Anemia

ANEMIA

Anemia refers to a deficit of red blood cells

(RBC) or hemoglobin in the blood resulting in
decreased oxygen-carrying capacity. It is the
most frequent hematologic disorder
encountered in children.
 Types
IRON DEFICIENCY ANEMIA:- a condition in
which there is a decreased number of circulating
hypochromic-microcytic erythrocytes which
is caused by an inadequate amount of available iron
for erythrocyte formation.
Pernicious Anemia:- a condition in which there is a
decreased number of circulating macrocytic-
normochromic erythrocytes which is caused by an
inadequate amount of vitamin B12.
Sickle cell disease is a severe, chronic, hemolytic
anemia occurring in persons who are homozygous
for the sickle gene. The clinical course is
characterized by episodes of pain due to the
occlusion of small blood vessels by sickled RBCs
 Etiology/Incidence
1. Blood loss related to:
a. Trauma and ulceration
b. Decreased production of platelets
c. Increased destruction of platelets
d. Decreased number of clotting factors
2. Impairment of RBC production
a. Nutritional deficiency
Iron deficiencymost common type of anemia
in all age groups; about 3% of all children
Folic acid deficiency
Vitamin B]2 deficiency
3. Decreased erythrocyte production
a. Pure RBC anemia
b. Secondary hemolytic anemia's associated with
chronic infection, renal disease, and drugs
c. Bone marrow depressionleukemia, aplastic anemias,
transient erythocytopenia of childhood
4. Increased erythrocyte destruction
Extrinsic factors
Drugs and chemicals
Infectionsparovirus
Antibody reactionspassively acquired antibodies against Rh,
A or B isoimmunization, autoimmune hemolytic anemia,
burns, poisons (including lead poisoning)
Intrinsic factors
Abnormalities of the RBC membrane
Enzymatic defectsglucose-6-phosphate dehydrogenase
deficiency (G6PD)
 Basic Physiology of Anemia
RBCs and hemoglobin are normally formed at the
same rate at which they are destroyed.
Whenever formation of RBCs or hemoglobin is decreased
or their destruction is increased, anemia results.
The ability of hemoglobin to carry oxygen to the tissues
and remove carbon dioxide for excretion by the lungs is
decreased.
In anemia of chronic infection and inflammation, the life
span of the RBC is moderately decreased and the ability of
the bone marrow to produce RBCs is significantly
decreased. (This is the principal factor in determining the
degree of anemia.)
 Hemolytic anemia's:
a. The RBCs are destroyed at abnormally high rates
primarily by the spleen.
b. The activity of the bone marrow increases to compensate
for the shortened survival time of the RBCs.
c. Bone marrow hypertrophies and occupies a larger than
normal share of the inner structure of bones.
d. Products of RBC breakdown increase with hemolysis.
e. Jaundice results when the liver is unable to clear
the blood of the pigment resulting from the breakdown of
hemoglobin from destroyed RBCs.
f. Iron builds up (hemosidcrosis) and may deposit on body
tissues.
 Clinical manifestations
Condition may be acute or chronic
Early symptoms
a. Listlessness
b. Fatigability
c. Anorexia related to decreased energy
Late symptoms
a. Pallor
b. Weakness
c. Tachycardia
d. Palpitations
e. Tachypnea; shortness of breath on exertion
f. jaundice (with hemolytic anemias)
 Diagnostic Evaluation
Complete blood count (CBC)
Serum iron and total iron-binding capacityratio
of less than 0.2
Serum ferritin-less than 12 ^gm/dL
B12, B6, folate levelsmay be decreased
Hemoglobin & hematocrit
Bone marrow biopsy
 Treatment
Iron Deficiency Anemia
Oral iron at a dose of 6 mg elemental iron per
kilogram per day given between meals
Dietary: decrease milk intake to 16 oz/day;
include iron-fortified cereals and bread products;
increase consumption of red meat.
Rarely is iron given intramuscularly at present
due to high incidence of allergic reactions. If
administered intramuscularly, it is given by Z-
track method.
Megaloblastic Anemia
Folate deficiencyadministration of folic acid
orally
B12 deficiencyadministration of B12
(cyanocobalamin [Cyanoject]) intramuscularly
For hemoglobin's of under 5 gm or cardiac
failure, usually a transfusion of packed RBCs
Unless there is cardiac failure, there is usually no
therapy, but supportive care is provided.
 Nursing Assessment
1. Obtain history of potential causes.
a. Dietary history including the amount of milk and meat consumed
b. Medications
c. Persistent infection, fever, or chronic disease
d. Exposure to drugs, poisons, etc.
e. Picacraving and consuming nonfood items (i.e, pencil; chips, ice, paper,
etc.)
2. Obtain a baseline assessment.
a. Observe skin and mucous membranes for pallor.
b. Obtain height and weight and plot on growth curve.
c. Measure vital signs including blood pressure.
d. Assess child's functional levellevel of exercise tolerance, mental
functioning.
e. Assess attainment of developmental milestones.
Observe for fatigue, listlessness, irritability, etc.
Observe for blood loss: bruising, bleeding, hematuria,
hematochezia (blood in stool).
 Nursing Diagnosis

A. Fatigue related to decreased ability of blood to trans

port oxygen to the tissues
B. Altered Nutrition (Less than Body Requirements) of
recommended daily dietary allowances
C. Risk for Infection related to debilitated state
D. Anxiety related to hospitalization and painful
diagnostic procedures (venipunctures, finger sticks,
etc.)
E. Altered Growth and Development related to decreased
energy