Bellatrix Pagdanganan BSN II-B ANEMIA (Report)

DESCRIPTION:
Anemia is a condition that develops when your blood lacks enough healthy red blood cells. These cells are the main transporters of oxygen to organs. If red blood cells are also deficient in hemoglobin, then your body isn't getting enough oxygen. Symptoms of anemia -- like fatigue -- occur because organs aren't getting what they need to function properly. Anemia is the most common blood condition in the U.S. It affects about 3.5 million Americans. Women and people with chronic diseases are at increased risk of anemia. Important factors to remember are: Certain forms of anemia are hereditary and infants may be affected from the time of birth. Women in the childbearing years are particularly susceptible to a form of anemia called iron-deficiency anemia because of the blood loss from menstruation and the increased blood supply demands during pregnancy. Seniors also may have a greater risk of developing anemia because of poor diet and other medical conditions. There are many types of anemia. All are very different in their causes and treatments. Iron-deficiency anemia, the most common type, is very treatable with diet changes and iron supplements. Some forms of anemia -- like the anemia that develops during pregnancy -- are even considered normal. However, some types of anemia may present lifelong health problems.

CAUSES:
There are more than 400 types of anemia, which are divided into three groups: Anemia caused by blood loss Anemia caused by decreased or faulty red blood cell production Anemia caused by destruction of red blood cells Anemia Caused by Blood Loss Red blood cells can be lost through bleeding, which can occur slowly over a long period of time, and can often go undetected. This kind of chronic bleeding commonly results from the following: Gastrointestinal conditions such as ulcers, hemorrhoids, gastritis (inflammation of the stomach), and cancer Use of nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen Menstruation and childbirth in women, especially if menstrual bleeding is excessive and if there are multiple pregnancies Anemia Caused by Decreased or Faulty Red Blood Cell Production The body may produce too few blood cells or the blood cells may not function correctly. In either case, anemia can result. Red blood cells may be faulty or decreased due to abnormal red blood cells or the a lack of minerals and vitamins needed for red blood cells to work properly. Conditions associated with these causes of anemia include the following: Sickle cell anemia Iron deficiency anemia Vitamin deficiency Bone marrow and stem cell problems Other health conditions Sickle cell anemia is an inherited disorder that affects African-Americans. Red blood cells become crescent-shaped because of a genetic defect. They break down rapidly, so oxygen does not get to the body's organs, causing anemia. The crescent-shaped red blood cells also get stuck in tiny blood vessels, causing pain. Iron-deficiency anemia occurs because of a lack of the mineral iron in the body. Bone marrow in the center of the bone needs iron to make hemoglobin, the part of the red blood cell that transports oxygen to the body's organs. Without adequate iron, the body cannot produce enough hemoglobin for red blood cells. The result is iron-deficiency anemia. This type of anemia can be caused by: An iron-poor diet, especially in infants, children, teens, vegans, and vegetarians The metabolic demands of pregnancy and breastfeeding that deplete a woman's iron stores Menstruation Frequent blood donation Endurance training Digestive conditions such as Crohn's disease or surgical removal of part of the stomach or small intestine Certain drugs, foods, and caffeinated drinks Vitamin-deficiency anemia may occur when vitamin B-12 and folate are deficient. These two vitamins are needed to make red blood cells. Conditions leading to anemia caused by vitamin deficiency include: Megaloblastic anemia: Vitamin B-12 or folate or both are deficient

Pernicious anemia: Poor vitamin B-12 absorption caused by conditions such as Crohn's disease, an intestinal parasite infection, surgical removal of part of the stomach or intestine, or infection with HIV Dietary deficiency: Eating little or no meat may cause a lack vitamin B-12, while overcooking or eating too few vegetables may cause a folate deficiency. Other causes of vitamin deficiency: pregnancy, certain medications, alcohol abuse, intestinal diseases such as tropical sprue and celiac disease During early pregnancy, sufficient folic acid can prevent the fetus from developing neural tube defects such as spina bifida. Bone marrow and stem cell problems may prevent the body from producing enough red blood cells. Some of the stem cells found in bone marrow develop into red blood cells. If stem cells are too few, defective, or replaced by other cells such as metastatic cancer cells, anemia may result. Anemias resulting from bone marrow or stem cell problems include: Aplastic anemia occurs when there's a marked reduction in the number of stem cells or absence of these cells. Aplastic anemia can be inherited, can occur without apparent cause, or can occur when the bone marrow is injured by medications, radiation, chemotherapy, or infection. Thalassemia occurs when the red cells can't mature and grow properly. Thalassemia is an inherited condition that typically affects people of Mediterranean, African, Middle Eastern, and Southeast Asian descent. This condition can range in severity from mild to life-threatening; the most severe form is called Cooley's anemia. Lead exposure is toxic to the bone marrow, leading to fewer red blood cells. Lead poisoning occurs in adults from work-related exposure and in children who eat paint chips, for example. Improperly glazed pottery can also taint food and liquids with lead. Anemias associated with other conditions usually occur when there are too few hormones necessary for red blood cell production. Conditions causing this type of anemia include the following: Advanced kidney disease Hypothyroidism Other chronic diseases -- examples include cancer, infection, and autoimmune disorders such as lupus or rheumatoid arthritis Anemia Caused by Destruction of Red Blood Cells When red blood cells are fragile and cannot withstand the routine stress of the circulatory system, they may rupture prematurely, causing hemolytic anemia. Hemolytic anemia can be present at birth or develop later. Sometimes there is no known cause (spontaneous). Known causes of hemolytic anemia may include: Inherited conditions, such as sickle cell anemia and thalassemia Stressors such as infections, drugs, snake or spider venom, or certain foods Toxins from advanced liver or kidney disease Inappropriate attack by the immune system (called hemolytic disease of the newborn when it occurs in the fetus of a pregnant woman) Vascular grafts, prosthetic heart valves, tumors, severe burns, chemical exposure, severe hypertension, and clotting disorders In rare cases, an enlarged spleen can trap red blood cells and destroy them before their circulating time is up.

RISK FACTORS:
1. Premenopausal Women-Up to 10% or more of adolescent and adult women under 49 years are iron deficient. Hispanic American and African-American women have double the prevalence for anemia compared to Caucasian women. The risk for anemia in adolescent girls is about 3%. Anemia is generally mild in young women, however, and is more likely to occur with one or more of the following conditions: Heavy menstruation for longer than 5 days Abnormal uterine bleeding, such as from fibroids Pregnancy. About 20% of women in industrialized countries have iron deficiency during pregnancy. Multiple pregnancies and births significantly increase the risk. 2. Older Adults-About 10% of adults age 65 years and older have anemia. For patients in nursing homes, about 50% are anemic. Causes of anemia in older adults include nutritional deficiencies, chronic inflammatory disease, and chronic renal disease. 3. Alcoholism-People with alcoholism are at risk for anemia both from internal bleeding as well as folate- and vitamin B deficiency-related anemias. 4. Iron-Poor Diets- Although most Americans probably consume too much iron in their diets, some people may be at risk for diet-related iron deficiencies, including: People whose diets are high in processed foods and lack any meat. Strict vegetarians. Vegetarians who avoid all animal products may have a slightly higher risk for deficiencies in iron and some B vitamins. Although dried beans and green vegetables often contain iron, it

is less easily absorbed from plants than from meat. Fortunately, most commercial cereals are fortified with vitamin B12 and folic acid (the synthetic form of folate). 5. Chronic or Critical Illnesses- Anyone with a chronic disease that causes inflammation or bleeding is at risk for anemia. Critical illness in the intensive care unit is also highly associated with anemia. 6. Excessive Exercise- Working out regularly may cause some iron loss, which is comparable to that from menstruation and rarely worrisome. Dietary choices may account for most cases of sports anemia. Intense, sustained exercise, such as that performed by marathon runners, may cause a condition called sports anemia, which may be due to slight gastrointestinal bleeding, damaged red blood cells, low iron intake, or poor intestinal absorption of iron. 7. Pregnancy- Iron deficiency occurs in 20% of pregnant women in developed countries. Even worse, 50% or more of women in nonindustrialized nations become iron deficient, and 30 - 50% are deficient in folic acid. Severe anemia is associated with a higher mortality rate among pregnant women. Mild-to-moderate anemia, however, does not pose any elevated risk. Pregnancy increases the risk for anemia in different ways: It increases the body's demand for folic acid and, therefore, poses a risk for deficiencies and an increased risk for megaloblastic anemia. Low levels of folate during pregnancy increase the risk of neural tube defects in newborns. It increases the body's demand for iron, thus posing a risk for iron deficiency anemia. Pregnant or nursing women need 30 mg of iron per day. Maternal iron deficiency anemia is associated with increased weight or size of the placenta, a condition that may later pose a risk for high blood pressure in the offspring. Pregnant women with low hemoglobin levels (the iron-bearing component in the blood) have an elevated risk for preterm or low birth weight infants. Pregnancy is also associated with fluid retention, which in turn may produce high volumes of plasma (the fluid component of blood). This can dilute red blood cells, which may lead to anemia. During delivery, heavy bleeding or multiple births can cause postpartum anemia, which occurs in about 10% of women. Postpartum anemia can last 6 - 12 months after giving birth.

SYMPTOMS:
The symptoms of anemia vary according to the type of anemia, the underlying cause, and any underlying health problems. Anemia may be associated with other medical conditions such as hemorrhage, ulcers, menstrual problems, or cancer -- and specific symptoms of those conditions may be noticed first. The body also has a remarkable ability to compensate for early anemia. If your anemia is mild or developed over a long period of time, you may not notice any symptoms. Symptoms common to many types of anemia include the following: Easy fatigue and loss of energy Unusually rapid heart beat, particularly with exercise Shortness of breath and headache, particularly with exercise Difficulty concentrating Dizziness Pale skin Leg cramps Insomnia Other symptoms are associated with specific forms of anemia. Anemia caused by iron deficiency: Hunger for strange substances such as paper, ice, or dirt (a condition called pica). Upward curvature of the nails referred to as koilonychias. Soreness of the mouth with cracks at the corners. Anemia caused by vitamin B-12 deficiency: A tingling, "pins and needles" sensation in the hands or feet. Lost sense of touch. A wobbly gait and difficulty walking. Clumsiness and stiffness of the arms and legs. Dementia Hallucinations, paranoia, and schizophrenia. Anemia caused by chronic red blood cell destruction: Jaundice (yellow skin and eyes) Brown or red urine Leg ulcers Failure to thrive in infancy Symptoms of gallstones

Sickle cell anemia: Fatigue Susceptibility to infection Delayed growth and development in children Episodes of severe pain, especially in the joints, abdomen, and limbs Anemia caused by sudden red blood cell destruction: Abdominal pain Brown or red urine Jaundice (yellow skin) Small bruises under the skin Seizures Symptoms of kidney failure Call your doctor about anemia if there is: Persistent fatigue, breathlessness, rapid heart rate, pale skin, or any other symptoms of anemia Poor diet or inadequate dietary intake of vitamins and minerals Very heavy menstrual periods Symptoms of an ulcer, gastritis, hemorrhoids, or colorectal cancer Concern about environmental exposure to lead A hereditary anemia runs in your family and you would like genetic counseling before having a child Women considering pregnancy -- your doctor will likely recommend that you begin taking supplements, especially folate, even before conception. These supplements benefit both mother and baby.

DIAGNOSTIC PROCEDURES:
The first step in any diagnosis is a physical examination to determine if the patient has symptoms of anemia and any complications. Because anemia may be the first symptom of a serious illness, determining its cause is very important. This may be difficult, particularly in the elderly, malnourished, or people with chronic diseases, whose anemia may be caused by one or more factors. A detailed medical, personal, and dietary history should report: Any family or personal history of anemia A history of gallbladder disease, jaundice, or enlarged spleen Heavy menstrual bleeding in women Any occurrence of blood in the stool or other signs of internal bleeding. (Even if the patient hasnot observed any bleeding, nonvisible blood may be present, so a rectal exam and stool test are essential.) Any dietary history, particularly in people who are elderly, poor, or both The doctor should examine the patient carefully, especially checking for swollen lymph nodes, an enlarged spleen, and pale skin and nail color. A complete blood count (CBC) blood test is performed to determine the presence of anemia. Other iron status blood tests are also used. Complete Blood Count (CBC) A complete blood count (CBC) is a panel of tests that measures red blood cells, white blood cells, and platelets. For diagnosis of anemia, the CBC provides critical information on the size, volume, and shape of red blood cells (erythrocytes). CBC results include measurements of hemoglobin, hematocrit, and mean corpuscular volume. Hemoglobin. Hemoglobin is the iron-bearing and oxygen-carrying component of red blood cells. The normal value for hemoglobin varies by age and gender. Anemia is generally considered when hemoglobin concentrations fall below 11 g/dL for pregnant women, 12 g/dL for non-pregnant women, and 13 g/dL for men. The severity of anemia is categorized by the following hemoglobin concentration ranges: Mild anemia is considered when hemoglobin is between 9.5 - 13.0 g/dL Moderate anemia is considered when hemoglobin is between 8.0 - 9.5 g/dL Severe anemia is considered for hemoglobin concentrations below 8.0 g/dL Hematocrit. Hematocrit is the percentage of blood composed of red blood cells. People with a high volume of plasma (the liquid portion of blood) may be anemic even if their blood count is normal because the blood cells have become diluted. Like hemoglobin, a normal hematocrit percentage depends on age and gender. Anemic ranges for hematocrit generally fall below: Children ages 6 months - 5 years: Below 33% Children ages 5 years - 12 years: Below 35% Children ages 12 years - 15 years: Below 36% Adult men: Below 39% Adult non-pregnant women: Below 36% Adult pregnant women: Below 33%

Other hemoglobin measurements such as mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) may also be calculated. Mean Corpuscular Volume. Mean corpuscular volume (MCV) is a measurement of the average size of red blood cells. The MCV increases when red blood cells are larger than normal (macrocytic) and decreases when red blood cells are smaller than normal (microcytic). Macrocytic cells can be a sign of anemia caused by vitamin B12 deficiency, while microcytic cells are a sign of iron-deficiency anemia or thalassemias. Other Iron Status Blood Tests Serum Ferritin. Ferritin is a protein that binds to iron and helps to store iron in the body. Low levels typically mean reduced iron stores. Normal values are generally 12 - 300 ng/mL for men and 12 - 150 ng/mL for women. Lower than normal levels of ferritin are a sign of iron-deficiency anemia, while higher than normal levels may indicate hemolytic anemia, megaloblastic anemia, or anemia of chronic disease. Serum Iron. Serum iron measures the amount of iron in the blood. A normal serum iron is 60 - 170 mcg/dL. Lower levels may indicate iron-deficiency anemia or anemia of chronic disease, while higher levels may indicate hemolytic anemia or vitamin B12 deficiency. Total Iron Binding Capacity. Total iron binding capacity (TIBC) measures the level of transferrin in the blood. Transferrin is a protein that carries iron in the blood. TIBC calculates how much or how little the transferrin in the body is carrying iron. A higher than normal TIBC is a sign of iron-deficiency anemia. A lower than normal level may indicate anemia of chronic disease, sickle cell, pernicious anemia, or hemolytic anemia. Reticulocyte Count. Reticulocytes are immature red blood cells, and their count reflects the rate of red blood cell production. The upper normal limit is about 100,000/mL. A low count, when bleeding isn't the cause, suggests problems in production in the bone marrow. An abnormally high count indicates that the red blood cells are being destroyed in high numbers and indicates hemolytic anemia. Recent research suggests that the reticulocyte hemoglobin content (CHr) test may be more accurate than a standard hemoglobin test for detecting iron deficiency in infants. Vitamin Deficiencies. Tests for vitamin B12 and folate levels. Other Diagnostic Tests If internal bleeding is suspected as the cause of anemia, the gastrointestinal tract is usually the first suspect as the source. A diagnosis in these cases can often be made if the patient has noticed blood in the stools, which can be black and tarry or red-streaked. Often, however, bleeding may be present but not visible. If so, stool tests for this hidden (occult) blood are required. Additional tests may then be needed to diagnose the precipitating condition. Endoscopy, in which a fiber optic tube is used to view into the gastrointestinal tract, is helpful in many patients, particularly when the source of bleeding is unclear. A colonoscopy may also be recommended to rule out colorectal cancer. If the patient's diet suggests low iron intake and other causes cannot be established using inexpensive or noninvasive techniques, then the patient may simply be given a monthly trial of iron supplements. If the patient fails to respond, further evaluation is needed.

TREATMENTS FOR ANEMIA

Your doctor will not treat your anemia until the underlying cause has been established. The treatment for one type of anemia may be both inappropriate and dangerous for another type of anemia. Anemia Caused by Blood Loss -If you suddenly lose a large volume of blood, you may be treated with fluids, a blood transfusion, oxygen, and possibly iron to help your body build new red blood cells. Chronic blood loss is treated by identifying the source of bleeding, stopping the bleeding, and, if necessary, giving treatment for iron-deficiency anemia. The most common cause of iron deficiency through blood loss is heavy menstrual bleeding in young women. Nonmenstruating women or men who develop iron deficiency need to have a colon exam (colonoscopy or barium enema) to help identify the source of chronic bleeding. Anemia Caused by Decreased Red Blood Cell Production -The type of treatment you receive depends on the cause of decreased red blood cell production. With iron deficiency anemia- Your doctor will probably recommend iron supplements that contain the ferrous form of iron, which your body can absorb easily. Timed-release iron supplements are not a good choice for most people because iron is primarily absorbed in the upper part of the digestive tract. If you use iron supplements, remember the following cautions: Always consult with your doctor before taking iron supplements. Excess iron intake can be harmful. Symptoms of iron overload include fatigue, vomiting, diarrhea, headache, irritability, heart disease, and joint problems. Iron supplements -- like all supplements and any medication -- should be kept out of the reach of children. Iron poisoning is the most common cause of accidental poisoning in young children. Eating even a few tablets can prove fatal in a matter of hours. Symptoms of poisoning in a child include dizziness, confusion, nausea, vomiting, and diarrhea. Seek medical help immediately.

Watch for side effects. You may need to continue taking iron supplements for up to one year. Taking iron supplements with food can help prevent common side effects, which may include nausea, diarrhea, constipation, and stomach pain. Let your doctor know if you continue to have side effects. Different formulations are available. Watch for drug interactions. Tell your doctor if you are being treated for another condition. For example, calcium supplements interfere with iron absorption so it is best to take them at different times of the day. Your doctor may also recommend that you increase the amount of iron in your diet. Good dietary sources of iron include red meat, beans, egg yolk, whole-grain products, nuts, and seafood. Many processed foods and milk are also reinforced with iron. Your doctor will monitor your red blood cell counts, including hematocrit, hemoglobin, and ferritin levels during treatment. If your anemia doesn't improve with iron supplements, your doctor will look for some other underlying cause. In rare cases, your doctor may prescribe iron injections or give you iron intravenously (through a needle in the vein). In extremely rare cases of life-threatening iron-deficiency anemia, treatment may involve a blood transfusion. For vitamin B-12 and folate deficiency anemia, the treatment depends on the cause of the deficiency. If your body stores are depleted of vitamin B-12, your doctor will most likely prescribe vitamin B-12 injections and may also recommend high doses of B-12 supplements or a B-12 nasal spray. There is a good chance that many of the symptoms of deficiency will improve once the body is provided with the needed B-12. Most people with vitamin B-12 deficiency have a permanent inability to absorb vitamin B-12 and will need injections every one to three months or pills daily for the rest of their lives. Some forms of gastric bypass surgery are associated with deficiencies of iron, vitamin B12, and other nutrients typically absorbed in the part of the stomach that is bypassed. Your doctor may also recommend that you increase the amount of vitamin B-12 in your diet. Good dietary sources of vitamin B-12 are meat, liver, and kidney; fish, oysters, and clams; and milk, cheese, and eggs. If you have a folate deficiency, your doctor will prescribe folate supplements and may recommend you increase the amount of folate in your diet. Good dietary sources of folate include fresh fruits, green leafy vegetables, cruciferous vegetables (cauliflower, broccoli, and brussel sprouts), liver and kidney, dairy products, and whole grain cereals. Vegetables should be eaten raw or lightly cooked. For anemia caused by problems of the bone marrow and stem cells, anemia tends to be more persistent and difficult to treat. The treatments for hereditary anemias, such as thalassemia or sickle cell disease, vary widely and depend on the specific condition and the severity of symptoms. Some anemias will not require any treatment while others may require repeated transfusions and other aggressive measures. Although aplastic anemia will occasionally go into spontaneous remission, people with this disorder generally require bone marrow transplantation. Anemia Caused by Increased Red Blood Cell Destruction -The treatment of hemolytic anemia will be tailored to the underlying cause. Mild cases of hemolytic anemia may not require any treatment at all. If an offending environmental agent can be identified -- a chemical, for example -- exposure to this agent should stop immediately. People with hemolytic anemia may need surgery to replace faulty heart valves, remove a tumor, or repair abnormal blood vessels. Supportive treatment -- like intravenous fluids and pain medication -- will often be given. A blood transfusion may be necessary in some cases. Steroids can halt the body's immune attack on its own red blood cells. Certain damaging factors can be removed from the blood by a treatment called plasmapheresis. If hemolytic anemia persists despite treatment, your doctor may recommend splenectomy --surgical removal of the spleen -- as a last resort. Most people can lead a normal life without their spleen. Gallbladder surgery may also be required if you have longstanding hemolytic anemia and symptoms of gallstones. Hemolytic anemia that damages the kidneys may make dialysis necessary. In extremely rare cases, bone marrow transplantation may be the only solution for certain types of hemolytic anemia. Sickle Cell Anemia Occasionally, children with sickle cell disease who have an appropriate donor may be cured by a bone marrow transplant. Alternatively, a drug called hydroxyurea appears to stimulate the formation of an alternate form of hemoglobin that isn't susceptible to the sickling, and may be used to reduce the frequency of bone pain crises. The bone pain can usually be eased with pain medications and the anemia may require transfusions

PHARMACOLOGIC MANAGEMENT:
Drug Type Erythropoietin Folic Acid Iron Effect A hormone normally produced by the kidney, which causes the bone marrow to produce red blood cells. A vitamin required by the bone marrow to produce effective red blood cells. A vitamin, which is a vital component of the hemoglobin molecule that allows it to carry oxygen in the blood.

Vitamin B12 A vitamin required by the bone marrow to produce effective red blood cells. Vitamin C A vitamin required by the bone marrow to produce effective red blood cells

NURSING MANAGEMENT:
1. Measure temperature of bath water with thermometer because anemia may cause poor circulation. 2. Provide blankets and warm clothing to increase comfort and aid circulation. 3. Notify physician if excessive vomiting, coughing or straining at stools occurs so that medication can be prescribed to alleviate symptom. 4. Avoid aspirin-containing products to prevent bleeding. 5. Avoid forceful blowing. 6. Avoid contact on gingival when brushing and flossing teeth. 7. Avoid situations in which trauma may occur, such as shaving with straight-edge razor, ambulating after taking medication that may cause orthostasis, or using sharp utensils. 8. Avoid purseful sexual intercourse and use adequate lubrication. 9. Avoid rectal thermometers, suppositories, and enemas. 10. Avoid heating pads or hot water bottles. 11. Iron salts are gastric irritants and should always be taken following meals. 12. Iron preparation taken on empty stomach cause dyspepsia, abdominal discomfort, and diarrhea 13. Liquid iron preparations should be well diluted and taken through a straw (undiluted liquid iron stains teeth). 14. Use of stool softeners or laxative to avoid PRN to avoid straining. 15.Ascorbic acid (Vitamin C) promotes iron absorption, thus iron preparations should be taken with orange juice. 16. Bowel movements will be black from excess iron excretion. 16. Iron supplements usually given for at least 6 months to restore body stores. 17. Keep skin clean and bedclothes dry. 18. Encourage diet high in protein, vitamins, and minerals. 19. Encourage cool, bland foods; flavored ices and ice cream are well tolerated. 20. Monitor Hb/Hct and assess whether other factors (e.g., nutritional deficiencies, fluid and electrolyte disorders, depression, etc.) are contributing to symptomatology. 21. Assess activity schedule and suggest daily activities that allow for rest periods. 22. Transfuse whole blood and packed red blood cells as ordered by physician.