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Anemia by Nasira.pptx

  1. 1. Institute of Health Science School of Nursing and Midwifery Department of AHN. Advanced Adult Health Nursing II Seminar presentation on Anemia. By Nasira Jemal 2/4/2023 Anemia by Nasira 1
  2. 2. Out Line  Definition of anemia  Classification of anemia  Clinical Manifestation of anemia  Causes of anemia  Assessment and Diagnostic Findings  Medical Management.  Application of nursing Process  Reference 2/4/2023 Anemia by Nasira 2
  3. 3. Objectives At the end of the presentation students will be able to:-  Define Anemia  List classification of anemia  Describe clinical manifestation of anemia  Identify cause of anemia  Explain Assessment and Diagnostic Findings  Explain Medical Management.  Apply nursing Process 2/4/2023 Anemia by Nasira 3
  4. 4. Anemia 2/4/2023 Anemia by Nasira 4
  5. 5. Anemia Anemia:-  Is a Greek word (‘An’=without,‘emia’= blood).  Is a condition in which the hemoglobin concentration is lower than normal  It reflects the presence of fewer than the normal number of erythrocytes .  As a result, the amount of oxygen delivered to body tissues is also diminished. 2/4/2023 Anemia by Nasira 5
  6. 6. Cont…  Anemia is not a specific disease state but a sign of an underlying disorder.  It is by far the most common hematologic condition.  WHO criteria for anemia in men and women are hemoglobin values <13 and <12 g/dl, respectively 2/4/2023 Anemia by Nasira 6
  7. 7. 2/4/2023 Anemia by Nasira 7
  8. 8. Classification of Anemia  Anemia classified in several ways  A physiologic approach classifies anemia according to whether the deficiency in erythrocytes is caused by Hypo-proliferative anemia- defect in their production Hemolytic anemia by their destruction , or By their loss (i.e., bleeding) 2/4/2023 Anemia by Nasira 8
  9. 9. 2/4/2023 Anemia by Nasira 9
  10. 10. Classification… In hypo proliferative anemia :-  Bone marrow does not produce adequate numbers of erythrocytes, may result from:-  Marrow damage due to :- - Medications e.g. chloramphenicol (Chloromycetin), - Chemicals e.g. benzene  lack of factors e.g.( Iron, vitamin B12, folic acid, erythropoietin; necessary for erythrocyte formation) 2/4/2023 Anemia by Nasira 10
  11. 11. Classification… In hemolytic anemia:-  Premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma,  The released hemoglobin is converted in large part to bilirubin and, then bilirubin concentration rises.  The increased erythrocyte destruction leads to tissue hypoxia, 2/4/2023 Anemia by Nasira 11
  12. 12. Cont…  Tissue hypoxia stimulates erythropoietin production(a glycoprotein hormone, naturally produced by the peri-tubular cells of the kidney, that stimulates red blood cell production).  This increased production is reflected in an increased reticulocyte (immature red blood cells) count as the bone marrow responds to the loss of erythrocytes. 2/4/2023 Anemia by Nasira 12
  13. 13. Cont… Hemolysis can result from  Abnormality within the erythrocyte itself (eg, sickle cell anemia, glucose-6-phosphate dehydrogenase [G- 6-PD] deficiency) or  Within the plasma (eg, immune hemolytic anemias),  From direct injury to the erythrocyte within the circulation (eg, hemolysis caused by mechanical heart valve). 2/4/2023 Anemia by Nasira 13
  14. 14. Cont…  Pernicious anemia is an inherited disorder caused by lack of intrinsic factor and inability to absorb vitamin B 12 2/4/2023 Anemia by Nasira 14
  15. 15. Hypo Proliferative Anemia. Iron Deficiency Anemia  The most common type of anemia in all age groups, and in the world.  Typically results when the intake of dietary iron is inadequate for hemoglobin synthesis.  The body can store about one fourth to one third of its iron, and it is not until those stores are depleted that iron deficiency anemia actually begins to develop 2/4/2023 Anemia by Nasira 15
  16. 16. Hypo Proliferative Anemia…  It is particularly prevalent in developing countries, where inadequate iron stores can result from inadequate intake of iron; e.g. vegetarian diets) or from blood loss (eg, from intestinal hookworm).  Iron deficiency is also common among adults in the United States and the most common cause is blood loss 2/4/2023 Anemia by Nasira 16
  17. 17. Hypo Proliferative Anemia… Anemias In Renal Disease  As renal function decreases, erythropoietin, which is produced by the kidney, also decreases.  This anemia is caused by both a mild shortening of erythrocyte lifespan and a deficiency of erythropoietin (necessary for erythropoiesis). 2/4/2023 Anemia by Nasira 17
  18. 18. Hypo Proliferative Anemia…  Because erythropoietin is also produced outside the kidney ( liver), some erythropoiesis continues, even in patients whose kidneys have been removed.  Patients undergoing long-term hemodialysis lose blood into the dialyzer and therefore may become iron deficient 2/4/2023 Anemia by Nasira 18
  19. 19. Hypo Proliferative Anemia… Anemia of Inflammation  Many chronic inflammatory diseases are associated with a normochromic, normocytic anemia (i.e., the erythrocytes are normal in color and size),  The deficiency is due to impaired production of RBCs. 2/4/2023 Anemia by Nasira 19
  20. 20. Hypo Proliferative Anemia… Aplastic anemia:-  Is a rare disease caused by a decrease in or, damage to the microenvironment within the marrow, and replacement of the marrow with fat.  Can be acquired or, rarely, congenital,  Viral infections and pregnancy can trigger it, or it may be caused by certain medications, chemicals, or radiation damage. 2/4/2023 Anemia by Nasira 20
  21. 21. Hypo Proliferative Anemia… Folic Acid Deficiency  The folate stores in the body are much smaller than those of vitamin B12can become depleted within months when the dietary intake of folate is deficient.  Folate is found in green vegetables and liver.  Thus, folate deficiency occurs in people who rarely eat uncooked vegetables. 2/4/2023 Anemia by Nasira 21
  22. 22. Hypo Proliferative Anemia…  Folic acid requirements are also increased in patients who used alcohol with liver disease, chronic hemolytic anemia and in women who are pregnant, because the need for erythrocyte production is increased in these conditions.  Some patients with mal absorptive diseases of the small bowel, such as celiac disease, may not absorb folic acid normally(Green, 2 2/4/2023 Anemia by Nasira 22
  23. 23. Hypo Proliferative Anemia… Vitamin B12 Deficiency  can occur in several ways.  Inadequate dietary intake is rare but can develop in strict vegans who consume no meat or dairy products.  Faulty absorption from the GI tract is more common, particularly in the older adult also occurs in conditions such as Crohn’s disease or after ileal resection, bariatric surgery, or gastrectomy 2/4/2023 Anemia by Nasira 23
  24. 24. Hemolytic Anemia Sickle cell anemia :-  Is a severe hemolytic anemia that results from inheritance of the sickle hemoglobin gene.  This gene causes the hemoglobin molecule to be defective.  The sickle hemoglobin (HbS) acquires a crystal-like formation when exposed to low oxygen tension. 2/4/2023 Anemia by Nasira 24
  25. 25. Hemolytic Anemia…  The erythrocyte containing HbS loses its round, pliable, biconcave disc shape and becomes dehydrated, rigid, and sickle shaped  These long, rigid erythrocytes can adhere to the endothelium of small vessels;  when they adhere to each other, blood flow to a region or an organ may be reduced ischemia or infarction results, the patient may have pain, swelling, and fever 2/4/2023 Anemia by Nasira 25
  26. 26. Hemolytic Anemia… 2/4/2023 Anemia by Nasira 26 A normal red blood cell (upper left) and a sickled red blood cell.
  27. 27. Hemolytic Anemia…  If the erythrocyte is again exposed to adequate amounts of oxygen before the membrane becomes too rigid (e.g., when it travels through the pulmonary circulation), it can revert to a normal shape  For this reason the “sickling crises” are intermittent. 2/4/2023 Anemia by Nasira 27
  28. 28. Hemolytic Anemia…  Sickled cells are rapidly hemolyzed and thus have a very short life span.  Anemia is always present; usually, hemoglobin values range between 5 and 11 g/dL (Natrajan & Kutlar, 2016).  Jaundice is characteristic and is usually obvious in the sclerae. 2/4/2023 Anemia by Nasira 28
  29. 29. Hemolytic Anemia…  Complications of sickle cell disease include :- Infection, Stroke, kidney injury, Impotence, Heart failure, and Pulmonary hypertension 2/4/2023 Anemia by Nasira 29
  30. 30. Hemolytic Anemia…  The bone marrow expands in childhood in a compensatory effort to offset the anemia,  Sometimes leading to enlargement of the bones of the face and skull.  Unusually susceptible to infection, particularly pneumonia and osteomyelitis. 2/4/2023 Anemia by Nasira 30
  31. 31. Hemolytic Anemia… Sickle Cell Crisis  There are three types of sickle cell crisis in the adult population.  acute vaso-occlusive crisis The most common & is the very painful, which results from entrapment of erythrocytes and leukocytes in the microcirculation, causing tissue hypoxia, inflammation, and necrosis due to inadequate blood flow to a specific region of tissue or organ 2/4/2023 Anemia by Nasira 31
  32. 32. Hemolytic Anemia…  Aplastic crisis  Results from infection with the human parvovirus.  The hemoglobin level falls rapidly and the marrow cannot compensate, as  Evidenced by an absence of reticulocytes (Natrajan & Kutlar, 2016). 2/4/2023 Anemia by Nasira 32
  33. 33. Hemolytic Anemia…  Sequestration crisis results  when other organs pool the sickled cells.  Although the spleen is the most common organ responsible for sequestration in children, most children with SCD have had a splenic infarction by 10 years of age, and the spleen is then no longer functional (auto-splenectomy) (Natrajan & Kutlar, 2016).  2/4/2023 Anemia by Nasira 33
  34. 34. Hemolytic Anemia… Thalassemia :-are a group of hereditary anemia characterized by:-  Hypochromia -abnormal hemoglobin content of erythrocytes),  Extreme microcytosis (smaller-than-normal erythrocytes),  Hemolysis, and variable degrees of anemia. 2/4/2023 Anemia by Nasira 34
  35. 35. Hemolytic Anemia…  Thalassemia are associated with defective synthesis of hemoglobin; the production of one or more globulin chains within the hemoglobin molecule is reduced. • This increases the rigidity of the erythrocytes and thus the premature destruction of these cells.  Thalassemia are classified into two major groups according to which hemoglobin chain is diminished: alpha or beta. 2/4/2023 Anemia by Nasira 35
  36. 36. Hemolytic Anemia…  When thalassemia is called “alpha” or “beta,” this refers to the part of hemoglobin that isn't being made.  If either the alpha or beta part is not made, there aren't enough building blocks to make normal amounts of hemoglobin.  Low alpha is called alpha thalassemia.  Low beta is called beta thalassemia. 2/4/2023 Anemia by Nasira 36
  37. 37. Hemolytic Anemia…  The alpha thalassemia are milder than the beta forms and often occur without symptoms  If left untreated, severe beta-thalassemia can be fatal within the first few years of life 2/4/2023 Anemia by Nasira 37
  38. 38. Hemolytic Anemia… Glucose-6-Phosphate Dehydrogenase Deficiency  G6PD deficiency is inherited, Children who have it are born with it because it was passed down in genes from one or both of the parents.  The gene responsible for this condition is on the X chromosome .  This gene produces an enzyme within the erythrocyte 2/4/2023 Anemia by Nasira 38
  39. 39. Hemolytic Anemia… Immune Hemolytic Anemia  Hemolytic anemia can result from exposure of the erythrocyte to antibodies.  Alloantibodies -antibodies against the host/ “self”)  From the immunization of a person with foreign antigens (e.g., the immunization of an Rh-negative person with Rh-positive blood). 2/4/2023 Anemia by Nasira 39
  40. 40. Hemolytic Anemia…  Alloantibodies tend to be of the immunoglobulin G (IgG) type and cause immediate destruction of the sensitized erythrocytes, either within the blood vessel (intravascular hemolysis) or within the liver.  E.g. hemolytic transfusion reaction 2/4/2023 Anemia by Nasira 40
  41. 41. Bleeding(from RBC loss)  Bleeding from GI tract  Epistaxis  Trauma  Bleeding from genito-urinary tract ( e.g. menorrhagia) 2/4/2023 Anemia by Nasira 41
  42. 42. Clinical Manifestations Symptoms of anemia will vary based on the:-  Severity of the anemia;  Rapidity of onset;  Duration of the anemia (ie, its chronicity);  Metabolic requirements of the patient;  Cardiac, pulmonary, or other underlying disease; and  Complications caused by the underlying disorder. 2/4/2023 Anemia by Nasira 42
  43. 43. General symptoms  Dyspnea, chest pain,  Muscle pain or cramping,  Tachycardia, weakness,  Fatigue, general malaise,  Pallor of the skin,& mucous membranes, 2/4/2023 Anemia by Nasira 43
  44. 44. Cont…  Megaloblastic or hemolytic anemia:- Jaundice  Iron deficiency:  Brittle, Ridged, concave nails,  Pica (unusual craving for starch, dirt, ice); Blood in stool, smooth, red tongue  Megaloblastic anemia: Beefy, red, sore tongue Angular cheilosis (ulceration of the corner of the mouth) 2/4/2023 Anemia by Nasira 44
  45. 45. Complications  Complications of severe anemia include:- Heart failure, Aesthesia, and Delirium.  Patients with underlying heart disease are far more likely to have angina or symptoms of heart failure than those without heart disease. 2/4/2023 Anemia by Nasira 45
  46. 46. Diagnostic Methods  Complete hematologic studies :- hemoglobin, hematocrit, reticulocyte count, and red blood cell (RBC) indices (measure the size, shape, and quality of RBC, 2/4/2023 Anemia by Nasira 46
  47. 47. Cont…  Particularly the mean corpuscular volume [MCV] is the average volume of red cells in a specimen and  RBC distribution width [RDW] (measures the differences in the volume and size of RBC).  Iron studies -serum iron level, total iron-binding capacity [TIBC], percent saturation, and ferritin (how much iron your body stores)  Serum vitamin B 12 and folate levels; haptoglobin 2/4/2023 Anemia by Nasira 47
  48. 48. Treatment Objectives  Improve the functional status of anemia  Prevent development of complications such as Heart Failure  Treatment of the underlying cause 2/4/2023 Anemia by Nasira 48
  49. 49. Non pharmacologic  Packed RBC or whole blood transfusion when thereis Heart Failure , severe hypoxic symptoms, acute ongoing bleeding)  Nutritional support  Non pharmacologic treatment pertinent to the underlying cause 2/4/2023 Anemia by Nasira 49
  50. 50. Cont… N.B:-Hematinic (Iron, folate and vitamin B12) should not be routinely administered to patients with anemia without a definitive diagnosis of the cause.  There is no universal pharmacologic treatment for all causes of anemia 2/4/2023 Anemia by Nasira 50
  51. 51. Medical management  For Iron deficiency anemia-Oral iron replacement  N.B. The cause of the iron deficiency state should be identified and treated. First line  Ferrous sulphate , 325mg (65mg elemental iron), OR 60mg elemental iron, TID between meals for at least 3 months following correction of the anemia. 2/4/2023 Anemia by Nasira 51
  52. 52. Cont…  N.B. For patients who do not tolerate ferrous sulfate tablets, they may be advised to take it with meals, or to take a smaller dose, or to change the brand to ferrous gluconate or fumarate tablets or elixir forms. OR  Ferrous gluconate, 325mg P.O. (39mg elemental iron), 1-2tabs, TID 2/4/2023 Anemia by Nasira 52
  53. 53. Cont… OR  Ferrous fumarate, 325mg P.O., (107 elemental iron), one tab, daily to twice per day. 2/4/2023 Anemia by Nasira 53
  54. 54. Cont…  For (Vitamin B12) deficiency  Cobalamin, 1000micrograms (1mg), IM, every day for one week, every week for four weeks and then,  If the underlying disorder persists, 1mg every month for the remainder of the patient's life. 2/4/2023 Anemia by Nasira 54
  55. 55. Cont… For Folate deficiency  Folic acid, 1 to 5mg P.O., daily for 1-4 months,  or until complete hematologic recovery. N.B Folic acid can partially reverse the hematologic abnormalities of Cobalamin (B12) deficiency BUT neurologic manifestations will progress. 2/4/2023 Anemia by Nasira 55
  56. 56. Cont…  Thus, it is important to rule out cobalamin deficiency before treating a patient with megalo-blastic anemia with folic acid alone 2/4/2023 Anemia by Nasira 56
  57. 57. Nursing Management  Preventive education is important  Nutritional advise  Administration of prescribed medication  Managing Fatigue  Preventing And Managing Infection  Promoting Coping Skills  Monitoring And Managing Potential Complications 2/4/2023 Anemia by Nasira 57
  58. 58. Reference  Handbook_for_Focus_on_Adult_Health_Medical_Surgic al_Nursing_  LindaThe Hematological Complications of Alcoholism HAROLD S. BALLARD, M.D.  Standard Treatment guide line 2021.  2018.14edi.Brunner_&_Suddarth’s_Textbook_of medical surgical nursing 2/4/2023 Anemia by Nasira 58
  59. 59. 2/4/2023 Anemia by Nasira 59

Hinweis der Redaktion

  • The spleen helps filter old and damaged cells from your bloodstream. If your spleen is overactive, it removes the blood cells too early and too quickly .
    mechanical heart valve associated with either structural deterioration or para valvular leak.
    Its main mechanism is a turbulent flow through the valve or between the sewing ring and the native ring.