ANEMIA IN ENGLISH

                                              

                                            ANEMIA  IN ENGLISH

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ANAEMIA-

            Anaemia is not a specific disease. It is a clinical syndrome of a lot of underlying disorders. It is characterized by lower number of normal RBCs in blood and less than normal hemoglobin level. As a result, the amount of oxygen delivered to body tissues is also diminished.

CLASSIFICATION/CAUSES OF ANEMIA-

Ø  Anemias are classified in many ways. Depending causes anemias are classified into 3 types-

Ø  Hypo proliferative anemia.-

Ø  In hypo-proliferative anemias, the marrow cannot produce adequate numbers of erythrocytes. Inadequate production of erythrocytes may result from

Ø  Bone marrow damage may be due to some medications, chemicals  or from a lack of factors which are necessary for erythrocyte formation such as iron, vitamin B12, folic acid, erythropoietin

Ø  Hemolytic anemia.

Ø  In hemolytic anemias, there is increased destruction of RBCs. The increased erythrocyte destruction results in decreased hemoglobin in blood and tissue hypoxia.

Ø  Hemolysis can result from an abnormality within the erythrocyte itself such as sickle cell anemia or due to glucose-6-phosphate dehydrogenase [G-6-PD] deficiency  

Ø  abnormality within the plasma (eg, immune hemolytic anemias),or from direct injury to the erythrocyte within the circulation

Ø  Anemia due to blood loss.

Ø  In this type of anemias number of RBCs reduced due to heavy bleeding of any reason such as-

Ø  Bleeding from gastrointestinal tract,

Ø  Intestinal parasites (worm infestation)

Ø  Epistaxis (nosebleed),

Ø  Trauma (accidents)

Ø  bleeding from genitourinary tract (menorrhagia)

Ø  Depending upon level  of  hemoglobin anemias are of 3 types-

Ø  Normal  level of Hb ranges from

Ø   14-18 g/dl for men and 12-16 g/dl for  women

Ø  Mild anemia ( level decreases to 10 g/dl)

Ø  Moderate anemia. (Hb  level  8 to 9.9 g/dl)

Ø  Severe anemia. (Hb  level 7.9 g/dl and less)

 

CLINICAL MANIFESTATIONS-

Ø  Mostly patient remains asymptomatic in mild to moderate anemia. Symptoms may include-

Ø  Fatigue

Ø  Pain in bones chest and joints

Ø  Shortness of breath

Ø  Dizziness

Ø  Tachycardia

Ø  Weakness

Ø  Pallor skin and mucus membrane

Ø  Pallor nails

Ø  Cold hand and feet

DIAGNOSTIC INVESTIGATIONS-

Ø  History taking and Physical examination. (presence of clinical manifestations of anemia)

Ø  Complete blood count and Hemoglobin

Ø  Reticulocyte count

Ø  S. Iron level and total iron binding capacity

Ø  S. vitamin b 12 and folic acid levels

Ø  Stool examination for occult blood/ova & cyst.

TREATMENT-

Ø  Management of anemia depends upon underlying cause of the anemia.

Ø  For Iron deficiency anemia iron preparations such as ferrous sulfate, ferrous gluconate, and ferrous fumarate are prescribed. In the situations hen oral iron is not absorbed properly, IV or, infrequently, intramuscular (IM) administration of iron may be needed. Diet modification may be advised.

Ø  Aplastic anemia may be managed with immunosuppressive therapy such as a combination of anti-thymocyte globulin (ATG) and cyclosporine or by a bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT).

Ø  Folate deficiency is treated by increasing the amount of folic acid in the diet and administering 1 mg of folic acid daily

Ø  Vitamin B12 deficiency (megaloblastic anemia) is treated by vitamin B12 replacement (monthly IM injections of vitamin B12 are prescribed)

Ø  Sickle cell anemia may be treated with Peripheral Blood Stem Cell Transplant.

Ø  If the cause of anemia is worm infestations than anthelmentics are prescribed.

Ø  For blood loss anemias cause is identified and treated such as treatment of ulcers, treatment of piles etc. surgery may be needed for theses disorders.

Ø   In severe anemia Blood transfusion may be prescribed to increase hemoglobin level.

 

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history, diet history and physical examination and a nursing care plan is prepared.

Ø  The nurse should focus on assisting the patient to prioritize activities and to establish a balance between activity and rest that is acceptable to the patient, to reduce fatigue.

Ø  Patients with chronic anemia should be encouraged to maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.

Ø  Dietary teaching sessions should be individualized, involve family members, and include cultural aspects related to food preferences and food preparation to prevent nutritional anemia.

Ø  The nurse should inform the patient that alcohol interferes with the utilization of essential nutrients and should advise the patient to avoid or limit his or her intake of alcohol.

Ø  The patients and relatives should be informed that not all anemias are associated with iron deficiency so that indiscriminate use of iron preparations is prevented.

Ø  Patients with acute blood loss or severe hemolysis may have decreased tissue perfusion from decreased blood volume so nurse should prepare for (IV) fluids or plasma expenders.

Ø  Patient with severe anemia may require oxygen inhalation therapy to prepare and start oxygen inhalation as prescribed by physician

Ø  The nurse monitors the patient’s vital signs and pulse oximeter readings closely and records in the nurses record and notify physician if necessary.

Ø  During discharge planning the patient is educated to adhere to drug therapy and diet modification plans and visit health center for follow up care.