anaemia by dr hanan said ali l.
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Anaemia By Dr. Hanan Said Ali. Objectives. Identify the components of blood. Enumerates what does blood do. Define the anaemia. Discus the etiologic classification of anaemia. Objectives Cont. Identify the clinical manifestations, Aetiology, Diagnosis, Treatment, Nursing care for:

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  • Identify the components of blood.
  • Enumerates what does blood do.
  • Define the anaemia.
  • Discus the etiologic classification of anaemia.
objectives cont
Objectives Cont.
  • Identify the clinical manifestations, Aetiology, Diagnosis, Treatment, Nursing care for:
  • Iron deficiency anaemia.
  • Megaloblastic or Macrocytic Anaemia:

Cobalamin(vitamin B12)

Folic acid deficiency

  • A plastic Anaemia
  • Haemolytic Anaemia
  • Haemolytic Anaemia


Study of blood and blood forming tissues

Key components of hematologic system are:


Blood forming tissues

Bone marrow


Lymph system

what does blood do
What Does Blood Do?
  • Transportation
    • Oxygen
    • Nutrients
    • Hormones
    • Waste Products
  • Regulation
    • Fluid, electrolyte
    • Acid-Base balance
  • Protection
    • Coagulation
    • Fight Infections
components of blood
Components of Blood
  • Plasma
    • 55%
  • Blood Cells
    • 45%
    • Three types
      • Erythrocytes/RBCs
      • Leukocytes/WBCs
      • Thrombocytes/Platelets
erythrocytes red blood cells
Erythrocytes/Red Blood Cells
  • Composed of hemoglobin
  • Erythropoiesis

= RBC production

      • Stimulated by hypoxia
      • Controlled by erythropoietin
        • Hormone synthesized in kidney
  • Hemolysis
    • = destruction of RBCs
    • Releases bilirubin into blood stream
    • Normal lifespan of RBC = 120 days
leukocytes white blood cells
Leukocytes/White Blood Cells
  • 5 types
    • Basophils
    • Eosinophils
    • Neutrophils
    • Monocytes
    • Lymphocytes
thrombocytes platelets
  • Must be present for clotting to occur
  • Involved in homeostasis



The term of anaemia refers to a deficiency in the number of circulating red blood cells available for oxygen transport

What is the etiologic classification of anaemia ?

1- Iron deficiency anaemia

When the stored iron is not replaced, haemoglobin production is reduced leads to iron- deficiency anaemia

iron deficiency anaemia cont
Iron deficiency anaemia Cont.


  • Inadequate dietary intake, malabsorption.
  • Blood loss of haemolysis
  • Gastrointestinal blood loss e.g. Peptic ulcer, gastritis, oesophagitis.
  • Menstrual bleeding....45 ml.....loss of 22mg of iron
  • Pregnancy...diversion of iron to the foetus
iron deficiency anaemia cont13
Iron deficiency anaemia Cont.

Clinical manifestation

In early course , the client may be free of symptoms

Mild.... Pallor , fatigue and exertion dyspnea.


  • Nail become brittle and concave and longitudinal ridges.
  • Glossitis (inflammation of tongue), bright- red .
  • Cheilosis (inflammation of lips- The corners of mouth may be cracked, reddened and painful.
  • Headache, paresthesia.
  • Burning sensation of the tongue result to lack of iron in tissues.
iron deficiency anaemia cont14
Iron deficiency anaemia Cont.



  • Peripheral blood smears (CBC)
  • Low serum iron levels, and elevated serum iron- binding capacity.
  • Absent iron stores in the bone marrow.
  • endoscopy, or colonoscopy to detect GI bleeding.


  • Increasing the intake of iron.
  • Administer nutrients for erythroporesesis
iron deficiency anaemia cont15
Iron deficiency anaemia Cont.

Role of nutrients for erythroporesesis

  • Cobalamin (Vit B12) has role in RBC maturation found in red meat especially liver.
  • Folic acid has role in RBC maturation in leaves, fish.
  • Vitamin B6 has role in haemoglobin synthesis found in eggs, whole grain and bread, potatoes.
  • Amino acids has role in synthesis of nucleoproteins

found in eggs, meat, milk, milk products

  • Vitamin C has role in conversion of folic acid to its active forms aids in absorption.
iron deficiency anaemia cont16
Iron deficiency anaemia Cont.

Medical therapy

Oral iron supplements (ferrous sulphate)

It should be taken after meals and with orange juice

Told the client that the stool will be black.

Parenteral iron is administered by IM or IV

megaloblastic or macrocytic anaemia
Megaloblastic or Macrocytic Anaemia

It characterized by morphological changes caused by defective DNA synthesis and abnormal RBC matured.

The common forms of mgaloblastic anaemia:

1- Cobalamin(vitamin B12)

  • Result from dietary deficiency.
  • Deficiency of gastric intrinsic factors.
  • Intestinal malabsorption and increased requirement.
megaloblastic or macrocytic anaemia cobalamin vitamin b12
Megaloblastic or Macrocytic Anaemia Cobalamin(vitamin B12)


  • General symptoms of anaemia .
  • GIT manifestation a a sore tongue, anorexia, nausea, vomiting and abdominal pain.
  • Neurovascular manifestation as weakness, parethesias of the feet and hands, muscle weakness, impaired thought process ranging from confusion to dementia
megaloblastic or macrocytic anaemia cobalamin vitamin b1219
Megaloblastic or Macrocytic Anaemia Cobalamin(vitamin B12)


Abnormal Schilling test result which demonstrates, the inability to absorb vitamin B12.


  • Parenteral administration of vitamin B12 once/month.
  • The nurse should ensure that injuries are not sustained because of the diminished sensation to heat and pain due to neurologic impairment.
  • Protect client from burn and trauma.
  • Evaluate skin for redness.
megaloblastic or macrocytic anaemia folic acid deficiency
Megaloblastic or Macrocytic AnaemiaFolic acid deficiency

Folic acid required for DNA synthesis leading to RBC formation and maturation.

Daily requirement of folic acid 100 to 200 mg.


  • Poor nutrition (Lack of vegetable, yeast, nuts, grains.
  • Malabsorption syndrome.
  • Drugs that impede the absorption and use of F acid

(oral contraceptives ,anti seizure agents).

  • Alcohol abuse and anorexia.
  • Haemodialysis client because of folic aid is dialyzable.
  • Pregnancy, and increased requirement & malnutrition.
megaloblastic or macrocytic anaemia folic acid deficiency21
Megaloblastic or Macrocytic Anaemia Folic acid deficiency

Clinical manifestation

Similar to cobalamin deficiency except the absence of neurologic problem, this lack of neurologic involvement differentiate folic acid deficiency from vit. B12.


Low serum folate level.


  • Anaemia caused by a dietary deficiency can be treated with 1 mg of folic acid for 3- month period.
  • Diet ... Orange, meat, eggs, cabbage, citrus fruits .
a plastic anaemia
A plastic Anaemia

Related to reduced or impaired erythrocyte production (fatty bone marrow).


It can be divided into the major groups:

1- Congenital

Caused by chromosomal alterations.

2- Acquired as a result of exposure to:

  • Ionizing radiation, chemical agents (DDT, alcohol)
  • Viral and bacterial infection(hepatitis, miliary TB)
a plastic anaemia23
A plastic Anaemia

Aetiology Cont.

Prescribed medication(alkalating agents, antimicrobial)




It caused by depression of activity of all blood-producing elements { There is decrease in white blood cells(Leukopoenia), Platelets(Thrombocytopoenia), and decrease in the formation of RBC, which lead to anaemia.

a plastic anaemia cont
A plastic Anaemia Cont.

Clinical Manifestation

  • Pallor of skin and mucous membranes.
  • Cardiovascular (fatigue, and dyspnea on exertion, palpitation)
  • Cerebral responses
  • Infection of skin and mucous membrane.
  • Haemorrhagic symptoms(bleeding tendencies into the skin and mucous membranes, nose, gums, vagina and rectum
a plastic anaemia cont25
A plastic Anaemia Cont.


  • The CBC characteristically reveals a pancytopoenia (a marked decrease in the numbering of cell types)
  • The reticulocyte count is low .
  • Bone marrow examination and biopsy


  • Bone marrow transplantation from a donor with identical human leukocyte antigen for person younger than 40 years.
a plastic anaemia cont26
A plastic Anaemia Cont.
  • The remainder of persons are treated with immunosuppressive therapy.

Nursing care

Is based on careful assessment and management of complications of pancytopoenia by:

  • Private room.
  • Protective isolation
  • Provide and instruct the client on meticulous hygiene.
  • Assessment and maintenance of oral care regimen.
  • Monitor invasive lines for sign of infection.
a plastic anaemia cont27
A plastic Anaemia Cont.

Nursing Care Cont.

  • Avoid bladder catheterization.
  • Instruct family and visitors on careful hand washing.
  • Nursing intervention for preventing bleeding.........

Teaching the person with a plastic anaemia include:

  • Prevent infection.
  • Prevent haemorrhage.
  • Prevent fatigue.
haemolytic anaemia
Haemolytic Anaemia


Premature destruction of erythrocyte occurring at such a rate that the bone marrow is unable to compensate for the loss of cells.

Haemolysis can occur either extra vascular or intravascular.

  • In extra vascular, the spleen removes erythrocytes from circulation at much more rapid rate.
  • In Intravascular it is secondary to the erythrocyte lysing and spilling the cell contents into the spleen
haemolytic anaemia cont
Haemolytic Anaemia Cont.


The causes may be acquired form or hereditary forms

Acquired forms

  • Immune system-mediated haemolysis is caused or associated with transfusion reactions, haemolytic disease of the newborn
  • Traumatic haemolysis is caused by presence of prosthetic heart valves; structural abnormalities of the heart; haemodialysis.
  • Infectious haemolysis are due to bacterial infection (cholera, typhoid)
haemolytic anaemia cont30
Haemolytic Anaemia Cont.
  • Toxic (chemical) haemolysis occurs as the result of exposure to toxic chemical agents; haemodialysis or uraemia.
  • Physical haemolysis are due to burns and radiation.
  • Hypophosphatemic haemolysis are due to hypophosphatemia (phosphate deficiency in plasma.

Hereditary Form

  • Structural defect i.e., plasma membrane defect, destruction due to fragility of the erythrocyte.
  • Enzyme deficiency i.e., deficiency of glycol tic enzymes
haemolytic anaemia cont31
Haemolytic Anaemia Cont.

Clinical Manifestation

  • Ischemia occurs when red cells clump in the capillary beds, causing cyanosis, pain and paresthesia.
  • Haemoglobinuria.



  • The presence of the antibody or complement on the RBCs (direct Coomb’s test) or in the serum(indirect Coomb’s test)
  • Decreased Hct.
  • Increased reticulocyte and bilirubin
anaemia caused by blood loss
Anaemia caused by blood loss

Anaemia resulting from blood loss may be caused by either acute or chronic.

Aetiology /Pathophysiology

  • Trauma
  • Complications of surgery
  • Diseases that disrupt vascular integrity.

There are two clinical concerns in such situation


  • There is sudden reduction in the total blood volume that can lead to hypovolaemic shock.
haemolytic anaemia cont33
Haemolytic Anaemia Cont.


  • Mild cases require no treatment.
  • Supportive care includes:
  • Administering corticosteroids and blood products.
  • Removing the spleen.

Nursing Management

  • Teach the client about drug therapy.
  • Preparing the client for surgery.
anaemia caused by blood loss cont
Anaemia caused by blood loss Cont.


  • If the acute loss is more gradual, the body maintains its blood volume by slowly increasing the plasma volume.
  • Consequently, the circulating fluid volume is preserved. But the number of RBCs available to carry oxygen is significantly diminished.
anaemia caused by blood loss cont35
Anaemia caused by blood loss Cont.

Clinical Manifestation

Clinical manifestation of acute blood loss according to varying degrees of blood volume loss as follows:

anaemia caused by blood loss cont36
Anaemia caused by blood loss Cont.


  • Replacing blood volume to prevent shock.
  • Identify the source of haemorrhage and stopping blood loss.
  • IV fluid used in emergency includes dextran, albumin, or crystalloid electrolyte solution such as ringer lactate
  • Blood transfusion (packed RBCs)
  • Supplemental iron .