Anemia
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What is anemia?
o Deficiency in O2 carrying capacity
o Decrease in erythrocytes RBC
o Decrease in quantity of hemoglobin
o Decrease in volume of PRBCs in plasma – hematocrit
What happens to the body when you experience anemia?
o Fatigue
o Increased heart rate
o Increased SOB
o Increase CO2 levels
o Overall a decrease in O2
What are the two principle functions of erythrocytes?
o Transport O2
o Pick up CO2 and transport back to the lungs to be exhaled
How does Iron deficiency, vitamin B9, vitamin B12 cause anemia?
o They are required to make healthy RBCs un the bone marrow; if deficient then
they will not be able to transport O2 and be a fucked-up shape
o Irons role: hemoglobin synthesis
o Folates role: synthesis of DNA, RNA and RBC maturation
o B-12 role: synthesis of DNA, RBC maturation, and facilitates folate metabolism
What is hemoglobin? What is hematocrit?
o Hemoglobin: iron containing protein in the RBC
o Hematocrit: measure of the % of RBC in the blood
What does oxygen stick to for transport to the body?
o Iron (heme)
What does carbon dioxide stick to be transported from the tissue back to the lungs?
o Globin (protein)
How long does a blood cell live? How long does it take for all new blood cells to be
formed?
o 120 days
o 4-6 weeks for complete replacement of blood (blood donors wait this long)
What is an immature red blood cell called? If you have a hemorrhage and your body has
to make new blood cells quickly, are they going to be able to transport enough oxygen
to your tissues and pick up carbon dioxide effectively?
o Reticulocyte / erythroblast take 48 hours to mature
o No, takes 48 hours to get full O2 carrying capacity
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Normal levels for RBC for men and women? Hemoglobin for men and women?
Hematocrit for men and women? What is their function and clinical manifestations for
low, normal, and high? Slide 13
o RBC
 Men 4.7 – 6.1
 Women 4.2 -5.4
o HCT
 Men 45-52%
 Women 37-48%
o Hgb
 Men 14-18 g/dL
 Women 12-16 g/dL
What causes anemia?
o Slide 8 of basics
How would you classify anemia and what are the clinical manifestations for each? Mild
anemia? Moderate anemia? Severe anemia?
o Slide 13
What does a MCV lower than 80 classified as? 80-100? Higher than 100? (Know Slide 9
of anemia basics)
o Micro acidic
o Normal acidic
o Macro acidic
Why is it hard to recognize an elderly patient with anemia?
o mistaken as side effects from medications or aging process
What are nursing interventions that can help correct or manage anemia?
o Slide 14
o Blood transfusions
o Drug therapy
o O2 therapy
o Dietary and lifestyle changes
o Arrange activities to allow for rest
o Avoid activity around meals
Iron deficiency anemia
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What is iron deficiency anemia?
o Lack of adequate iron to produce enough hemoglobin to support optimum
health
o Iron binds O2 to RBC to transport to tissues
How does an iron deficit cause anemia?
o Not enough iron to bind to O2 for transport, then body will lack O2 to tissues
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What is the classification for IDA? (Microcytic and hypochromic, normocytic and
normochromic, or Macrocytic and megaloblastic)
o Mycrocytic (small) and hypochromic (lack of hemoglobin) (pt will be pale as fuck)
What causes IDA and who is at risk?
o Slide 3 in specifics
What are the clinical manifestations (signs and symptoms) of IDA?
o Slide 6
o Fatigue
o Pale skin
o Weakness
o Increased HR
o SOB
o Glossitis
o Cheilitis
o Brittle nails
o Unusual cravings - PICA
o Poor appetite
How is IDA diagnosed and screened?
o Decreased iron
o Decreased ferritin
o Decreased transferrin
o Increased TIBC
o MCV lower than 80
How is IDA treated?
o Would be based on cause of IDA
o Dietary – increase iron rich food
o Blood loss – stop bleed and increase intake of iron via various routes
o Frequent blood donors should take precautions
o Pregnancy – supplements until resolved
What food should a person with IDA eat? What enhances absorption? What decreases
absorption?
o Lean beef, turkey, pork, chicken and eggs, fish, legumes, dried fruit, dark leafy
green veggies, beans, whole grain bread and cereal
o Enhance absorption with vitamin C (citrus fruit, leafy greens, fruit)
o Decrease absorption with milk and antacids
How long before meals should you take iron PO?
o 1 hour before meals (does not include vitamin C food/drinks)
o Iron will cause black/dark green stool – THIS IS NORMAL
o Take laxative and stool softener
What teaching should you provide a patient taking PO iron?
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o Best absorbed in acidic environment
o Don’t take with milk or antacid
o Take 1hr prior to meals
o May stain teeth – oral care
What precautions should you take when administering Iron Dextran (IM route)?
o Change the needle
o Z track
What precautions should you take when administering IV Iron?
o High risk for allergic reaction
o Give loading/trial dose after verification of no iron allergy
(Make sure you understand the IDA diagnosis chart on slide four of anemia specifics
PowerPoint.)
o Ok
Folate or Folic acid deficiency anemia
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What is folic acid/ folate deficiency anemia?
o Decreased folate = large cells that are oval and not round
How does a folic acid/ folate deficit cause anemia?
o Large oval shape cells do not carry O2 and do not pick up CO2 efficiently
How is folic acid deficiency anemia classified? (Microcytic and hypochromic, normocytic
and normochromic, or Macrocytic and megaloblastic)
o Macrocytic and megaloblastic
What causes FADA and who is at risk?
o Dietary deficieny, malabsorption syndrome, celiac disease, crohn’s disease, small
bowel resection, medications – see slides, pregnancy, chronic alcoholism,
chronic hemodialysis
What are the clinical manifestations (signs and symptoms) of FADA?
o Dyspepsia
o GI problems
o Smooth beefy red tongue
o Pallor
o Fatigue
o Weakness
o Tinnitus
o tachycardia
How is FADA diagnosed and screened?
o CBC
o Folate levels
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How is FADA treated?
o Dietary
o Medication
o Treat the cause
What food should a person with FADA eat?
o Green leafy veggies, meat, liver, fish, legumes, peanuts, orange juice, avocados,
etc.
o Slide 10
Vitamin B12 anemia (Pernicious anemia)
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What is Vitamin B12 deficiency anemia?
o Body does not have enough healthy cells because of deficit of b-12
How does a Vitamin B12 deficiency cause anemia?
o Lack of healthy efficient RBCs
o Oval shaped
How is Vitamin B12 deficiency anemia classified? (Microcytic and hypochromic,
normocytic and normochromic, or Macrocytic and megaloblastic)
o Macrocytic and megaloblastic
What causes Vitamin B12 deficiency anemia and who is at risk?
o Lack of intrinsic factor in stomach caused by chronic gastritis, stomach surgery,
autoimmune conditions that attack the stomach (crohn’s), T1DM, thyroid
disease, family Hx of decreased intrinsic factor
What are the clinical manifestations (signs and symptoms) of Vitamin B12 anemia?
o Slide 12
What is the major difference that is associated with Vitamin B12 anemia and not folic
acid or iron deficiency anemia?
o Confusion and unsteady gait/weakness
o Damages myelin sheath and causes damage
How is Vitamin B12 diagnosed and screened?
o Symptoms
o CBC
o B12 levels
How is Vitamin B12 treated?
o PO vitamin B12 if absorption is not affected. IM b12 injection weekly/monthly
after therapeutic levels (lifetime). Blood transfusions if needed for severe
deficiency
What food should a person with Vitamin B12 eat?
o Meat, eggs, enriched grain products, milk and dairy, fish (especially salmon)
What education/ teaching can you give the patient with Vitamin B12 anemia?
o B12 supplementation for lifetime, good oral hygiene due to changes in mouth,
CNS changes that are serious, safety due to gait and paresthesia, eat foods high
in iron, folate acid, vitamin C to help RBC production as well
Chronic anemia
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What is chronic anemia?
o Long term anemia
o Underproduction of RBCs and mild shortening of RBC survival
What causes chronic anemia?
o Cancer
o Autoimmune diseases HIV
o Malaria
o Hepatitis
o Heart failure
o Chronic inflammation
o Bleeding episodes (menstruation cycle)
How is chronic anemia treated?
o Correct the underlying disorder
o Blood transfusion (not for long term)
o Erythropoietin drug
What is Epoetin alfa? How does it work?
o Slide 13
o Medication used to treat anemia in people with long term serious kidney
disease, HIV, chemo patients, anemic patients prior to surgery that have high
blood loss
o Signals bone marrow to make more RBCs
o Very similar to natural substances