes down
notes
 Prophylactic folic acid is indicated because active hemolysis can consume folate
and cause megaloblastosis
Second Line Treatment
  Other immunosuppressant like Rituximab, a monoclonal antibody directed against
the CD20 antigen expressed on B cells, has been shown to be effective in AIHA
(375 mg/m2 weekly for a median of 4 weeks) and cyclosporine
Last option treatments
 High-dose cyclophosphamide (50 mg/kg/day for 4 days) followed by granulocyte
colony-stimulating factor was effective in achieving complete remission in 5 of 8
patients with highly refractory warm AIHA
Supportive Therapy
 Blood transfusions- A blood transfusion is given to quickly increase red blood cell
count and to replace destroyed red blood cells with new ones.

 Plasmapheresis- Plasmapheresis is a procedure that removes antibodies from the

blood. The plasma, which contains the antibodies, is separated from the rest of the blood.
Then, plasma from a donor and the rest of the blood is put back in body. This treatment
may help if other treatments for immune hemolytic anemia don't work.

SURGICAL METHOD
 Bone marrow transplantation- In some types of hemolytic anemia, such as thalassemia,
the bone marrow doesn't make enough healthy red blood cells. The red blood cells it does
make may be destroyed before their normal lifespan is over. Blood and marrow stem cell
transplants may be used to treat these types of hemolytic anemia.
A blood and marrow stem cell transplant replaces damaged stem cells with healthy
ones from another person (a donor).
During the transplant, which is like a blood transfusion, you get donated stem cells
through a tube placed in a vein. Once the stem cells are in body, they travel to
bone marrow and begin making new blood cells.

 Splenectomy-Splenectomy is commonly thought to be the most effective

conventional second-line treatment of warm AIHA to be proposed to patients
unresponsive or intolerant to corticosteroids, in those that require a daily
maintenance dose of prednisone greater than 10 mg, and in those with multiple
relapses
 Discuss the
10min nursing Teacher Power List out some
management discuss the point nursing
of hemolytic nursing diagnosis for
anemia managemen hemolytic
t of anemia
hemolytic
anemia
using power
point.
Students
actively
listens and
contribute
points
NURSING MANAGEMENT
The management of anemia by nurses should be accurate and appropriate so that
objectives and goals would be achieved.
Nursing Assessment
The assessment of anemia involves:
 Health history and physical examination. Both provide important data about the
type of anemia involved, the extent and type of symptoms it produces, and the
impact of those symptoms on the patient’s life.
 Medication history. Some medications can depress bone marrow activity, induce
hemolysis, or interfere with folate metabolism.
 History of alcohol intake. An accurate history of alcohol intake including the
amount and duration should be obtained.
 Family history. Assessment of family history is important because certain
anemias are inherited.
 Athletic endeavours. Assess if the patient has any athletic endeavour because
extreme exercise can decrease erythropoiesis and erythrocyte survival.
 Nutritional assessment. Assessing the nutritional status and habits is important
because it may indicate deficiencies in essential nutrients such as iron, vitamin
B12, and folic acid.
Diagnosis
Based on the assessment data, major nursing diagnosis for patients with hemolytic anemia
include:
 Fatigue related to decreased hemoglobin and diminished oxygen-carrying capacity
of the blood.
 Imbalanced nutrition, less than body requirements, related to inadequate intake
of essential nutrients.
 Impaired tissue perfusion related to insufficient hemoglobin and haematocrit.
Planning & Goals
The major goals for a patient with anemia include:
 Decreased fatigue
 Attainment or maintenance of adequate nutrition.
 Maintenance of adequate tissue perfusion.
 Compliance with prescribed therapy.
  Absence of complications.

Nursing Interventions
Nursing interventions are based on the data assessed by the nurse and on the symptoms
that the patient manifests.
To manage fatigue:
 Prioritize activities. Assist the patient in prioritizing activities and
establishing balance between activity and rest that would be acceptable to the
patient.
 Exercise and physical activity. Patients with chronic anemia need to maintain
some physical activity and exercise to prevent the deconditioning that results from
inactivity.
To maintain adequate nutrition:
 Diet. The nurse should encourage a healthy diet that is packed with essential
nutrients.
 Alcohol intake. The nurse should inform the patient that alcohol interferes with
the utilization of essential nutrients and should advise the patient to avoid or limit
his or her intake of alcoholic beverages.
 Dietary teaching. Sessions should be individualized and involve the family
members and include cultural aspects related to food preference and preparation.
To maintain adequate perfusion:
 Blood transfusion monitoring. The nurse should monitor the patient’s vital signs
and pulse oximeter readings closely.
To promote compliance with prescribed therapy:
 Enhance compliance. The nurse should assist the patient to develop ways to
incorporate the therapeutic plan into everyday activities.
 Medication intake. Patients receiving high-dose corticosteroids may need
assistance to obtain needed insurance coverage or to explore alternative ways to
obtain these medications.
Evaluation
Included in the expected patient outcomes are the following:
 Reports less fatigue.
 Attains and maintains adequate nutrition.
 Maintains adequate perfusion.
 Absence of complications.
SUMMARY
So far we discussed about hemolytic anemia its definition, types, etiological factors,
clinical manifestations, diagnostic evaluation, management and nursing management

CONCLUSION
Hemolysis is the premature destruction of erythrocytes. A hemolytic anemia will develop
if bone marrow activity cannot compensate for the erythrocyte loss. The severity of the
anemia depends on whether the onset of hemolysis is gradual or abrupt and on the extent
of erythrocyte destruction. Mild hemolysis can be asymptomatic while the anemia in
severe hemolysis can be life threatening and cause angina and cardiopulmonary
decompensation
RECAPITULATION
 What is hemolytic anemia?
 Which age group are more affected by AIHA?
 What are the types of immune hemolytic anemia?
 What is foot strike hemolysis?
 What symptoms are seen in a patient with haemolytic anemia?
 What are the diagnostic tests for haemolytic anemia?
 Which is the first line treatment of hemolytic anemias?
 List out some nursing diagnosis for hemolytic anemia

ASSIGNMENT
Write an assignment on Nursing Process For Patient With Hemolytic Anemia and
submit it on 27/04/18 in PG Lecture hall 1