ANEAMIA PRESENTATION:

Presenter:-LAZARUS NKHOMA.

Date: 09.10.2011.

Time: 1 hr.

Venue: LSON.

OBJECTIVES:

At the end of the presentation students should have an understanding of anaemia thus its causes,
clinical features, treatment and its complications.

SPECIFIC OBJECTIVES

Students should be able to:-

1. Define anaemia.

2. Identify causes of anaemia.

3. State the signs and symptoms of anaemia.

4. Describe different types/classifications of anaemia.

5. Manage a patient with anaemia

ANAEMIA:

DEFINITION:

This is a deficit in the circulating hemoglobin mass and is said to be present when red cell volume or
hemoglobin concentration is an individual is below normal range for age and sex

This can also be defined as reduction in quantity or quality of blood.

CLASSIFICATION:

This is about five types of anaemia.

1. PERNICIOUS/MEGALOBLASTIC ANAEMIA:

This is caused by deficiencies of vitamin B12 and folic acid. There are two types of anaemia and these
are:-

(i) Macrocytic anaemia in which cells are larger than normal.

(ii) Microcytic anaemia in which cells are smaller than normal.

CLINICAL FEATURES:

(a) Irritability

(b) Failure to gain weight

(c) Chronic diarrhea

(d) Thrombocytopenia in severe deficiency

(e) Extremely pale particularly the mucous membranes

(f) Fatigue and weakness

(g) Parenthesis (tingling and numbness of feet) due to reduced blood volume.

(h) Smooth sore cracked tongue.

DIAGNOSIS:

- Decreased serum folate (normal 5-20mg/ml)

- Decreased red cell folate (normal 150-600 mg/ml)

2. IRON DEFICIENCY ANAEMIA:

This results when the intake of dietary iron is inadequate for hemoglobin synthesis. This type is likely to
occur in:-

- Low birth weight babies

- Pregnant women

- People on a low iron diet

- People with hookworm infestation

- People with menorrhagia or any other serious or chronic bleeding

CLINICAL FEATURES:

(a) Irritability

(b) Failure to gain weight

(c) Chronic diarrhea

(d) Thrombocytopenia in severe deficiency

(e) Extremely pale particularly to mucous membranes

(f) Fatigue and weakness

(g) Paresthesis (tingling and numbness of feet) due to reduced blood.

(h) Smooth sore cracked tongue.

(i) Pallor

(ii) Tiredness and fatigue

(iii) Breathlessness

(iv) Cardiac failure in extreme cases

DIAGNOSIS:

- Decreased serum folate (normal 5-20 mg/ml)

- Decreased red cell folate (normal 150-600 mg/ml)

CLINICAL FEATURES:

(a) Pallor

(b) Tiredness and fatigue

(c) Breathlessness

(d) Cardiac failure in extreme cases

(e) Ridged nails

(f) Angular cheilosis

(g) Poor physical performance

(h) Poor school performance

DIAGNOSIS:

- Serum iron is reduced.

3. APLASTIC ANAEMIA:
This type of anaemia is caused by decreased or damage to bone marrow stem cells. This result from
failure of cell production in the bone marrow associated with marrow hypoplasia, hyperplasia or
dysplasia. It does not only cause anaemia but also neutropenia and thrombocytopenia. It may also be
due to administration of certain drugs e.g. chloramphenicol.

CLINICAL FEATURES:

(a) Fatigue

(b) Dyspnea

(c) Retinal hemorrhage

(d) Pallor

4. HAEMOLYTIC ANAEMIA:

This is the excessive destruction of red blood cells caused by diseases like leukemia, sickle cell anaemia
and thalassemia. In this type the life span of red blood cells is reduced, thus reduction in number of red
blood cell in circulation leading to inadequate oxygen which cause renal hypoxia which in turn stimulate
an increase in erythropoietin release from the kidney. The erythropoietin stimulates the bone marrow
to compensate by producing new red blood cells and releasing red blood cell into circulation somewhat
premature as reticulocytes.

CLINICAL FEATURES:

These vary according to the degree in some patients it is asymptomatic but most patients complain of:-

(a) Restlessness

(b) Dizziness

(c) Mild jaundice and hepatomegaly

(d) Splenomegaly

(e) Pallor

5. HAEMORRHAGIC ANAEMIA:
This is due to excessive loss of blood through epistaxis, menorrhagia, trauma, bleeding from the mucous
membranes.

CLINICAL FEATURES:

(a) HYPOTENSION

(b) Tachycardia

(c) Cold extremities

(d) Air hunger

(e) Anxiety

(f) Pallor

DIAGNOSIS:

- Blood for hemoglobin

- Physical examination

CAUSES:

There are many causes of anaemia and some include:

(i) Malaria especially in children in areas where malaria is very prevalent

(ii) Chronic blood loss by hookworm infestation, peptic ulcers etc.

(iii) Chronic infections like Aids

(iv) Sickle cell disease

(v) Pregnancy

(vi) Iron deficiency

NORMAL HAEMOGLOBIN LEVELS:

BIRTH 3 MONTHS 6 MONTHS-6 YRS

7-12 YRS 12 15 YRS

M F

HB 16.5g/dl 10.0g/dl 12.5g/dl 13.0g/dl 14.0g/dl 13.5g/dl

TREATMENT:

OBJECTIVES:

- To identify the specific cause and treat

- To prevent complications like renal failure

INVESTIGATIONS: Blood for full blood count, Hb, groups and X-match,mps.

DRUGS:

(i) Folic acid children > 4 years = 0.4 mg/day

children < 4 years = 0.3 mg/day

infants = 0.1mg/day

(ii) Ferrous sulphate.

- Severe iron deficiency anaemia, 4-6 mg/Kg/day in 3 divided doses

- Mild to moderate anaemia, 3mg/Kg/day in 1-2 divided doses

NB: Feso4 is given in all types of anaemia except hemolytic.

(iii) Blood transfusion when indicated i.e. Hb/5Mg.

NURSING MANAGEMENT:
 OBJECTIVES:

- To alleviate and control the cause

- To bring the client back to normal status

- To prevent complications like acute renal failure

-Most anaemia is treated symptomatically and in children the most common cause is insufficient diet
rich in iron.

BED REST/POSITION:

In severe anaemia the child is usually pyrexia, she runs a risk of going into cardiac failure at the slightest
strain, therefore the care should be that which prevent strain and restore good health.

Rest is essential in lowering patients oxygen requirement for reducing strain on the heart and lungs.
Patient should be propped up in bed with support of pillows. This allows easy breathing and prevents
congestion on the lungs. Tell the mother to assist in the care and maintenance of the childs position.

OBSERVATIONS:

Vital signs observation of temperature, pulse, respirations and blood pressure should be done hourly,
hourly, 1 hourly, 2 hourly & 4 hourly as the condition improves.

Temperature for pyrexia and pulse for tachycardia and if present, infuse fluids as ordered like normal
saline to increase the volume of blood. For dyspnea and if present then check the position and oxygen
therapy is ordered blood pressure for hypotension, if present increase the flow rate.

Observe for pallor if severe there may be need to transfuse blood depending on the Doctors order
observe for urine i.e. consistency, colour, smell and output to assess the kidney functions. Record the
findings on the fluid balance chart.

Observe the mouth for any lesions as they are prone to sores. Observe the skin, if very dry then it means
there is severe anaemia. Observe the eating pattern of the patient as they usually have anorexia, help
the child by giving appetizing, small frequent meals. Observe the general condition of the child and take
measures appropriately.

FLUID AND EFFECTROLYTE BALANCE:

Infuse prescribe fluids e.g. normal saline to maintain the fluid and electrolyte balance and increase blood
volume. Record the intake and output on the fluid balance chart to prevent fluid overload. Encourage
oral fluids if the child can tolerate.

NUTRITION:
Food is an important factor in providing good health. A high protein diet e.g. beans, soya beans, eggs,
meat, for repair of tissue and red blood cell formation. Vitamins for protection of the body from other
infections e.g. fruits and vegetables carbohydrates for energy as the child may be weak. Although the
child may have anorexia, encourage then to eat by:

- preparing attractive food

- giving small frequent meals

- train the family in preparation of food and involve them in planning of the meals for the child.
Provide the food that the child likes most. Tell the mother to continue breast feeding the child.

PSYCHOLOGICAL CARE:

Explain the disease process to the mother i.e. definition, causes, signs and symptoms and its
management to alley anxiety, tell the mother that in children anaemia is mostly caused by inadequate
balanced diet. Explain each and every procedure that is going to be done on the child such as scalp vein,
blood collection for hemoglobin, cross-match and grouping, oral care etc. so as to gain cooperation and
understanding of the mother.

HYGIENE:

Mostly if severe anaemia bed rest is recommended, therefore bed bath should be done daily to promote
comfort, prevent infection of the skin and promote peripheral circulation. Encourage the mother to bath
their children as they tend not to bath their babies when they are sick. Oral care should be done before
meals to promote appetite reduce risk of infections such as gingivitis, stomatitis and prevent halitosis.
Nail care to prevent auto infection and injury to themselves.

ELIMINATION:

Observe the elimination pattern of the child thus the amount, consistency, smell and frequency. Ask the
mother how frequent the baby is wetting the nappy so as to detect any renal abnormality.

I.E.C. ON PREVENTION:

1. Educate the mother on dietary importance as it prevents anaemia.

2. Educate on the disease process i.e definition causes, signs and symptoms and treatment

3. Educate the mother on drug compliance.

4. The importance of review dates to be followed so as to check the hemoglobin levels

5. Tell the mother the importance of taking the child to hospital before review date if the child is
sick or has severe signs of anaemia or any illness.

COMPLICATIONS:
1. Congestive cardiac failure due to increased workload of the heart

2. Paresthesis due to reduced blood flow to extremities

3. Confusion due to inadequate blood to the brain

4. Renal failure due to reduce blood flow to the kidney

5. Fluid overload.

6. brain damage due to hypoxia