ANEMIA
DEFINE: Anemia is a disorder of the RBCs (not a disease but manifestations of patho). Anemia
results from a decrease in erythrocytes (low RBCs), decrease in hemoglobin’s (Hgb), and
decrease in the volume of RBCs (HCT), or impaired function of RBCs.
Morphology:
 Normocytic, normochromic (normal size and color)
 Microcytic, hypochromic (small and pale)
 Macrocytic (large)
CAUSES:
1. Acute or chronic blood loss
 Acute: Trauma, ruptured aortic aneurysm, and GI bleeding
 Chronic: Bleeding duodenal ulcer, colon cancer, and liver disease
2. Decreased production
 Deficient in nutrients: iron, cobalamin, and folic acid
 Decreased erythropoietin
 Decreased iron availability
3. Increased RBC destruction
 Hemolysis: sickle cell disease, Medication, incompatible blood, and trauma
The decrease of RBCs  leads to a decrease of oxygen
carrying capacity  which results in TISSUE HYPOXIA
DIAGNOSTIC:
 Complete blood count (CBC)
 Reticulocyte count
 Peripheral blood smear
LAB VALUES:
 Hemoglobin (Hgb)
 Male: 14-18
 Female: 12-16
 Hematocrit (Hct)
 Male: 40-52%
 Female: 37-47%
 WBCs
 (5,000-10,000)
 Platelet
 (150,000-400,000)
CLINICAL MANIFESTATIONS: Caused by the body’s response to tissue hypoxia. Manifestations
vary based on rate of development, severity of anemia, presence of co-existing disease.
HEMOGLOBIN levels are used to determine severity of anemia.
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Mild Anemia (Hgb: 10-12)
- Probably with exist without causing any symptoms… If symptoms do occur it’s
because the patient has and underlying disease or has a response to heavy
exercise.
- SX: palpitations, dyspnea (SOB), and mild fatigue
Moderate Anemia (Hgb 6-10)
- The cardio symptoms are increased and can occur at rest or with activity
Severe Anemia (Hgb less than 6)
- INTEGUMENTARY: pallor (decreased Hgb), Jaundice (increased concentration of
serum bilirubin), and Pruritus (increased serum and skin bile salt concentrations
and RBC destruction)
- CARDIOPULMONARY: Tachycardia, increased pule pressure, systolic murmurs,
angina, HF, and myocardial infarction
- PULMONARY: Tachypnea, orthopnea (SOB when lying flat), Dyspnea at rest
- NEURO: headache, vertigo, irritability, and depression
- GENERAL: anorexia and weight loss
TREATMENT: depends on the cause of anemia and specific patient needs!!!
NURSING MANAGEMENT:
 Assessment
- Subjective: important health info, past health history, medications, surgery and
other treatments, dietary history, and family history
- Objective: General, Integumentary, Respiratory, Cardio, GI, Neuro, and
Diagnostic findings
 Diagnosis
- Fatigue: related to not enough O2 in blood
- Imbalanced nutrition: less than the body’s requirements related to inadequate
nutritional intake and anorexia
- Ineffective health management: lack of knowledge about appropriate nutrition
and medication
 Planning: THE GOALS
- Assume normal activates of daily living
- Maintain good nutrition
- Develop no complications related to anemia
 Implementation: MAIN GOAL IS TO CORRECT THE CAUSE OF ANEMIA, but some
acute interventions are…
- Blood transfusions, drug therapy, RBC replacement, O2 therapy, dietary changes,
and lifestyle changes
-
FATIGUE: alternate rest and activity periods, avoid activities after meals, and
assist with regular physical activities
Collab with dietitian, educate about nutritional needs, and encourage them to
increase intake of food high in iron
GERONTOLOGIC CONSIDERATIONS:
 In healthy older men, a modest decline in hemoglobin of about 1 g/dL occurs
between ages 70 and 88 years, in part because of the decreased production of
testosterone
 Only a minimal decrease in hemoglobin occurs between these ages in healthy
women (about 0.2 g/dL)
 Underlying causes may be iron deficiency, bleeding, chronic disease/inflammation,
renal insufficiency, or a hematologic cancer.
 SX may be mistaken for normal aging changes…. pallor, confusion, ataxia, fatigue,
and worsening cardiovascular and respiratory problems.