ANEMIA DEFINITION

A reduction in either the number of RBCs, the amount of haemoglobin, or the hematocrit. A clinical sign, not a specific disease, because it is a manifestation of several abnormal conditions. Can result from dietary problems, genetic disorders, bone marrow disease, or excessive bleeding. Gastrointestinal bleeding is the most common reason for anemia in adults.

TYPES OF ANEMIA 1. Sickle cell anemia Autosomal recessive inheritance of two defective gene alleles foe haemoglobin synthesis. 2. Glucose 6 phosphate dehydrogenase defiency anemia (G6PD) X-linked recessive defiency of the enzyme G6PD. 3. Autoimmune haemolytic anemia
Abnormal immune function in which a persons immune reactive cells fail to recognize his or her

own red blood cells as self-cells. 4. Iron defiency anemia Inadequate iron intake caused by: Iron-deficient diet Chronic alcoholism Malabsorption syndromes Partial gastrectomy

Rapid metabolic (anabolic) activity caused by: Pregnancy Adolescence Infection

5. Vitamin B12 deficiency anemia

Zeilstra Hanna M. Nicolas BSN IV-A Group 3

 Dietary deficiency Failure to absorb vitamin B12 from intestinal tract as a result of: Partial gastrectomy Pernicious anemia

6. Folic acid deficiency anemia Dietary deficiency Malabsorption syndromes

Drugs: 7. Aplastic anemia Exposure to myelotoxic agents Radiation Benzene Chloramphenicol Alkylating agents Antimetabolites Sulphonamides Insecticides Oral contraceptives Anticonvulsants Methotrexate

Viral infection (unproven) Epstein-Barr virus Hepatitis B Cytomegalovirus

Zeilstra Hanna M. Nicolas BSN IV-A Group 3

CLINICAL MANIFESTATIONS Integumentary

Pallor, especially of the ears, the nail beds, the palmar creases, the conjunctiva, and around the mouth Cool to touch Intoleraednce of cold temperature Nails become brittle and may lose the normal convex shape; over time, nails become concave and fingers assume clublike appearance

Cardiovascular Tachycardia at basal activity levels, increasing with activity and during and immediately after meals Murmurs and gallops heard on auscultation when anemia is severe Orthostatic hypotension

Respiratory Dyspnea on exertion Decreased oxygen saturation levels

Neurologic Increased somnolence and fatigue Headache

ETIOLOGY AND PATHOPHYSIOLOGY 1. Anemia is one of the most common problems in clinical practice; it may be a primary pathology or secondary to an underlying condition.
2. Anemia is classified according to either morphologic characteristics of erythrocytes or etiologic

mechanisms resulting in decreased hemoglobin or RBC mass.

Zeilstra Hanna M. Nicolas BSN IV-A Group 3

3. Morphologi characteristics refer to average RBC size and hemoglobin content. Average RBC size may be normal (normocytic), smaller than normal (microcytic), or larger than normal (hypochromic). 4. Physiologic mechanisms include: a. Decreased or ineffective RBC or hemoglobin production (bone marrow failure). b. Decreased or premature RBC destruction (hemolysis). c. Increased RBC loss (hemorrhage). 5. Bone marrow failure may result from nutritional deficiency, toxic exposure, invasion or replacement of marrow by tumor or fibrous tissue, or unknown causes. 6. Hemolysis may result from an intrinsic RBC defect incompatible with normal cell survival or from an extrinsic factor promotes cell destruction.

DIAGNOSTIC EXAMINATIONS Diagnostic evaluation to determine cause and type of anemia includes: a. Hemoglobin and hematocrit b. RBC indices c. Examination of stained blood capacity d. Reticulocyte count e. Serum iron level f. Total iron binding capacity g. Serum ferritin h. Serum folate level i. Vitamin b12 level j. Hemoglobin electrophoresis k. Coombs test l. White blood cell studies- may include bone marrow aspiration and biopsy or studies to determine the source of any chronic blood loss.

Zeilstra Hanna M. Nicolas BSN IV-A Group 3