ANEMIA

Anemia is one of This can lead to

the more common health problems
blood disorders that because RBCs
occurs when the contain
hemoglobin, which
level of healthy red
carries oxygen to the
blood cells (RBCs)
body's tissues.
in the body
Anemia can cause a
becomes too low. variety of
complications,
including fatigue and
stress on bodily
Anemia organs.
 Low blood
Anemia is simply a hemoglobin level
lower than the normal range for a
particular age and sex of the patient.
Most common hematologic disorder by far

Anemia
03/18/17
 Hb RBC
Males 120 160g/L (4.0-5.5)x 1012/L
Females 110 150g/L (3.5-5.0)x 1012/L
Neonates 170 200g/L (6.0-7.0)x 1012/L

The normal range for Hb and RBC

 Based on general mechanisms
Morphological classification

Anemia classification
 Microcytic

Normocytic

Macrocytic

Anemia: morphological classification

Normal Red Blood Cells - Peripheral Blood Smear

03/18/17
Normal Red Blood Cells
9
TYPE CAUSE

Sickle Cell Autosomal recessive inheritance of two defective

Disease genes for hemoglobin synthesis

G6PD X-linked recessive inherited deficiency of the

Deficiency enzyme glucose-6-phosphate dehydrogenase

Autoimmune Abnormal immune function; immune reactive cells

Hemolytic fail to recognize own blood cells as self cells

Iron Inadequate iron intake (iron deficient diet, chronic

Deficiency alcoholism, malabsorption syndromes, partial
gastrectomy);
Or rapid metabolic activity (pregnancy,
adolescence, infection)
TYPE CAUSE

Vitamin B12 Dietary deficiency

Failure to absorb vitamin B12 from intestinal tract (partial
Deficiency
gastrectomy, pernicious anemia)

Folic Acid Dietary deficiency

Deficiency Malabsorption syndromes
Drugs (Oral contraceptives, anticonvulsants,
methotrexate)

Aplastic Anemia Exposure to myelotoxic agents

(radiation, benzene, chloromycetin, alkylating agents,
anti-metabolities, sulfonamides, insecticides)
Viral Infections [unproven]
(Epstein-Barr virus, hepatitis B, cytomegalovirus)
 Blood loss can also Anemia sometimes
cause anemia -
whether it's because of
excessive bleeding due
to injury, surgery, or a
problem with the
blood's clotting ability.
Slower, long-term blood
loss, such as intestinal
bleeding from
inflammatory bowel
disease (IBD), can also
cause anemia.
results from heavy
menstrual periods in
teen girls and women.
Any of these factors
will also increase the
body's need for iron
because iron is needed
to make new RBCs.

Anemia caused by
blood loss
 Clinical
Causes manifestations
Hemorrhage
Decreased RBCs, Hgb,
Hct, MCV, and MCHC;
fatigue

Anemia caused by
blood loss - Acute
Causes
Gastrointestinal or other Clinical
malignancy manifestations
Bleeding ulcers Early: weakness, cool moist
Bleeding hemorrhoids skin, tachycardia,
hypotension
Hypermenorrhea
Late: decreased hgb and hct

Anemia caused by
blood loss - Chronic
Management
Immediate identification Space clients activities
of the source of loss and and allowing frequent
institution of appropriate
treatment rest periods to optimize
Transfusion therapy limited energy reserves
(severe symptoms only)
Iron supplements
Instruct clients to eat
food rich in iron and
vitamins

Anemia caused by
blood loss
 A disorder characterized
by bone marrow
hypoplasia or aplasia
resulting in pancytopenia
Characterized by
cessation of activity of all
blood-forming elements
Aplastic Anemia
Destruction of hematopoietic
stem cells is thought to be an
immune-mediated mechanism
Idiopathic or caused by
exposure to chemical toxins;
ionizing radiation; viral
infections; certain drugs
May be congenital
Clinical
manifestations
Anemia pallor,
weakness, fatigue,
exertional dyspnea, Thrombocytopenia
palpitations bleeding from gums,
Infections associated nose, gastrointestinal or
with neutropenia fever, genitourinary tracts,
headache, malaise,
adventitious breath purpura, petechiae,
sounds, abdominal pain, ecchymoses
diarrhea, erythema, pain,
exudate at wounds or
sites of invasive
procedure

Aplastic Anemia
Diagnostics
CBC
Peripheral blood smear
Bone marrow aspiration
and biopsy
Medical Management
Allogeneic bone marrow
transplantation treatment of
choice for severe aplastic anemia
Immunosuppressive therapy
Androgen therapy
Platelet and RBC transfusion
Antibiotics and antifungals

Aplastic Anemia
Nursing
Management
Observe strict
handwashing
Encourage good personal
hygiene daily shower or
bath with mild soap,
mouth care, and perirectal Use only soft toothbrush for mouth
care after using the toilet care and electric razor for shaving
Monitor vital signs Keep nails short
frequently Avoid intramuscular injections and
Minimize invasive other invasive procedures
procedures or possible Prevent constipation by use of
trauma to skin or mucous stool softeners
membranes
Restrict activity based on platelet
count and active bleeding

Aplastic Anemia
Nursing
Management
Monitor pad count for
menstruating women
Avoid use of vaginal
tampons
Administer blood
products as ordered

Aplastic Anemia
Hemo" means blood, "lytic"
means destroying

Occurs when red blood cells

are being destroyed The bone marrow simply can't keep
prematurely. up with the body's demand for new
cells.

RBCs have much shorter This can happen for a variety of

lifespan. reasons. Sometimes, infections or
certain medications - such as
antibiotics or anti-seizure medicines -
are to blame.

Hemolytic Anemia
Hemolysis can
occur:

1. Extravascularly
Autoimmune Hemolytic
Anemia
Hereditary Spherocytosis

2. Intravascularly
Enzyme Deficiency
Anemia
Sickle Cell Disease

Hemolytic Anemia
 3. Drug-induced
1/5 of hemolytic anemias
Classifications: Methyldopa, penicillin,
1.Warm-reacting quinine, quinidine
Idiopathic
Commonly seen in women
Associated diseases SLE,
rheumatoid arthritis, CLL,
myeloma
2.Cold-reacting
Less common
Affects mostly older adults
women
Associated diseases
Reynauds phenomenon,
mononucleosis, mycoplasma

Hemolytic Anemia
pneumoniae, Epstein-Barr virus,
mumps, Legionnaires disease

Autoimmune Hemolytic Anemia

Diagnostics:
1.Coombs test
2.Blood test

Medical Management:
Administer cortecosteroids or
danzol (Cyclomen)
Splenectomy
Plasmapheresis
Transfusions
Nursing Management:
Teaching client on drug therapy
Prepare patient for surgery if
indicated
Help client and family cope with

Hemolytic Anemia
illness
Avoid exposure to cold

Autoimmune Hemolytic Anemia

Direct and Indirect Coombs Tests
 Most common problem of
alteration in erythrocyte
shape
Affects all races and both
genders equally
Inherited autosomal
dominant
Characterized by membrane
abnormality that leads to
osmotic swelling of the RBC
Clinical manifestations:
Pallor
Fatigue
Exertional dyspnea
Jaundice
Enlarged spleen
Diagnostic:
Peripheral blood smear
Radioactive chromium to

Hemolytic Anemia
and susceptibility to
destruction by spleen
determine RBC survival time

Hereditary Spherocytosis
Medical management:
Splenectomy
Pneumoccocal and
haemophilus influenzae Nursing management:
vaccines are given
before splenectomy Careful monitoring on
signs of infection and
anemia
Wound management if
client underwent
splenectomy
Genetic counseling
Teach client energy
conservation techniques

Hemolytic Anemia
Hereditary Spherocytosis
Glucose-6-phosphate
dehydrogenase (G6PD)
deficiency
Most commonly affects men of
African heritage
With this condition the RBCs either
do not make enough of the enzyme
G6PD (the enzyme responsible for
the antioxidant reactions in RBC)
or the enzyme that is produced is
abnormal and doesn't work well.
Hemolytic Anemia
Enzyme Deficiency
When someone born with
this deficiency has an
infection, takes certain
medicines, or is exposed to
specific substances, the
body's RBCs suffer extra
stress.
Without adequate G6PD to
protect them, many red
blood cells are destroyed
prematurely.
Causes:
Exposure to oxidizing
agents
Viral or bacterial infection
Exposure to oxidant drugs
antimalarials,
antipyretics, sulfonamides,
quinidine, vitamin K
derivatives
Hemolytic Anemia
Enzyme Deficiency
When someone born with
this deficiency has an
infection, takes certain
medicines, or is exposed to
specific substances, the
body's RBCs suffer extra
stress.
Without adequate G6PD to
protect them, many red
blood cells are destroyed
prematurely.
 PRECIPITATING FACTORS
Antimalarials: primaquine, quinine, chloroquine
Antibiotics: nitrofuantoin, furazolidine,
cotrimoxazole, Nalidixic acid,
Chloramphenicol,
Others:
Vitamin K large doses
Naphthalene (moth balls)
Benzene, Methylene blue
Probenecid
Acetyl salicylic acid (aspirin)
Fava beans
Septicemia and viral hepatitis in def. pts
Diabetic ketoacidosis
FAVA BEANS
Diagnosis: Clinical manifestations:
Laboratory confirmation of Jaundice
the lack of G6PD enzyme
Back pain
Hemoglobinuria

Hemolytic Anemia
Enzyme Deficiency
Medical management:
Based on recognition of
Nursing management:
the disorder and cessation Teaching client and
of offending drugs family to avoid offending
drugs
Hydration
Blood transfusion

Hemolytic Anemia
Enzyme Deficiency
SICKLE CELL
ANEMIA
 Sickle cell anemia is a serious disease in which the
body makes sickle-shaped red blood cells.
Sickle-shaped means that the red blood cells are
shaped like a "C."
Normal red blood cells are disc-shaped and look like
doughnuts without holes in the center. They move
easily through your blood vessels. Red blood cells
contain the protein hemoglobin. This iron-rich
protein gives blood its red color and carries oxygen
from the lungs to the rest of the body.

What Is Sickle Cell

Anemia?
 Sickle cells contain abnormal hemoglobin that
causes the cells to have a sickle shape. Sickle-
shaped cells dont move easily through your blood
vessels. Theyre stiff and sticky and tend to form
clumps and get stuck in the blood vessels.
The clumps of sickle cells block blood flow in the
blood vessels that lead to the limbs and organs.
Blocked blood vessels can cause pain, serious
infections, and organ damage.

What Is Sickle Cell

Anemia?
What Is Sickle Cell
Anemia?
 Sickle cell anemia is one type of anemia. Anemia is a
condition in which your blood has a lower than normal
number of red blood cells. This condition also can occur
if your red blood cells dont have enough hemoglobin.
Red blood cells are made in the spongy marrow inside
the large bones of the body. Bone marrow is always
making new red blood cells to replace old ones. Normal
red blood cells last about 120 days in the bloodstream
and then die. They carry oxygen and remove carbon
dioxide (a waste product) from your body.

Overview
 In sickle cell anemia, a lower-than-normal number of
red blood cells occur because sickle cells dont last
very long. Sickle cells usually die after only about 10
to 20 days. The bone marrow cant make new red
blood cells fast enough to replace the dying ones.
Sickle cell anemia is an inherited, lifelong disease.
People who have the disease are born with it. They
inherit two copies of the sickle cell geneone from
each parent.

Overview
 People who inherit a sickle cell gene from one
parent and a normal gene from the other parent
have a condition called sickle cell trait. Sickle cell
trait is different from sickle cell anemia. People who
have sickle cell trait dont have the disease, but they
have one of the genes that cause it. Like people
who have sickle cell anemia, people who have
sickle cell trait can pass the gene to their children.

Overview
 Sickle cell anemia is an inherited disease. People
who have the disease inherit two copies of the sickle
cell geneone from each parent.
The sickle cell gene causes the body to make
abnormal hemoglobin. Hemoglobin is the iron-rich
protein that gives blood its red color and carries
oxygen from the lungs to the rest of the body.

What Causes Sickle Cell

Anemia?
 In sickle cell anemia, the hemoglobin sticks together
when it delivers oxygen to the bodys tissues. These
clumps of hemoglobin are like liquid fibers. They
cause the red blood cells to become stiff and
shaped like a sickle, or C. The sickled red blood
cells tend to stick together and get caught in the
blood vessels.
Two copies of the sickle cell gene are needed for
the body to make the abnormal hemoglobin found in
sickle cell anemia.

What Causes Sickle Cell

Anemia?
 If you inherit only one copy of the sickle cell
gene (from one parent), you will not have
sickle cell anemia. Instead, you will have
sickle cell trait.
People who have sickle cell trait usually
have no symptoms and lead normal lives.
However, they can pass the sickle cell gene
to their children.

Sickle Cell Trait

 Example of an
Inheritance Pattern for
Sickle Cell Trait
 Most common in people whose families come from
Africa, South or Central America (especially
Panama), Caribbean islands, Mediterranean
countries (such as Turkey, Greece, and Italy), India,
and Saudi Arabia.

Who Is At Risk for Sickle

Cell Anemia?
 The signs and symptoms of sickle cell anemia vary.
Some people have mild symptoms. Others have
very severe symptoms and often are hospitalized for
treatment.
Sickle cell anemia is present at birth, but many
infants dont show any signs until after 4 months of
age.

What Are the Signs and Symptoms

of Sickle Cell Anemia?
Signs and Symptoms Related to Anemia
The most common symptom of anemia is fatigue (feeling
tired or weak). Other signs and symptoms of anemia
include:
Shortness of breath
Dizziness
Headache
Coldness in the hands and feet
Pale skin
Chest pain

What Are the Signs and Symptoms

of Sickle Cell Anemia?
Signs and Symptoms Related to Pain
Sudden pain throughout the body is a common
symptom of sickle cell anemia. This pain is called a
"sickle cell crisis. Sickle cell crises often affect the
bones, lungs, abdomen, and joints.
A sickle cell crisis occurs when sickled red blood cells
form clumps in the bloodstream. These clumps of cells
block blood flow through the small blood vessels in the
limbs and organs. This can cause pain and organ
damage.

What Are the Signs and Symptoms

of Sickle Cell Anemia?
Hand-Foot Syndrome
Sickle cells can block the small blood vessels in the
hands or feet. It can lead to pain, swelling, and fever.
One or both hands and/or feet may be affected at the
same time.

Complications of Sickle
Cell Anemia
Splenic Crisis
The spleen is an organ in the abdomen. Normally, it
filters out abnormal red blood cells and helps fight
infection. In some cases, the spleen may trap cells
that should be in the bloodstream. This causes the
spleen to grow large and leads to anemia.

Complications of Sickle
Cell Anemia
Acute Chest Syndrome
Acute chest syndrome is a life-threatening condition
linked to sickle cell anemia. Its similar to pneumonia.
The condition is caused by an infection or sickle cells
trapped in the lungs.

Complications of Sickle
Cell Anemia
Priapism
Males who have sickle cell anemia may have painful
and unwanted erections. This condition is called
priapism. It happens because the sickle cells block
blood flow out of an erect penis. Over time, priapism
can damage the penis and lead to impotence.

Complications of Sickle
Cell Anemia
Multiple Organ Failure
Multiple organ failure is rare, but serious. It happens if
you have a sickle cell crisis that causes two out of
three major organs (lungs, liver, or kidney) to fail.
Symptoms are fever and changes in mental status -
sudden tiredness and loss of interest in surroundings

Complications of Sickle
Cell Anemia
 Early diagnosis of sickle cell anemia is very
important. Children who have the disease need
prompt and proper treatment.
The test uses blood from the same blood samples
used for other routine newborn screening tests. It
can show whether a newborn infant has sickle cell
anemia or sickle cell trait.

How Is Sickle Cell Anemia

Diagnosed?
 Sickle cell anemia has no widely available cure.
However, treatments can help relieve symptoms and
treat complications. The goals of treating sickle cell
anemia are to relieve pain; prevent infections,
eye damage, and strokes; and control
complications (if they occur).
Bone marrow transplants may offer a cure in a
small number of sickle cell anemia cases.
Researchers continue to look for new treatments for
the disease. These include gene therapy and
improved bone marrow

How Is Sickle Cell Anemia

Treated?
Bone Marrow Transplant
A bone marrow transplant can work well for treating
sickle cell anemia. This treatment may even offer a
cure in a small number of cases.
However, the procedure is risky and can lead to
serious side effects or even death. Because of this,
only some people can or should have this procedure.

How Is Sickle Cell Anemia

Treated?
Gene Therapy
Gene therapy is being studied as a possible
treatment for sickle cell anemia. Researchers want to
know whether a normal gene can be put in the bone
marrow of a person who has sickle cell anemia. This
would cause the body to make normal red blood cells.
Researchers also are studying whether they can "turn
off" the sickle cell gene or "turn on" a gene that makes
red blood cells behave normally.

How Is Sickle Cell Anemia

Treated?
Researchers are studying several new medicines for
sickle cell anemia. These include:
Butyric acid. This is a food additive that may increase
normal hemoglobin in the blood.
Nitric oxide. This medicine may make sickle cells less
sticky and keep blood vessels open. People who have
sickle cell anemia have low levels of nitric oxide in their
blood.
Decitadine. This medicine increases hemoglobin F levels
(this type of hemoglobin carries more oxygen). It may be a
good choice instead of hydroxyurea.

How Is Sickle Cell Anemia

Treated?
 You can't prevent sickle cell anemia because its an
inherited disease. However, you can take steps to
reduce its complications.
People who are at high risk for sickle cell anemia
and are planning to have children may want to
consider genetic counseling. A counselor can help
you understand your risk of having a child who has
the disease and help explain the choices that are
available to you.

How Can Sickle Cell

Anemia Be Prevented?
Thalassemia is a blood disorder
passed down through families
(inherited) in which the body
makes an abnormal form of
hemoglobin, the protein in red
blood cells that carries oxygen.
The disorder results in excessive
destruction of red blood cells,
which leads to anemia.
Characterized by a decreased
synthesis of one of the globin
chains of hgb.
Types:
Alpha thalassemia - occurs
when a gene or genes related
to the alpha globin protein are
missing or changed (mutated).
Beta thalassemia - occurs
when similar gene defects
affect production of the beta
globin protein.

Hemolytic Anemia
Thalassemia
 Alpha thalassemias -
Southeast Asia, the Middle
East, China, and in those of
African descent
Beta thalassemias -
Mediterranean origin, and to
a lesser extent, Chinese,
other Asians, and African
Americans
Hemolytic Anemia
Thalassemia
Forms:
Major/Cooleys anemia
Homozygous
Severe anemia, low
MCHC (hypochromic),
low MCV (microcytic)
Needs blood transfusion
Minor
Heterozygous
Mild anemia, usually
asymptomatic
Risk factors: Clinical manifestations:
Asian, Chinese, Causes stillbirth
Mediterranean, or African Bone deformities in the face
American ethnicity Fatigue
Family history of the Growth failure
disorder SOB
Yellow skin (jaundice)

Hemolytic Anemia
Thalassemia

Growth failure begins between
10-12 years.
Death usually occurs during the
young adult years, between 17-30
years.
Diagnostics:
CBC
Hemoglobin electrophoresis
Medical management:
Transfusion therapy with
chelation therapy
BMT children less than 5
years old
Splenectomy
Nursing management:
Be sensitive to emotional
needs of clients receiving
transfusion
Be aware that hopelessness
and depression may occur at
age of onset
Refer couples for genetic
counseling

Hemolytic Anemia
Mutational analysis

Thalassemia

Iron is an important building
block for red blood cells.
When your body does not
have enough iron, it will
make fewer red blood cells
or red blood cells that are
too small. This is called iron
deficiency anemia.
Iron Deficiency Anemia
Iron deficiency anemia is
the most common form
of anemia.
Body has 4 g of iron:
- 3 g in hgb
- 500mg-1g in liver and marrow
- Rest is found in certain tissues
and enzyme systems
The body normally gets iron
through diet and by re-using
iron from old red blood cells.

Causes:
lose more blood cells and iron
than body can replace
body does not do a good job of
absorbing iron
body is able to absorb iron, but
not eating enough foods
containing iron
body needs more iron than
normal (pregnant or breastfeeding)
Iron Deficiency Anemia
Iron loss due to bleeding:
Heavy, long, or frequent
menstrual periods
Cancer in the esophagus,
stomach, or colon
Esophageal varices
Use of aspirin, ibuprofen, or
arthritis medicines for a long
time, which can cause
gastrointestinal bleeding
PUD
 Not enough iron in the
The body may not diet:
absorb enough iron in strict vegetarian
the diet due to: older adult and not eating a full
Celiac disease diet
Crohns disease
Gastric bypass surgery
Taking too many antacids that
contain calcium

Iron Deficiency Anemia

Clinical manifestations:
Mild
Feeling grumpy Severe
Feeling weak or tired more Blue color to the whites of the eyes
Brittle nails
often than usual, or with
Light-headedness when you stand
exercise up
Headaches Pale skin color
Problems concentrating or SOB
thinking Sore tongue

Iron Deficiency Anemia

Diagnostics: Medical management:
Hematocrit and hemoglobin (red blood Determine and correct cause of IDA
cell measures) initial step
RBC indices Oral iron supplementation
Bone marrow exam (rare)
Iron binding capacity (TIBC) in the blood Nursing management:
Serum ferritin
Instruct client to take iron after meals
Serum iron level and with orange juice or vitamin C
Colonoscopy Tell patient that stool may be black or
Fecal occult blood test
tarry
Upper endoscopy
If client cant tolerate oral iron,
parenteral injection is recommended

Iron Deficiency Anemia

Vitamin B12 deficiency anemia
is a low red blood cell count due
to a lack of vitamin B12.
Causes:
Dietary factors
Eating a vegetarian diet
Poor diet in infants
Poor nutrition during
pregnancy
Megaloblastic / Macrocytic Anemia
Vitamin B12 Deficiency
Health conditions
Chronic alcoholism
Crohn's disease, celiac
disease, infection with the fish
tapeworm, or other problems
that make it difficult for your
body to digest foods
Pernicious anemia, a type of
vitamin B12 anemia that occurs
when your body destroys cells
that make intrinsic factor

Causes:
Health conditions
Pernicious anemia, a type of
vitamin B12 anemia that occurs
when your body destroys cells
that make intrinsic factor
Surgeries that remove certain
parts of stomach or small
intestine
Taking antacids and other
heartburn medicines for a long
period of time
Megaloblastic / Macrocytic Anemia
Vitamin B12 Deficiency
Clinical manifestations:
Diarrhea or constipation
Fatigue, lack of energy, or light-
headedness when standing up
or with exertion
Loss of appetite
Pale skin
Problems concentrating
Shortness of breath, mostly
during exercise
Swollen, red tongue or bleeding
gums
 Diagnostics:
Clinical manifestations: CBC
Nerve damage
Reticulocyte count
Confusion or change in mental
Vitamin B12 level
status (dementia) in severe
EGD
cases
Enteroscopy
Depression
Bone marrow biopsy
Loss of balance
Numbness and tingling of
hands and feet

Megaloblastic / Macrocytic Anemia

Vitamin B12 Deficiency
Management:
Parenteral vitamin B12
administration
Oral supplementation

Megaloblastic / Macrocytic Anemia

Vitamin B12 Deficiency
 In folate-deficiency anemia, the
red blood cells are abnormally
large. Such cells are called
Folate-deficiency anemia is a megalocytes. They are also
decrease in red blood cells due called megaloblasts. They are
to a lack of folate. seen in the bone marrow. This is
why this anemia is also called
Folate (folic acid) is needed for megaloblastic anemia.
red blood cells to form and
grow. Folate is taken by the
body by eating green leafy
vegetables and liver. However,
body does not store folate in
large amounts. So eat plenty of
folate-rich foods to maintain
Megaloblastic / Macrocytic Anemia
normal levels of this vitamin.

Folic Acid Deficiency

Risk factors: Causes:
Alcoholism Too little folic acid in diet
Eating overcooked food Hemolytic anemia
Poor diet Long-term alcoholism
Pregnancy Use of certain medications
- Phenytoin (Dilantin)
- Methotrexate
- Sulfasalazine
- Triamterene
- Pyrimethamine
- Trimethoprim-sulfamethoxazole
- Barbiturates

Megaloblastic / Macrocytic Anemia

Folic Acid Deficiency
Clinical manifestations: Diagnostics:
Fatigue CBC
Headache Red blood cell folate level
Pallor Bone marrow examination
Sore throat and tongue (rare)

Megaloblastic / Macrocytic Anemia

Folic Acid Deficiency
Management:
Oral folic acid
- Daily requirements (100-200mg)
- 1mg of folic acid/day for 3
months
Well-balanced diet
Provide food sources of folic
acid and instructions on proper
preparation
- Organ meats
- Eggs
- Cabbage, broccoli
- Citrus fruits
- Brussels sprouts
Megaloblastic / Macrocytic Anemia
Folic Acid Deficiency
Anemia of chronic disease is
anemia that is found in people
with certain long-term (chronic)
medical conditions.
Certain chronic infections,
inflammatory diseases, and
other illnesses can affect the
body's ability to produce red
blood cells.
Anemia of Chronic Disease
Conditions that can lead to
ACD:
Autoimmune disorders, such
as Crohn's
disease, SLE, rheumatoid arthritis,
and ulcerative colitis
Cancer, including lymphoma
and Hodgkin's disease
CKD
Liver cirrhosis
Long-term infections, such
as bacterial
endocarditis, osteomyelitis,
HIV/AIDS, hepatitis B or hepatitis C
Clinical manifestations: Diagnostics:
Feeling weak or tired Hemoglobin level
Headache Red blood cell count
Paleness Reticulocyte count
SOB Serum ferritin
Serum iron

Anemia of Chronic Disease

Medical Management: Nursing Management:
Iron supplementation Allow frequent rest periods to
Blood transfusion (rare) avoid fatigue
Maximize periods of high
energy

Anemia of Chronic Disease

Polycythemia vera is a disorder
of the bone marrow.
It mainly causes too much
production of red blood cells,
although the numbers of white
blood cells and platelets are
also increased.
Erythrocytosis
Polycythemia Vera
It is a rare disease that occurs
more often in men than women,
and is rare in patients under
age 40.
It is usually associated with a
gene mutation called
JAK2V617F. The cause of this
mutation is unknown.
 Red coloring, especially of the
Clinical manifestations: face
Difficulty breathing when lying Shortness of breath
down Symptoms of phlebitis
Dizziness Bluish skin color
Excessive bleeding Fatigue
Fullness in the left upper Red skin spots
abdomen (due to enlarged Vision problems
spleen)
Headache
Itchiness, especially after a
warm bath

Erythrocytosis
Polycythemia Vera

Diagnostics:
Bone marrow biopsy
Complete blood
count with differential
Comprehensive metabolic
panel
Erythropoietin level
Genetic test for the
JAK2V617F mutation
Oxygen saturation of the blood
Red blood cell mass
Erythrocytosis
Vitamin B12 level
Polycythemia Vera
Medical Management:
The goal of treatment is to
reduce the thickness of the
blood and prevent bleeding
and clotting.
Phlebotomy
Aimed at maintaining hct and hgb
at normal levels
1 unit of blood is removed weekly
Use of alkylating agents
hydroxyurea
Use of radioactive phosphorus
Use of interferon to lower
blood counts
END