Anaemia

Reduced oxygen carrying capacity of blood, or reduced numbers of red blood cells or their haemoglobin content or both. Diagnosed by a simple blood test for Haemoglobin levels

Haemoglobin Average is 14.8 g per dl. Range; men 13.5 - 18 women 11.5 - 16

Haematocrit value Percentage of the blood which is red cells, usually about 45%

Symptoms

fatigue weakness fainting shortness of breath on exertion

dizziness headache insomnia anorexia and dyspepsia

tingling in extremities angina amenorrhoea

palpitations intermittent claudication

Signs pallor skin and membranes tachycardia cardiac failure angular stromatitis

glossitis

Types

Anaemia can be caused basically in one of three ways, secondary to decreased erythropoiesis, increased haemolysis or secondary to blood loss

Deficiency of erythropoetic agents; iron vit B12 vit C folic acid thyroxine copper

Haemolytic Inadequate production - renal failure Chronic blood loss Hypoplastic or aplastic

Classification microcytic normocytic macrocytic haemolytic

Microcytic - Iron deficiency

Causes menstruation - menorrhagia blood loss low iron diet malabsorption

increased demand eg. growth or pregnancy

Cell changes microcytic hypochromic, variation in shape and size of RBCs

Treatment

Correct underlying cause Iron supplement eg ferrous sulphate, 600 mg/day, (120g ferrous iron)

With good treatment HB should rise by 1g/week Full recovery and replacement of iron stores may take up to 6 months

Normocytic Failure of production by bone marrow

Anaemia due to blood loss

Causes menorrhagia peptic ulcer haemorrhoids GI cancer colitis hook worm

Treatment the cause erythropoietic factors

Anaemic of chronic disease Decreased release of iron from bone marrow to developing erythrocytes

Macrocytic Vit B12 and foliate are both required for DNA synthesis

Pernicious anaemia

B12 malabsorption Usually in elderly Post gastrectomy, lack of intrinsic factor

Cell changes abnormal macrocytic

Treatment oral B12 and diet B12 injections

Folic acid deficiency

Macrocytic as in pernicious anaemia Give 5mg folic acid/day ? prophylactic folic acid in pregnancy

Found in green vegetables and offal, (liver and kidney)

Macrocytosis of pregnancy Possibly results from shortage of folic acid

Macrocytic anaemia also found in, newborn alcoholics liver diseasehypothyroidism aplasic anaemia

Haemolytic Excessive red cell breakdown - haemolysis May be raised serum bilirubin

Causes Spherocytosis Thalassaemia (abnormal haemoglobin) Malaria

Glucose-6-phosphate dehydrogenase deficiency May be triggered by drugs or infections

Sickle Cell Anaemia Abnormal Hb results in abnormal shaped cells

Found mostly in Negroid and Mediterranean peoples Important to know about pre-op

Specific nursing management in anaemia

Possible factors

Diet Assess and plan the diet with patient and dietitian to compensate for deficiencies.

Gastric Lack of hydrochloric acid or intrinsic factor, by-pass stomach by using injections.

Blood loss Assess site and degree, arrest cause and take steps to return the HB to normal.

Pregnancy Consider the periconceptual period as well as pregnancy. Give advice pregnancy prevention.

Systemic disease Correction and care while ill.

Poor financial circumstances

Ignorance of dietary needs

Childhood and pregnancy, Dietary demands are greater.

Treatment of cause

Care during iron injections, care of blood transfusions, ensure medication compliance.

Observations Bowel habits, type/colour occult blood urine observation/tests menstrual patterns, length severity blood tests.

Breathlessness Depends on severity, bed rest and positioning, monitor respiratory rate, observe for cyanosis, oxygen if required.

Tachycardia/tiredness Record pulse rate, planned rest periods.

Diet Record what patient actually eats, weight charts.

General measures ADLs, care of the mouth, finger nails, psychological, sociological