The document discusses anemia, including its definition, classification, causes, pathophysiology, clinical manifestations, diagnosis, and management. It specifically examines common types of anemia in children like iron deficiency anemia, sickle cell anemia, and aplastic anemia. For iron deficiency anemia, the document outlines causes like insufficient intake or absorption, increased losses, and increased demands. It also discusses clinical signs and treatments like oral or parenteral iron supplementation. For sickle cell anemia, the document describes the pathophysiology of sickling and associated complications. It provides details on aplastic anemia's pathogenesis and potential causes like infections, drugs, chemicals, and immune disorders.
3. Learning Objectives
At the end of the class the students will be able to
• define anemia
• list down the causes of anemia
• describe the Pathophysiology of anemia
• discuss the clinical manifestations of anemia
• state the diagnostic evaluation of anemia
• explain the management of anemia and aplastic anemia
4.
5. Functions of Blood
Transports
Nutrients absorbed from GI tract
O2 – from lungs to cells of whole body
CO2 – from metabolized cells to lungs
Wastes - from metabolized cells to kidney
Hormones – from endocrine glands to target cells
Body temperature control
Maintenance of body fluid pH (Buffering action)
Prevent blood loss (coagulation)
Prevent diseases (phagocytosis and antibody production)
7. INTRODUCTION
Anemia is a common blood disorder that occurs
when the body does not have enough RBCs.
RBC carry Oxygen throughout the body using a
protein called Hemoglobin. If there are not
enough of these cells or the protein results in
anemia.
8. DEFINITION
The term Anemia describes a condition in which
the number of Red Blood Cells(RBC) or
Hemoglobin(Hgb) concentration is reduced below
the normal values for age.
It is derived from the Greek word
“Ana” - Absent or decreased
“Emia”- Blood
10. ETIOLOGICAL
BASED ON THE DISTURBANCE OF ERYTHROPOIESIS
Anemia
Decreased
production
Iron deficiency
Anemia
Bone marrow
suppression
Hemorrhage
Increased Loss
Increased
destruction
11. Morphological (Size
and colour of RBC)
Classification
Normocytic
(Normal cell size)
Normochromic
(Normal amount of
RBC)
Microcytic
(Smaller than
Normal cell size)
Hypochromic
( RBC)
Macrocytic
(Larger than
Normal cell size)
Hyperchromic
( RBC)
14. IRON DEFICIENCY ANEMIA
Iron deficiency is the most common micronutrient
deficiency worldwide and one of the most important public
health problems, affecting approximately 25% of the world’s
population
(WHO).The
according to the World Health Organization
most common causes of iron
efficiency in children include insufficient intake, low birth
weight and gastrointestinal losses related to excessive
intake of cow milk
15. DEFINITION
Lack of supplemental iron for the synthesis of
most prevalent nutritional and
disorder among infant and
hemoglobin
hematological
children
17. ETIOLOGY cont…
• Insufficient supply of iron at birth (from mother)
• Prematurity (for full term 5-6 months they can store iron
but preterm only 2-3months )
• Insufficient intake of iron during the period ofrapid
growth (toddler)
• Impaired absorption
• Lack of vitamin C
• Blood loss
• Worm infestation
• Excessive intake of cow milk
18. Supply of inadequate iron
Depletion of iron stores
Depletion of serum transferrin
concentration
Sub normal Hb concentration
Sub normal oxygen carrying capacity
PATHOPHYSIOLOGY
22. CLINICAL MANIFESTATIONScont..
• Poor attention span
• Learning problem
• Behavioral problem
• Slow cognitive development
• Poor school performnace
23. CLINICAL MANIFESTATIONScont..
• Excessive pallor of the skin, conjunctiva and
mucous membrane
• Nails become thin, brittle and flat
• Pica and atrophy of tongue papillae
24. CLINICAL MANIFESTATIONScont..
• In severe anemia spleen mayenlarge
• Cardiac enlargement with soft systolic murmur
• Unhappiness
• Lack of co-operation
25. DIAGNOSTIC EVALUATION
• Total blood count
• Peripheral bloodsmear
• Serum ferretin
• Total iron binding capacity
• Recticulocyte count
26. MANAGEMENT
Oral Iron therapy
Most economical and effective
medication
Simple salt like ferrous sulphate,
ferrous fumarate and ferrous
gluconate,
elemental iron in oral 6mg/kg
24hours
supplemental iron10-50mg/kg/day
27. MANAGEMENT cont..
Parenteral IronTherapy
• Iron dextran complex : 50 mg/ml in 2 ml saline
• R o u t e intramuscular --- z track
method intravenous --- infusion methods
28. Iron: How much do we need?
Category Requirement
Preterm infants 2-4 mg/kg/day
Full terminfants 1 mg/kg day
Children 1-3 years old 7mg/day
Children 4-8 years old 10 mg/day
Children 9-13 yearsold 8 mg/day
Males 14-18 11 mg/day
Females 14-18 15 mg/day
30. NURSING MANAGEMENT
• Assist the child in developing a schedule for
daily activity and rest.
• Stress the importance of frequent rest periods.
• Monitor hemoglobin, hematocrit, RBC count,
and reticulocyte counts.
• Educate energy-conservation techniques.
• Encourage child to continue iron therapy for a
total therapy time (6 months to a year), even
when fatigue is no longer present.
31. NURSING MANAGEMENT
• Explain the importance of the diagnostic
procedures (such as complete blood
count), bone marrow aspiration and a
possible referral to a hematologist.
• Explain the importance of iron
replacement/supplementation.
• Educate the parents and the family
regarding foods rich in iron (organ and
other meats, leafy green vegetables,
molasses, beans).
32. PREVENTION
• Adequate antenatal care for the prevention of maternal
anemia and iron and folic acid supplementation to all
antenatal mother.
• Prevention of preterm delivery and control of infections in
prenatal, natal and post natal period.
33. PREVENTION cont..
• Introduction of semisolid and solid foods from 4 to 6
months of age as complementary feeding.
• Universal immunization to all children to prevent chronic
illness
• Iron and folic acid supplementation to the children and
adolescent girls
34. PREVENTION cont..
• Adequate treatment of parasitic infestations, chronic
illness.
• Improvement of living condition by avoidance of open air
defecation, environmental sanitation, hygienic measures,
balanced diet and preventing nutritional deficiencies.
35. PREVENTION cont…
• Encourage breastfeeding exclusively for 4-6 Months
• For 4 months an additional source of iron should be added, first as
an iron supplement, then transitioning to iron-fortified infant cereals.
• For <12 months who are not breastfed or are partially breastfed,
use only iron-fortified formulas (12 mg of iron per litre).
• For 6 Months encourage one feeding per day of foods rich in
vitamin C.
• Avoid feeding unmodified (nonformula) cow milk until age of 12
months.
• 1-5 years should also consume an adequate amount of iron-
containingfoods to meet daily requirements.
36. COMPLICATIONS
• Mild iron deficiency anemia usually does not
cause complications. However, left untreated
lead to the following health problems
– Heart failure
– Delayed growth and development
– Infections
37. NURSING DIAGNOSIS
• Fatigue related to decreased hemoglobin anddiminished
oxygen-carrying capacity of the blood.
• Parental Deficient knowledge related to the complexity of
treatment, lack of resources, or unfamiliarity with the
disease condition.
• Risk for infection related to invasion of microorganism
• Risk for bleeding related to bone marrow malfunctions
38.
39. DEFINITION
Sickle cell anemia is one of a group of disease
collectively termed hemoglobinopathies, in
which normal adult Hgb is partly or completely
replaced by abnormal sickle Hgb.
40. Cont…
Sickle cell disease includes all those hereditary
disorders whose clinical, hematologic and
pathologic features are related to the presence
of HbS
41. PATHOPHYSIOLOGY
– Due to obstruction caused by the sickled
RBC’s
– increased RBC destruction
The abnormal adhesion,entanglement and
enmeshing ofrigid sickle-shaped RBC’s with
one another
Intermittently block the micro circulation
46. CLINICAL MANIFESTATIONS cont..
Vasoocclusive crisis
• Pain in areas of involvement
• Extremities-painful swelling of hands and feet(sickle
cell dactylitis or hand foot syndrome), painful joints
• Abdomen-severe pain resembling acute surgical
condition.
62. DEFINITION
Aplastic anemia is caused by bone marrow
depression and involved all the blood elements
resulting pancytopenia (insufficient number of
RBC’s, WBC’s and platelets. )
63. Cont…
• Hemopoietic failure is mediated by activated
cytotoxic T cells in blood and marrow.
• Involvement off only RBC’s is termed as hypoplastic
anemia
• Involvement of granulocytes is known as
agranulocytosis
• Involvement of platelets is known as
thrombocytopenia
64. CAUSES
• Aplastic anemia can be congenital as Fanconi
anemia
• Diamond-blackfan syndrome
• Dyskeratosis congenita
• TAR syndrome
65. CAUSES
• Acquired aplastic anemia may occur due to
• Viral infections (HIV, HB, EBV)
• Bacterial or parasitic infections
• Infilteration of malignant cells as in leukemia
• Exposure to radiation, chemicals (DDT)
• Drugs (chloramphenicol, antimetabolites)
66. CAUSES
• Human parvovirus infection
• Immune disorders such as eosinophilic faciitis
and hypoimmunoglobulinemia
• Industrial and house hold chemicals including
benzene and its derivatives which are found in
peroleum products, dyes, paint remover, shellac
and lacquers
68. • Recurrent infections are common due to leukopenia
and neutropenia
• Intracranial bleeding may occur and presented as
head ache
• Irritability
• Excessive drowsiness
• Convulsions
• unconsciousness
CLINICAL MANIFESTATIONScont..
71. MANAGEMENT
• Immunosuppresents
• Drugs such as cyclosporine and anti thymocyte
globulin suppress the activity of immune cells
• Corticosteroids such as methylprednisone
72. MANAGEMENT
• Bone marrow stimulants
• Colony stimulating factors such as
sargramostism (leukine)
• Neupogen, neulasta helps to stimulate the bone
marrow to produce new blood cells
• Blood transfusion
74. Summary
Anemia is defined as reduction of RBCs or Hgb concentration to levels
below normal for age. The nurse’s role in treatment of anemia is to
assist in establishing a diagnosis, prepare the child for laboratory test
administer prescribed medications, decrease tissue oxygen needs,
implement safety precautions, and observe for complications.The main
nursing goal in prevention of nutritional anemia is parent education
regarding correct feedingpractices.
