HAEMATOLOGY General nursing care for haematological disorders p 684 Blood transfusion p 688 • Reactions p 687 table 36.5 (T&E Periods) • Nursing responsibilities • Management p 688 table 36.3 Anaemia p 688 • Classification • Pathophysiology • Medical management Pernicious anaemia p 689 • Assessment and common findings • Diagnostic studies • Management Iron deficiency anaemia p 690 • Risk factors • Assessment and common findings • Diagnostic studies • Management • Essential health information Folic acid deficiency p 691 • Risk factors • Clinical manifestations • Diagnostic studies • Management

1. Anaemia
BY C SETTLEY

2. What is Anaemia? Pg. 688
• Anaemia results from a lack of red blood cells or dysfunctional red blood cells in the body.
•This leads to reduced oxygen flow to the body's organs.
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3. What does Red blood cells consist of?
•THE MAIN COMPONENTS OF BLOOD:
• Plasma
• Plasma is the liquid component of blood, in which the red blood cells, white
blood cells, and platelets are suspended.
• It constitutes more than half of the blood's volume and consists mostly of water
that contains dissolved salts (electrolytes) and proteins.
• The major protein in plasma is albumin.
• Albumin helps keep fluid from leaking out of blood vessels and into tissues, and
albumin binds to and carries substances such as hormones and certain drugs.
• Other proteins in plasma include antibodies (immunoglobulins), which actively
defend the body against viruses, bacteria, fungi, and cancer cells, and clotting
factors, which control bleeding.
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4. What does Red blood cells consist of?
•THE MAIN COMPONENTS OF BLOOD:
• Red blood cells
• Red blood cells (also called erythrocytes) make up about 40% of the blood's
volume.
• Red blood cells contain hemoglobin, a protein that gives blood its red color and
enables it to carry oxygen from the lungs and deliver it to all body tissues.
• Oxygen is used by cells to produce energy that the body needs, leaving carbon
dioxide as a waste product.
• Red blood cells carry carbon dioxide away from the tissues and back to the
lungs.
• When the number of red blood cells is too low (anemia), blood carries less
oxygen, and fatigue and weakness develop.
• When the number of red blood cells is too high (erythrocytosis, as in
polycythemia vera), blood can become too thick, which may cause the blood to
clot more easily and increase the risk of heart attacks and strokes.
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5. What does Red blood cells consist of?
•THE MAIN COMPONENTS OF BLOOD:
• White blood cells
• White blood cells (also called leukocytes) are fewer in number than red blood cells, with a ratio
of about 1 white blood cell to every 600 to 700 red blood cells. White blood cells are responsible
primarily for defending the body against infection. 5 TYPES:
• Neutrophils, the most numerous type, help protect the body against infections by killing and
ingesting bacteria and fungi and by ingesting foreign debris.
• Lymphocytes consist of three main types: T cells (T lymphocytes) and natural killer cells, which
both help protect against viral infections and can detect and destroy some cancer cells, and B
cells (B lymphocytes), which develop into cells that produce antibodies.
• Monocytes ingest dead or damaged cells and help defend against many infectious organisms.
• Eosinophils kill parasites, destroy cancer cells, and are involved in allergic responses.
• Basophils also participate in allergic responses.
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6. What does Red blood cells consist of?
•THE MAIN COMPONENTS OF BLOOD:
• White blood cells
• Some white blood cells flow smoothly through the bloodstream, but many adhere to blood
vessel walls or even penetrate the vessel walls to enter other tissues.
• When white blood cells reach the site of an infection or other problem, they release substances
that attract more white blood cells
• The white blood cells function like an army, dispersed throughout the body but ready at a
moment's notice to gather and fight off an invading organism.
• White blood cells accomplish this by engulfing and digesting organisms and by producing
antibodies that attach to organisms so that they can be more easily destroyed.
• When the number of white blood cells is too low (leukopenia), infections are more likely to
occur.
• A higher than normal number of white blood cells (leukocytosis) may not directly cause
symptoms, but the high number of cells can be an indication of an underlying disorder such as an
infection, inflammatory process or leukemia.
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7. What does Red blood cells consist of?
•THE MAIN COMPONENTS OF BLOOD:
• Platelets
• Platelets (also called thrombocytes) are cell-like particles that are smaller
than red or white blood cells.
• Platelets help in the clotting process by gathering at a bleeding site and
clumping together to form a plug that helps seal the blood vessel.
• At the same time, they release substances that help promote further
clotting.
• When the number of platelets is too low (thrombocytopenia), bruising
and abnormal bleeding become more likely.
• When the number of platelets is too high (thrombocythemia), blood may
clot excessively causing a transient ischemic attack.
• When the number of platelets is extremely high, the platelets can absorb
clotting proteins and paradoxically cause bleeding.
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9. Causes of anaemia
•Blood loss (whether acute or chronic)
•Acute blood loss may be seen on a road accident or after surgery. Blood loss of more than
500ml usually require blood fiber.
•Chronic blood loss occurs during excessive menstruation, worm infestation and other
conditions.
•The formation of red blood cells is not sufficient from the bone marrow.
•The lack of essential factors like iron, and vitamin B12, folate and erythropoietin.
•Rapid expansion of the youth, resulting in increased demand for iron which is above the
level of iron absorption.
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10. Causes of anaemia
•Menstrual cycle in women with a loss estimated 30mg of iron each month causes of iron
deficiency.
•Toxic factors: inflammatory disease, liver and kidney failure, medications.
•Hormone deficiency: low levels of thyroid hormones.
•Attacks the bone marrow: blood cancers, bone marrow disease.
•Disorders of red blood cells: conditions such as thalassemia.
•Destruction of red blood cells
•May occur in some infections or taking a medication.
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11. Classification of anaemia- pg. 689
Disease process involved Type of anaemia
Decreased production of erythrocytes Aplastic anaemia
Pernicious anaemia
Iron deficiency anaemia
Folic acid deficiency anaemia
Increased erythrocyte destruction Haemolytic anaemia
Sickle cell anaemia
Blood loss Haemorrhagic anaemia
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12. Pathophysiology of Anaemia- pg. 689
•Regardless of the type, the main characteristic of anaemia is
poor perfusion of body tissues resulting in hypoxia
•When hypoxia is sensed, the compensatory mechanisms are
activated to restore adequate supply of oxygen to the tissues
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13. Pathophysiology of Anaemia- pg. 689
•These compensatory mechanisms include:
• Increasing the rate at which RBC’s are produced
• Increasing the heart rate to increase cardiac output
• Redirecting blood from tissues of low oxygen needs (skin, GIT) to
vital organs (brain, heart)
• Shifting the haemoglobin dissociation curve to the right to increase
the removal of more oxygen by the tissues at the same partial
pressure of oxygen
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14. Medical management of Anaemia-
pg. 689
•IDENTIFICATION AND MANAGEMENT OF THE UNDERLYING
CAUSES OF ANAEMIA
• Improve dietary intake of iron and folic acid
• Prevent haemorrhage and bleeding from all sites
• Minimise exposure to toxic agents that cause aplastic anaemia
• Stem cell or bone marrow transplant
• Blood component therapy, plasma, platelets, or plasma proteins
such as albumin
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15. Medical management of Anaemia-
pg. 689
•SYMPTOM MANAGEMENT
• Administration of oxygen to the patient to prevent hypoxia and help
reduce workload of the heart
• Administration of prescribed erythropoietin to help increase the
production of RBS’s. Route: S/C. The patient should have an adequate
nutritional status and a well functioning bone marrow that is able to
produce BRC’s for this treatment to be effective.
• Iron supplements. Indication for IM iron supplements is indicated for
patients with malabsorption of oral iron, poor tolerance of oral meds
and specific need for large amounts
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16. Pharmacological management of Anaemia-
pg. 689
•According to Standard treatment guidelines
• Oral iron supplementation
• Ferrous sulphate compound BPC, oral, 170 mg (± 65 mg elemental
iron), 12 hourly.
• Do not ingest with tea, antacids or calcium supplements/milk.
• Doses should be taken on an empty stomach, but if
gastrointestinal side effects occur doses should be taken with
meals.
• Continue with treatment for 3 months once Hb has normalised to
replace iron stores.
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17. Pharmacological management of Anaemia-
pg. 689
•Follow the patient after one month of treatment and Hb
should rise by at least 2 g/dl in the adherent patient without
on-going blood loss.
• Prophylaxis: during pregnancy:
•Ferrous sulphate compound BPC, oral, 170 mg (± 65 mg
elemental iron), 12 hourly.
•Consider the following if there is failure to respond to iron
therapy:
• » non-adherence, » continued blood loss, » wrong diagnosis »
malabsorption, and » mixed deficiency; concurrent folate or vitamin
B12 deficiency.
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18. Aplastic anaemia- pg. 689
•Results from failure of the erythrocyte-producing organs, in
particular bone marrow, to produce adequate numbers of
erythrocytes.
•It can be congenital or acquired.
•May be fatal as it may evolve rapidly and if not corrected
•Causes:
• Destruction of the bone marrow by toxic chemicals
• Toxic drugs
• Radiation
• Invasion of the bone marrow by cancer cells, viral infections, pregnancy
& autoimmune factors
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19. Aplastic anaemia
Assessment and common findings- pg. 689
•A history of exposure to causative factors
•Complaints of progressive weakness, fatigue, numbness and a
tingling sensation in the extrimities
•Dyspnea on exertion and pallor
•Headaches, anorexia and an increased tendency to bleeding
(nosebleeds, bleeding gums)
•Because the patient is prone to infection, fever may be detected
as well as ulcers in the mouth
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20. Aplastic anaemia
Assessment and common findings- pg. 689
•Diagnosis can be made on findings of low Hb, low RBC count,
platelets and prolonged bleeding time
•Bone marrow aspiration will show bone marrow replacement
by fat
•Reticulocytes and immature granulocytes may be detected by a
peripheral blood smear.
•If there is infection, blood cultures will detect the offending
micro-organisms
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21. Aplastic anaemia: Management- pg. 689
•Identify and treat the underling cause
•Toxic meds can only be prescribed if there are no alternative
therapy
•Monitor blood count
•Administer RBC’s & platelets as prescribed
•Administer drugs as prescribed, incl. antibiotics,
immunosuppressive drugs before bone marrow transplantation
and steroids to stimulate the production of granulocytes
•Administer oxygen in cases of severe anaemia as prescribed
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22. Pernicious anaemia- pg. 689
•A decrease in red blood cells when the body can't absorb enough vitamin B12.
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23. Pernicious anaemia
Assessment & common findings- pg. 690
•A history of gastric surgery or vegetarian diet with an inadequate intake of Vit B12
•Fatigue, weakness, dyspnoea, palpitations and pallor
•Numbness and tingling of extremities, irritability, depression and decreased ability to
concentrate
•Skin and sclera of the eyes may be jaundiced
•Sores in the mouth and the tongue may appear beefy red
•Weight loss, indigestion, bloating, diarrhoea or constipation
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24. Pernicious anaemia
Diagnostic studies- pg. 690
•Hb- lower than 4-5 g/dl
•Low RBC
•Low WBC
•Low platelets
•Low serum levels of vit B12 and folate
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25. The following are normal complete blood
count results for adults:
Red blood cell count Male: 4.32-5.72 trillion cells/L*
(4.32-5.72 million
cells/mcL**)Female: 3.90-5.03
trillion cells/L
(3.90-5.03 million cells/mcL)
Hemoglobin Male: 13.5-17.5 grams/dL***
(135-175 grams/L)
Female: 12.0-15.5 grams/dL
(120-155 grams/L)
Hematocrit Male: 38.8-50.0 percent
Female: 34.9-44.5 percent
White blood cell count 3.5-10.5 billion cells/L
(3,500 to 10,500 cells/mcL)
Platelet count 150-450 billion/L
(150,000 to 450,000/mcL**)
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26. Pernicious anaemia
Management- pg. 690
•Oral supplements of Vit B12
•Iron
•Folic acid
•Or IM for defective absorption
•Encourage vit B intake and bed rest during acute phase
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27. Iron deficiency anaemia- pg. 690
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•Insufficient iron for Hb synthesis
•Insufficient intake of iron, inadequate absorption of iron
•Blood loss
•Increased iron demands as in pregnancy, childhood & adolescence

28. Iron deficiency anaemia
Risk factors- pg. 690
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•History of peptic ulcers
•Gastritis
•Chronic alcoholism
•High fibre diet
•Menorrhagia

29. Iron deficiency anaemia
Assessment and common findings- pg. 690
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•History of malnutrition, peptic ulcers, alcoholism, high fibre diet and
menorrhagia
•Complaints of weakness, fatigue, irritability, dyspnoea on exertion
•Pregnancy
•Skin may be dry and pale
•Nails spoon shaped and brittle
•Stomatitis(inflammation of the mucous membrane of the mouth) and
cheilosis (Inflammation and small cracks in one or both corners of the mouth)
•Headaches and difficulty concentrating

30. Iron deficiency anaemia
Diagnostic studies- pg. 690
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•FBC: low HB & RBC
•Low serum iron and ferritin
•Endoscopic studies, bone marrow and radiographic tests of the
GIT may be done to detect underlying cause
•Stools may be tested for occult blood (check for hidden blood in
the stool).

31. Iron deficiency anaemia
Management- pg. 690
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•See table 36.4

32. Iron deficiency anaemia
Essential health information- pg. 691
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•Teach the patient about iron supplements that should be taken one hour
before meals as it will then be best absorbed
•Take with Vit C as it is best absorbed
•Change of stools
•GIT irritation may occur
•Brush teeth regularly as folic acid may be deposited on teeth
•Rinse mouth
•Do not crush tablets
•Advise about indications for taking the suuplements

33. Folic acid deficiency anaemia- pg. 691
•A condition in which there isn't enough folic acid in the body.
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34. Folic acid deficiency anaemia
Risk factors- pg. 691
•Pregnancy
•Patients with malabsorptive bowel syndrome
•Alcohol abuse
•Abnormal destruction of RBC’s
•Old age
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35. Folic acid deficiency anaemia
Clinical manifestations- pg. 691
•Symptoms include fatigue and mouth sores.
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36. Folic acid deficiency anaemia
Diagnostic studies- pg. 691
•Hb, WBC and platelet Levels low
•Levels of folate and Vit B12 are decreased
•Positive Sickling’s test
•MANGEMENT: By treating underlying cause and proving
supplements as prescribed
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37. Reference list
Mogotlane, S. Chauke, M. Matlakala, M, Mokoena , J. & Young, A. (eds). 2013. Juta’s complete
Textbook of Medical Surgical Nursing. Cape Town: Juta.
https://www.msdmanuals.com/home/blood-disorders/biology-of-blood/components-of-blood
https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-20384919
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