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Devapriya J
ANEMIA Roll no 35
3rd sem BSc Nursing
GOVT College of
Nursing Trivandrum
INDEX
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SL No. CONTENT
1 INTRODUCTION
2 DEFINITION
3 TYPES OF ΑΝΕΜΙΑ
4 PATHOPHYSIOLOGY
5 ETIOLOGY
6 SYMPTOMS
7 DIAGNOSTIC TESTS
8 TREATMENT
9 NURSING MANAGEMENT
10 COMPLICATION
11 CONCLUSION
12 REFERENCE
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Introduction
Anemia is a widespread health issue affecting
millions worldcoide, impacting quality of life,
Productivity and overall well-being. It is a
conditoon characterized by reduced red
60oodcells of hemoglobin scompromising oxygen
delivery to body tissues.
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Definition
Anemia is a medical condition characterised by a
decrease in the number of Red blood cells or the
amount of hemoglobins in the blood, leading to
inadequate oxygen delivery to body Tissues
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TYPES OF ANEMIA
Iron Deficiency Anemia (IDA)
Vitamin Deficiency Anaemia (VDA)
1: Vitamin B12 Deficiency
2: Folate Deficiency
Anemia of Chronic Disease (ACD)
Sickle Cell Anemia
Thalassemia
Pernicious Anemia
Hemolytic Anemia
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Iron Deficiency Anemia (IDA)
Anemia caused by inadequate iron intake
absorption or utilization
Characteristics: Low serum leonlevels,
microcytic (Small RBCs), hypochromic(pale RBCs),
Low ferum levels
Causes: Inadequate dietary iron, Chronic blood
loss (menstruation, ulcers, pregnancy)
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Vitamin Deficiency Anaemia (VDA)
1:Vitamin B12 Deficiency
Anaemia caused by inadequate vitamin B12
Intake or absorption
Characteristics: Cow serum vitamos B12
levels, Macrocytic, Megaloblastic, Neurological
symptoms
Causes: inadequate dietary vitamin B12,
Malabsorption (pernicious anemia)
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2: Folate Deficiency
Anemia caused by inadequate folate intake or
absorption
Characteristics: low serum folate levels,
Macrocytic megaloblastic, Similar to vitamus Bia
deficiency
Causes: Inadequate dietary folate, Pregnancy
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Anemia of Chronic Disease
(ACD)
Anemia associated with chronic disease eg (KD,
Cancer, HIV)
Characteristics: Nosmocytic, Hypochromic,
Elevated inflammatory markers
Causes: Chronic inflammation, Impaired
erythropoiesis
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Sickle Cell Anemia
Genetic disorder causing abnormal hemoglobin
production
Characteristics: Abnormal sickle shaped RBCs,
Chronic hemolysis, Recurrent pain crises
Causes: Genetic mutation (HbS), Autosomal
recessive inheritance
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Thalassemia
Genetic disorder affecting hemoglobin
production
Characterstics: Variable severity, Microcytic,
Hypochromic Anemia, Jaundice, and Bone
delomities
Causes: Genetic mutation, Autosornal recessive
inheritance
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Pernicious Anemia
Autoimmune disorder causing vitamin B12
deficiency
Characteristics: Low serum vitamin B12 levels,
Macrocytic megaloblastic, Neurological
symptoms
Causes: Autoantibodies against intrinsic factor,
Gastric mucosal atrophy
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Hemolytic Anemia
Anemia caused by premature RBC destruction
Characteristics: variable severity, Jaundice,
Anemia
Causes: Auto immune disorders, Infections,
Medications
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Pathophysiology
Anemia occurs when the body’s ability to
produce or maintain healthy red brood cells is
compromised. This can result from:
1. Inadequate erythropoiesis (RBC production)
2. Increased RBC destruction( hemolysis)
3. Blood loss
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Etiology
Anemia can be caused by various factors.
1. Nutritional deficiencies (iron, Vit B12,
folate)
2. Chronic disease (CKD, cancer, HIV)
3. Genetic disorders (sickle cell, thalassemia)
4. Infection (malaria, hookworm)
5. medications (chemotherapy, NSAIDS)
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Anemia classified based on morphology:
Anemia can be classified based on the morphological
characteristics of the red blood cells (RBCs), such as
their size, shape, and color. The main morphological
classifications of anemia are:
1. Normocytic Anemia
2. Microcytic Anemia
3. Macrocytic Anemia
4. Hypochromic Anemia
5. Hyperchromic Anemia
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1. Normocytic Anemia
Definition: Red blood cells are of normal size (mean
corpuscular volume or MCV is within the normal range)
Causes: Acute blood los, Chronic disease (e.g., chronic
kidney disease, chronic inflammation)
Aplastic anemia, Hemolytic anemia, Sickle cell anemia
Bone marrow failure
MCV range :80-100fl(normal range )
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2. Microcytic Anemia
Definition: Red blood cells are smaller than
normal (MCV is below the normal range).
Causes: Iron deficiency anemia, Thalassemia,
Anemia of chronic disease
MCV Range: <80 fL
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3. Macrocytic Anemia
Definition: Red blood cells are larger than normal (MCV is
above the normal range)
Causes: Vitamin B12 deficiency
Folate deficiency, Alcoholism
Liver disease, Hypothyroidis,
Myelodysplastic syndrome,
Certain medications (e.g., chemotherapy)
MCV Range: >100 fL
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4. Hypochromic Anemia
Definition: Red blood cells have less hemoglobin
than normal, resulting in paler color (decreased
mean corpuscular hemoglobin concentration or
MCHC).
Causes: Iron deficiency anemia, Thalassemia
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5. Hyperchromic Anemia
Definition: RBCs have more hemoglobin than
normal, which can be seen in conditions like:
*Spherocytosis
*Hereditary spherocytosis
*Autoimmune hemolytic anemia
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Summary
Microcytic: Small RBCs (e.g., iron deficiency,
thalassemia)
Normocytic: Normal-sized RBCs (e.g., acute blood
loss, chronic disease)
Macrocytic: Large RBCs (e.g., B12/folate
deficiency, alcoholism)
Hypochromic: Pale RBCs (e.g., iron deficiency)
Hyperchromic: Darker RBCs (e.g., spherocytosis)
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Symptoms of Anemia:
Mild Anaemia Moderate Severe
Anemia Anemia
.Headache .Confusion
Fatigue, .Weakness,P .cold hands and feet . Disorientation
aleskin, Shortness of .hair loss .Rapid heartbeat
breath, Dizziness .poor appetite .Swelling in legs,
Hb level:11-12.9g/dL . Restless leg ankles, and feet
( for men) syndrome . Chest pain
:11-11.9g/dL (for Hb level: 8.0–10.9
women) g/dL (both men and
women)
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System wise changes in Anemia:
1. Cardiovascular System
2. Respiratory System
3. Nervous System
4. Gastrointestinal System
5. Integumentary System
6. Immune System
7. Renal System
8. Musculoskeletal System
9. Reproductive System
10. General Symptoms
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1. Cardiovascular System:
Tachycardia: Increased heart rate to
compensate for decreased oxygen delivery
Palpitations: Resulting from increased cardiac
output
Heart murmurs: Due to hyperdynamic
circulation
Heart failure (in severe cases): Due to prolonged
workload on the heart
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2. Respiratory System
Dyspnea: Shortness of breath, especially during
exertion
Tachypnea: Increased respiratory rate to
enhance oxygen intake
Hypoxia: In severe cases, reduced oxygen
delivery to tissues
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3. Nervous System
Fatigue and Weakness: Reduced oxygen
delivery to muscles and brain
Dizziness and Fainting: Poor oxygenation to the
brain
Cognitive Impairment: Difficulty concentrating
and mental fog
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4. Gastrointestinal System
Glossitis: Inflammation of the tongue, especially
in iron-deficiency anemia
Pica: Craving for non-nutritive substances (e.g.,
dirt, ice)
Malabsorption: In conditions like celiac disease
or Crohn’s disease contributing to anemia
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5. Integumentary System
Pallor: Paleness of skin, mucous membranes, and
nail beds
Brittle Nails and Hair: Seen in nutritional
deficiencies like iron-deficiency anemia
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6. Immune System
Impaired Immunity: Reduced ability to fight
infections, particularly in vitamin-deficiency-
related anemias
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7. Renal System
Reduced Erythropoiesis: Anemia of chronic
kidney disease due to decreased erythropoietin
production
Compensatory Erythropoietin Increase: In
response to hypoxia (in healthy kidneys)
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8. Musculoskeletal System
Myopathy: Muscle weakness due to inadequate
oxygen supply
Bone Pain: In conditions like sickle cell anemia
or bone marrow hyperplasia
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9. Reproductive System
Menstrual Irregularities: Heavy menstrual
bleeding may exacerbate anemia
Fetal Growth Restriction: In pregnant women
with severe anemia
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10. General Symptoms
Fatigue: Most common symptom due to lack of
oxygen delivery to tissues
Cold Intolerance: Reduced metabolic activity
Irritability: Seen in chronic anemia due to
persistent hypoxia
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Diagnostic Tests:
1. Complete Blood Count (CBC):
- Hemoglobin (Hb) level <13.5g/dL
- Hematocrit(Hct) level<40%
- Red Blood Cell (RBC) count
- White Blood Cell (WBC) count
- Platlet count
2. Peripheral Blood Smear (PBS:
- RBC Morphology
- WBC Differential
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3. Exythrocyte Sedimentation Rate (ESR):
- Measures Inflammation
4. Reticulocyte count:
- Measures Immature RBCs
5. Vitamin Deficiency Anemia Test:
- Serum Vitamin B12
- Serum Folate Level
- Methylmalonic acid (MMA) Level
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6. Iron deficiency Anemia tests:
- Serum Iron Level
- Serum Ferritin Level
- Trasferrin Saturation
- Total Iron Binding Capacity (TIBC)
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Treatment
1. Iron Deficiency Anemia:
- Iron supplements(oral/IV)
- Vitamin C supplements
- Increase dietary intake of iron
- Address underlying bleeding or loss
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2. Vitamin Deficiency Anemia:
- Vitamen B12injections: (IM/IV)
- Folate supplements
- Increase the dietary intake of vitamin
3 Anemia of Chronic Disease:
- Treat underlying disease
- Erythropoietin-stimulating agents
- Iron supplements
- Blood transfusions
- Dietary modifications
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Dietary Management of Anemia
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Nurses can educate patients and their families on
the importance of appropriate dietary choices to
enhance iron absorption and improve blood health
1. Iron-Rich Food:
- Heme Iron (from animal sources): This form of
iron is more easily absorbed by the body. Include
foods such as:
- Red meat, Poultry, Fish, Organ meat
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- Non-Heme Iron (from plant sources): Although
less efficiently absorbed, plant-based sources are
still important, especially for vegetarians:
Leafy greens, Legumes, Fortified cereals and
grains, Tofu and tempeh, Nuts and seeds
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2. Vitamin C-Rich Foods
- Vitamin C enhances the absorption of non-
heme iron. Include foods such as:
Citrus fruits, Berries, Bell peppers, Tomatoes, Broccoli
3. Folic Acid (Vitamin B9)
- Folic acid is essential for the production of
red blood cells. Foods rich in folate include:
Leafy greens (spinach, romaine lettuce),
Fortified cereals and grains, Beans and lentils,
Avocados, Asparagus
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4. Vitamin B12
- Vitamin B12 is important for red blood cell
production and preventing pernicious
anemia. Good sources include:
Meat, poultry, fish, and eggs, Dairy products,
Fortified plant-based milks
5. Avoid Iron Absorption Inhibitors
- Some foods and substances can inhibit the
absorption of iron
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6. Educate patients to avoid:
- Tannins (found in tea and coffee)
- Calcium-rich foods when consuming iron-
rich meals, as calcium can compete with
iron for absorption
- Phytates (found in whole grains, legumes, and
some seeds), though soaking and sprouting these
foods can reduce their impact on iron absorption
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7. Iron Supplements
- If dietary intake is insufficient, iron supplements
may be necessary. Nurses should remind patients
to take them with a source of Vitamin C to
enhance absorption, and to avoid taking them
with foods or drinks that inhibit absorption (such
as coffee or calcium-rich foods)
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8. Hydration and General Health
Staying well-hydrated helps improve overall blood
circulation, so encourage drinking adequate fluids,
especially water.
A balanced diet that includes adequate amounts of other
nutrients (like proteins and healthy fats) supports
general health and assists the body in utilizing iron
efficiently
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Nursing Role in Dietary Management:
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Assessment
Nurses should assess the patient’s dietary habits
and preferences, including potential barriers
(such as vegetarianism or food allergies)
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Education
Nurses should educate patients about the types of
foods that can enhance or inhibit iron absorption
and recommend meal plans accordingly
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Monitoring
Nurses should monitor for signs of improvement
in anemia and possible side effects of iron
supplementation (like constipation or
gastrointestinal upset)
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Referral
If needed, nurses should refer patients to a
dietitian for personalized meal planning and
further nutritional guidance.
Proper dietary management, along with medical
treatment as appropriate, can effectively support
anemia recovery and enhance overall well-being
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Nursing diagnosis of Anemia
Nursing diagnoses for anemia are focused on
addressing the underlying causes, symptoms, and
complications associated with the condition.
Anemia can result from a variety of etiologies,
such as iron deficiency, vitamin B12 deficiency,
chronic disease, or blood loss. Here are some
common nursing diagnoses related to anemia:
1. Fatigue related to decreased 54
oxygen-carrying capacity of the
blood secondary to anemia
Rationale: Anemia reduces the number of red
blood cells and hemoglobin, leading to less
oxygen delivery to tissues, causing fatigue and
weakness.
Expected Outcomes:
Patient reports increased energy levels.
Patient demonstrates improved activity tolerance
2. Imbalanced Nutrition: Less Than 55
Body Requirements related to
insufficient iron, folate, or vitamin
B12 intake
Rationale: Dietary deficiencies of iron, vitamin B12, or folate
contribute to anemia. A poor diet can exacerbate or cause
nutritional deficiencies.
Expected Outcomes:
Patient demonstrates understanding of the importance of iron
and vitamin-rich foods.
Patient consumes iron-rich foods and/or follows prescribed
supplementation regimen
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3. Ineffective Tissue Perfusion related to
decreased red blood cell count and
oxygen delivery
Rationale: Anemia can reduce oxygen supply to tissues,
affecting the function of organs and systems.
Expected Outcomes:
Patient exhibits stable vital signs.
Skin color and mucous membranes appear pink and
warm.
No signs of hypoxia (e.g., shortness of breath, confusion,
dizziness).
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4. Activity Intolerance related to
fatigue and decreased oxygenation
Rationale: Fatigue, weakness, and decreased
oxygen supply to tissues result in reduced ability
to engage in normal physical activity.
Expected Outcomes:
Patient demonstrates improved activity tolerance.
Patient performs activities of daily living (ADLs)
with minimal fatigue
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5. Risk for Impaired Skin Integrity related to poor
nutrition, poor oxygenation, or inadequate fluid
intake
Rationale: Poor circulation, inadequate nutrition, and
the physical stress of anemia can increase the risk of
skin breakdown.
Expected Outcomes:
Skin remains intact without signs of breakdown or
pressure ulcers.
Patient maintains good hygiene and hydration practices
6. Deficient Knowledge related to 59
anemia management, including dietary
changes, iron supplementation, or
symptom monitoring
Rationale: Many patients may not fully understand their
diagnosis of anemia or how to manage it effectively,
including nutrition, medication, and symptom monitoring.
Expected Outcomes:
Patient verbalizes understanding of dietary requirements
(e.g., iron-rich foods, vitamin C for absorption).
Patient follows prescribed treatment plan, including
taking iron supplements or other medications
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7. Risk for Complications: Hypoxia related to
inadequate red blood cells to meet tissue oxygen
demands
Rationale: Severe anemia can lead to hypoxia,
particularly in cases of acute blood loss or chronic
anemia with a low hemoglobin level.
Expected Outcomes:
Patient demonstrates no signs of hypoxia (e.g.,
adequate oxygen saturation levels, normal
respiratory rate)
8. Chronic Pain related to underlying 61
causes of anemia (e.g., sickle cell
anemia, gastrointestinal bleeding, or
inflammation)
Rationale: Chronic anemia may be associated with
persistent or intermittent pain, such as in sickle cell
disease or gastrointestinal disorders causing bleeding.
Expected Outcomes:
Patient reports a reduction in pain intensity.
Patient demonstrates improved coping mechanisms
for pain management
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9. Altered Thought Processes related to
hypoxia and lack of oxygen to the brain
Rationale: In severe anemia, reduced oxygen supply
to the brain can lead to confusion, poor concentration,
and altered mental status
Expected Outcomes:
Patient exhibits normal cognitive function and
alertness.
No signs of confusion or difficulty concentrating
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Conclusion
Anemia is a common condition that requires
prompt recognition and treatment. Nurses play a
crucial role in managing anemia, educating
patients, and preventing complications
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Reference
Medical Surgical Nursing Lewis,
Chapter 27
Hematological problem
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Administer prescribed medications, such as iron
supplements, Vitamin B12 injections, or
erythropoiesis-stimulating agents as indicated
Educate the patient on the importance of
adherence to treatment plans and follow-up care.
Promote energy conservation by teaching pacing
techniques and assisting with activities as needed.
Assess for signs of complications (e.g., bleeding,
changes in skin integrity, hypoxia) and intervene
promptly
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THANK YOU !
Any questions?