Anemia, classification, management and diagnosis for Nursing

1. ANEMIA
Prepared by:
Kopila Mugrati
(MSN)

2. DEFINITION:
• Anemia is a clinical condition in which the hemoglobin concentration
is lower than normal; it reflects the presence of fewer than the
normal number of erythrocytes (i.e., red blood cells [RBCs]) within
the circulation. As a result, the amount of oxygen delivered to body
tissues is also diminished (hypoxia).

3. • Anemia is not a specific disease state but a sign of an underlying disorder.
• Men: Hb < 13.5 or HCT < 41%
• Women: Hb < 12.0 or HCT < 36%

4. INCIDENCE:
• The prevalence of anemia among pregnant women was even higher (75%). In other
words, three out of four pregnant women in Nepal are anaemic.

5. RISK FACTORS:
• Aging ( adults 65 and older)
• (Hereditary anemias) Family history: Risk increases if family has a history of an
inherited anemia, such as sickle cell anemia.
• A diet lacking in certain vitamins and minerals: A diet consistently low in iron,
vitamin B-12 and folate increases the risk of anemia.
• Intestinal disorders: Having an intestinal disorder that affects the absorption of
nutrients in your small intestine — such as Crohn's disease and celiac disease —
are at risk of anemia.
• Menstruation: In general, women who haven't had menopause have a greater risk
of iron deficiency anemia than do men and postmenopausal women. Menstruation
causes the loss of red blood cells.

6. continue..
• Pregnancy: In pregnancy, lacking intake of a multivitamin with folic acid and iron,
increases risk of anemia.
• Chronic conditions: In cases like cancer, kidney failure, diabetes or another chronic
condition, can lead to a shortage of red blood cells.
• Slow, chronic blood loss from an ulcer or other source within your body can deplete
your body's store of iron, leading to iron deficiency anemia.
• Other factors: A history of certain infections, blood diseases and autoimmune
disorders increases the risk of anemia. Alcoholism, exposure to toxic chemicals, and
the use of some medications can affect red blood cell production and lead to anemia

7. CLASSIFICATION OF
ANEMIA
I. Etiologic Classification
1. Impaired RBC production
2. Excessive destruction
3. Blood loss
II. Morphologic Classification
1. Macrocytic anemia
2. Microcytic hypochromic anemia
3. Normochromic normocytic anemia

8. ETIOLOGY/CAUSES:
Decreased production of
healthy RBCs
Increased RBC destruction
(hemolysis)
loss of blood

9. ETIOLOGICAL CLASSIFICATION OF ANEMIA
• Decreased RBC production:
 defective DNA synthesis
Decreased hemoglobin synthesis
Decreased number of erythrocyte precursors

10. Increased
RBC
destruction
(hemolysis) :
b. Intrinsic : sickle
cell anemia,
enzyme deficiency
a. Extrinsic:
physical trauma,
antibodies,
infectious agents,
toxins

11. INCREASED RBC DESTRUCTION (HEMOLYSIS)
(CONT.)
Hemolytic anemia
1. Intracorpuscular defect
1. Membrane : Hereditary spherocytosis
Hereditary ovalocytosis, etc.
2. Enzyme : G-6PD deficiency, PK def., etc.
3. Hemoglobin : Thalassemia, Hemoglobino-
pathies

12. INCREASED RBC DESTRUCTION (HEMOLYSIS)
(CONT.)
2. Extracorpuscular defect
1. Mechanical : March hemolytic anemia
• MAHA (Microangiopathic HA)
2. Chemical/Physical
3. Infection : Clostridium tetani
4. Antibodies : HTR, SLE
5. Hypersplenism

13. Blood
loss
1. Acute :
trauma,
blood vessel
rupture
2. Chronic:
gastritis,
hemorrhoids,
menstruation

14. MORPHOLOGICAL CLASSIFICATION OF
ANEMIA
1. Macrocytic anemia
2. Microcytic hypochromic anemia
3. Normochromic normocytic anemia

15. MACROCYTIC ANEMIA
Develops due to:
i. Megaloblastic dyspoiesis/ erythropoiesis:
1. Vit. B12 deficiency : Pernicious anemia
2. Folic acid deficiency : Nutritional megaloblastic anemia, Sprue, Other
malabsorption
3. Inborn errors of metabolism : Orotic aciduria, etc.
4. Abnormal DNA synthesis : Chemotherapy, Anticonvulsant, Oral
contraceptives

16. MACROCYTIC ANEMIA (CONT..)
ii . Non-megaloblastic erythropoiesis:
1. In chronic hemolytic anemia
2. Liver diseases
3. hypothyroidism

17. MICROCYTIC HYPOCHROMIC ANEMIA
1. Fe deficiency anemia : Chronic blood loss, Inadequate diet,
Malabsorption, Increased demand, etc.
2. Abnormal globin synthesis : Thalassemia with or without Hemoglobinopathies
3. Abnormal porphyrin and heme synthesis : Pyridoxine responsive
anemia, etc.
4. Other abnormal Fe metabolism

18. NORMOCYTIC NORMOCHROMIC ANEMIA
1. Blood loss
2. Increased plasma volume : Pregnancy, Overhydration
3. Hemolytic anemia : depend on each cause
4. Hypoplastic marrow : Aplastic anemia, RBC aplasia
5. Infiltrate BM : Leukemia, Multiple myeloma,
Myelofibrosis, etc.
6. Abnormal endocrine : Hypothyroidism, Adrenal
insufficiency, etc.
7. Kidney disease / Liver disease / Cirrhosis

20. WHO GRADING OF ANEMIA
Hemoglobin level Grade of anemia
10gm/dl Mild anemia
7gm/dl
Moderate anemia
<7gm/dl Severe anemia

21. CLINICAL GRADING OF ANEMIA
Pallor observed in Grade of anemia
conjunctiva, mucous
membrane only
Mild anemia
Skin Moderate anemia
Palmar creases along with
skin and mucous
membrane
Severe anemia

22. CLINICAL MANIFESTATIONS
• Fatigue
• Listlessness
• Anorexia
• Lately: pallor in conjunctiva, mucous membrane, Skin, Palmar creases
• Weakness
• Vertigo
• Headache
• malaise

23. • Drowsiness
• Sore tongue
• Tachypnea
• Shortness of breath on exertion
• Tachycardia
• Palpitation
• Hepatomegaly in some cases, enlarged lymph gland.

25. DIAGNOSTIC MEASURES
History collection
Physical examination
Blood examination: CBC, Hct, PCV, MCV, TLC, MCH
Bone marrow cytology
Blood enzyme analysis
Serum Fe level, clotting factors
Hemoglobin electrophoresis
DNA analysis

26. COMPLICATIONS
• Circulatory collapse
• Shock
• CCF
• Systemic or local infection
• enlarged heart (cardiomegaly) (When the hemoglobin level is low, the heart attempts
to compensate by pumping faster and harder in an effort to deliver more blood to
hypoxic tissue)

27. MANAGEMENT
• Medical management includes:
1. Immediate control of bleeding/ blood loss
2. Restore blood volume by I/V infusion, blood transfusion along with the treatment
of shock and cause of bleeding
3. Iron supplement, folic acid, Vitamin B-12, and replacement of specific nutrients
4. Removal of toxins if present.

28. NURSING MANAGEMENT:
• Assess the Health history and physical exam:
• Assessment of the GI system may disclose complaints of nausea, vomiting (with specific questions
about the appearance of any emesis [e.g., looks like “coffee grounds”]), melena (dark stools),
diarrhea, anorexia, and glossitis (inflammation of the tongue).
• Stools should be tested for occult blood.
• Women should be assessed about their menstrual periods (e.g., excessive menstrual flow, other
vaginal bleeding) and the use of iron supplements during pregnancy.
• Medication history. Some medications can depress bone marrow activity, induce hemolysis, or
interfere with folate metabolism.

29. • 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 endeavors. Assess if the patient has any athletic endeavor 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.

30. NURSING DIAGNOSIS
• Fatigue related to decreased hemoglobin and diminished oxygen-carrying capacity of
the blood.
• Altered nutrition, less than body requirements, related to inadequate intake of
essential nutrients.
• Altered tissue perfusion related to insufficient hemoglobin and hematocrit.
• Risk for infection related to general weakness.

31. NURSING INTERVENTIONS
• maintaining adequate nutrition
• managing fatigue
• activity intolerance
• promoting adherence with prescribed therapy
• monitoring and managing potential complications