Anemia

NUR 1020

Angela Maietta MSN, RN

Student Learning Outcomes

Understand the structure and function of the organs, tissues, and cells of
the hematologic system.
Identify essential data that is part of a comprehensive hematologic
assessment.
Describe diagnostic tests used in assessment of hematologic function.
Dierentiate among the following types of anemia: iron deficiency, Vitamin
B 12 deficiency and folic acid deficiency in terms of pathophysiology.
Identify gerontologic considerations important to the assessment and
treatment of anemia in older adults.
Formulate a concept map for the client with anemia.
Understand the pharmacological agents used in the management of anemia.

What is Anemia?

Decreased red blood cells (erythrocytes) circulating

through the blood system.

Pathophysiology

RBCs are the transporters of oxygen around the body;

thus, in anemia the amount of oxygen delivered to the
body is diminished.
What is the medical term for this?

Anemia can become a problem because RBCs bind to

oxygen Fewer RBCs to carry oxygen around the body
means less of the fuel that the organs and cells need to live.

Anemia is actually an oxygenation problem!

Potential Causes of Anemia

Blood loss

A lack of production of RBC

An increase destruction of RBC

A deficiency of necessary components such as

folic acid, iron, erythropoietin, and/or vitamin
B12

Assessment
Symptoms can occur due to hypoxia resulting from anemia:
Subjective:

Objective:

Weakness, fatigue
Pallor (pale skin)
Shortness of breath
Sensitivity to cold
Numbness or tingling of
extremities
Loss of appetite

Decreased capillary refill

Orthostatic hypotension
Tachycardia
Chest pain
Smooth, sore tongue (iron
and vitamin B12
deficiency)

The more rapidly anemia develops, the more severe the symptoms

Anemia is not a disease, only a sign of an

underlying disorder. What are the most common
underlying causes of anemia?

Iron Deficiency Anemia

The most common form of anemia worldwide:

Intake of dietary iron is inadequate for the composition of hemoglobin.

The body can store 1/4 to 1/3 of its iron; these stores must be depleted prior to the
development of anemia.

In the United States, it most commonly aects toddlers and women of childbearing age.

Clinical manifestations: weakness and fatigue. If deficiency is prolonged, smooth, sore

tongue and brittled and ridged nails.

Diagnosis is via history and laboratory evaluation of hemoglobin and iron stores.

Nursing management:

Preventive education for menstruating and pregnant women

Nutritional counseling: food sources high in iron: organ meats, beans, leafy green
vegetables, raisins and molasses.

Taking iron-rich foods with a source of Vitamin C enhances the absorption of iron.

Vitamin B12 Deficiency

Occurs as a result of:
Inadequate intake of Vitamin B12 (strict vegetarians)
Faulty absorption from the GI tract (Crohn's, bariatric surgery)
Chronic use of proton pump inhibitors to reduce gastric acid production or the use of
metformin for diabetes.
Lack of the intrinsic factor in the stomach gastric mucosa that binds with dietary vitamin B12
(also called pernicious anemia; typically genetic).

Large amounts of B12 are stored in the body, so this condition may not become apparent until up to
four years after B12 absorption stops or slows down.

Clinical manifestations: weakness and fatigue. If deficiency is severe, smooth, sore, red tongue may
occur and neurological symptoms.

Diagnosis is via history and laboratory evaluation of hemoglobin and serum vitamin B12 level.

The Schilling test helps determine the cause of vitamin B12 deficiency (indicates pernicious anemia).

Nursing management:

Nutritional counseling: food sources high in Vitamin B12: meat, eggs, whole grains, and most
vegetables.

Folic Acid Deficiency

Occurs as a result of:

Typically results when the intake of dietary folate is inadequate.

The stores of folate within the body can become depleted within 4 months of when
dietary intake of folate is deficient.

In the United States, it most commonly aects infants and teenagers.

Clinical manifestations: weakness and fatigue.

Diagnosis is via history and laboratory evaluation of hemoglobin and serum folate levels.

Nursing management:

Preventive education: a woman's body needs eight times more folic acid during pregnancy.

Alcohol increases folic acid requirements.

Nutritional counseling: food sources high in folate: green vegetables and liver.

Smoking increases the risk of developing folate deficiency by interfering with the
absorption of vitamin C, which the body needs to absorb folic acid.

Laboratory Evaluation
Hemoglobin: the total amount of the red blood cells in the blood
Hematocrit: the percentage of RBCs in relation to the total blood
volume
RBC indices are used to determine the type and cause of most anemias:
Reticulocyte count: measures the number of new RBCs
Mean corpuscular volume (MCV): measures the size of the cell
Red cell distribution width (RDW): measures the range of variation
of red blood cell

Additional Laboratory Evaluation

To assess for potential causes of anemia:
Iron Studies
Vitamin B12 level
Folate level
Complete blood count

Gerontologic Considerations

The overall prevalence of anemia increases with age to almost 50% in

older adults with chronic illness.

The impact of anemia in the older adult is significant and may include
decreased mobility, increased depression, increased risk of falling, and
delirium.

Older adults with anemia are not able to compensate as well as younger
individuals.

Nursing Care

Encourage increased dietary intake of the deficient nutrient

Manage fatigue (most common symptom)

Teach about the risk of experiencing dizziness upon standing

Promoting compliance with prescribed therapy (at the proper time and
technique for optimal absorption)

Teach about time frame for resolution

Maintain adequate nutrition

Maintain adequate perfusion

Monitoring and managing potential complications

Medical Management:
Treatment Depends on the Cause
1. Correcting or controlling the cause of the anemia.
How would you correct Iron deficiency anemia?
Vitamin B12 deficiency anemia?
Folic acid deficiency anemia?

2. If the anemia is severe, transfusion of RBCs may be

necessary.
What clinical indications would lead you to contact a physician for
a potential transfusion order?

Complications
Heart Failure:
Heart failure can develop due to the increased demand on the heart
to provide oxygen to tissues. A low HCT decreases the amount of
oxygen carried to tissues in the body, which makes the heart work
harder and beat faster (tachycardia, palpitations).

Nursing Actions:

Administer oxygen and monitor oxygen saturation

Monitor cardiac rhythm
Obtain daily weight
Administer blood transfusion, as prescribed
Administer cardiac medications as prescribed (diuretics)
Administer anti-anemia medications as prescribed

Pharmacological Treatment of:

Anemia

Iron Deficiency Anemia

Ferrous sulfate (Feosol): iron replacement for the treatment of
iron deficiency anemia.
Instruct patient to take an hour before meals, as iron is best
absorbed on an empty stomach; take with orange juice or other
forms of vitamin C for best absorption.
Many patients have dicult tolerating iron supplements because
of GI side eects (constipation, nausea, vomiting). In this case, it
can be taken with meals (decreases absorption by 50%) or given
intravenous.
Antacids should not be take with iron, as they greatly diminish
absorption.

Vitamin B12 Deficiency

Cyanocobalamin (Vitamin B12): vitamin B12 replacement for
the treatment of vitamin B12 deficiency or pernicious anemia.

Can by administered by mouth, intramuscular, intranasal, or

intravenous.
Vegetarians can prevent or treat deficiency with oral
supplements or fortified soy milk.
When deficiency is due to defect in absorption or absence of
intrinsic factor, replacement is by monthly intramuscular
injections of vitamin B12.

Folic Acid Deficiency

Folic Acid (Folate): folic acid replacement for the treatment of
folic acid deficiency anemia.
Can by administered by mouth or intramuscular.
Administered intramuscular only to individuals with
malabsorption problems.
Although multivitamins often contain folic acid, additional
supplements are often necessary to fully replace deficient body
stores.
Patients who abuse alcohol should receive folic acid as long as
they consume alcohol.

Erythropoiesis-Stimulating Agents
Epoetin Alpha (Epogen, Procrit): injectable medication for the
treatment of anemia in individuals with long term illness, such as
kidney disease or cancer.

Very similar to the natural substance in the body (erythropoietin)

which signals the bone marrow to make more red blood cells.
When this natural mechanism is not working, it may become
necessary to stimulate the bone marrow to produce more red
blood cells.
May cause or worsen hypertension; monitor blood pressure closely.