Our Lady of Fatima University

C O L L E G E OF N U R S I N G

ANEMIA
In Partial Fulfillment of the Requirements for NCM 105 RLE

A case study presented to:

Ma’am Potenciana A. Maroma, RN, PhD

Submitted By:
Andrea Patrice F. Custodio
Introduction
Anemia is defined as a low number of red blood cells. In a routine blood test, anemia is
reported as a low hemoglobin or hematocrit. Hemoglobin is the main protein in red blood
cells. It carries oxygen, and delivers it throughout the body. If the patient have anemia,
hemoglobin level will be low too. If it is low enough, the tissues or organs may not get
enough oxygen. Symptoms of anemia, like fatigue or pain, happen because organs aren't
getting what they need to work the way they should.
Symptoms:

Anemia signs and symptoms vary depending on the cause. If the anemia is caused by a
chronic disease, the disease can mask them, so that the anemia might be detected by tests
for another condition.

Depending on the causes of anemia, patient might have no symptoms. Signs and
symptoms, if occur, might include:

 Fatigue
 Weakness
 Pale or yellowish skin
 Irregular heartbeats
  Shortness of breath
 Dizziness or lightheadedness
 Chest pain
 Cold hands and feet
 Headaches

Symptoms worsen as anemia worsens.

Decreased or impaired RBCs

Bone marrow is soft, spongy tissue at the center of bones, and it plays an essential role in
creating RBCs. The marrow produces stem cells, which develop into RBCs, white blood
cells, and platelets. A number of diseases can affect bone marrow, including leukemia.
This is a type of cancer that triggers the production of excessive and abnormal white
blood cells, disrupting the production of RBCs.

In some cases, anemia results when RBCs do not grow and mature as usual, as with
thalassemia — a hereditary form of anemia, in which the body makes an abnormal form
or inadequate amount of hemoglobin.  The disorder results in large numbers of red blood
cells being destroyed, which leads to anemia.
Types:

Some forms of anemia cause specific symptoms, including:

 Aplastic anemia: causes a deficiency of all blood cell types: red blood cells, white
blood cells, and platelets.
 Vitamin-deficiency anemia - Vitamin B-12(Cobalamin) and folate are both
essential for the production of RBCs. If a person does not consume enough of either
vitamin, their RBC count may be low.
 Folic acid deficiency anemia: Having too little folate (vitamin B9) in the blood
causes folic acid deficiency anemia.

Folate is necessary for your body to make new red blood cells

 Hemolytic anemia:  is a disorder in which red blood cells are destroyed faster than
they can be made. The destruction of red blood cells is called hemolysis
 Sickle cell anemia:  is an inherited red blood cell disorder in which there aren't
enough healthy red blood cells to carry oxygen throughout the body.
 Iron-deficiency anemia is the most common type of anemia, and blood loss is often
the cause. A shortage of iron in the blood leads to this form of the condition, and low iron
levels frequently occur as a result of blood loss.

When the body loses blood, it draws water from tissues beyond the bloodstream to help
keep the blood vessels full. This additional water dilutes the blood, reducing the RBC
count. Blood loss can be acute and rapid or chronic. Some causes of rapid blood loss
include surgery, childbirth, and trauma.

Chronic blood loss is more often responsible for anemia. It can result from a stomach
ulcer, cancer, or another type of tumor.

ANATOMY AND PHYSIOLOGY

 Functions of the Blood

The primary function of blood is to deliver oxygen and nutrients to and remove wastes
from body cells. The specific functions of blood also include defense, distribution of heat,
and maintenance of homeostasis.

Blood is a fluid connective tissue critical to the transportation of nutrients, gases, and
wastes throughout the body; to defend the body against infection and other threats; and to
the homeostatic regulation of pH, temperature, and other internal conditions. Blood is
composed of formed elements: erythrocytes, leukocytes, and cell fragments called
platelets, and a fluid extracellular matrix called plasma. More than 90 percent of plasma
is water. The remainder is mostly plasma proteins, mainly albumin, globulins, and
fibrinogen, and other dissolved solutes such as glucose, lipids, electrolytes, and dissolved
gases. Because of the formed elements and the plasma proteins and other solutes, blood is
sticky and more viscous than water. It is also slightly alkaline, and its temperature is
slightly higher than normal body temperature.
TRANSPORTATION

Nutrients from the foods you eat are absorbed in the digestive tract. Most of these
travel in the bloodstream directly to the liver, where they are processed and released back
into the bloodstream for delivery to body cells. Oxygen from the air you breathe diffuses
into the blood, which moves from the lungs to the heart, which then pumps it out to the
rest of the body. Moreover, endocrine glands scattered throughout the body release their
products, called hormones, into the bloodstream, which carries them to distant target
cells. Blood also picks up cellular wastes and byproducts, and transports them to various
organs for removal. For instance, blood moves carbon dioxide to the lungs for exhalation
from the body, and various waste products are transported to the kidneys and liver for
excretion from the body in the form of urine or bile.

DEFENSE

Many types of WBCs protect the body from external threats, such as disease-causing
bacteria that have entered the bloodstream in a wound. Other WBCs seek out and destroy
internal threats, such as cells with mutated DNA that could multiply to become
cancerous, or body cells infected with viruses. When damage to the vessels results in
bleeding, blood platelets and certain proteins dissolved in the plasma, the fluid portion of
the blood, interact to block the ruptured areas of the blood vessels involved. This protects
the body from further blood loss.

MAINTENANCE OF HOMEOSTASIS

If you were exercising on a warm day, your rising core body temperature would trigger
several homeostatic mechanisms, including increased transport of blood from your core
to your body periphery, which is typically cooler. As blood passes through the vessels of
the skin, heat would be dissipated to the environment, and the blood returning to your
body core would be cooler. In contrast, on a cold day, blood is diverted away from the
skin to maintain a warmer body core. Blood also helps to maintain the chemical balance
of the body. Proteins and other compounds in blood act as buffers, which thereby help to
regulate the pH of body tissues. Blood also helps to regulate the water content of body
cells.

BLOOD PLASMA

Like other fluids in the body, plasma is composed primarily of water: In fact, it is about
92 percent water. Dissolved or suspended within this water is a mixture of substances,
most of which are proteins. There are literally hundreds of substances dissolved or
suspended in the plasma, although many of them are found only in very small quantities.

PLASMA PROTEINS

About 7 percent of the volume of plasma, nearly all that is not water, is made of proteins.
These include several plasma proteins (proteins that are unique to the plasma), plus a
much smaller number of regulatory proteins, including enzymes and some hormones.

The three major groups of plasma proteins are as follows:

 Albumin is the most abundant of the plasma proteins. Manufactured by the liver,
albumin molecules serve as binding proteins, transport vehicles for fatty acids and
steroid hormones. However, their binding to albumin enables their transport in the
watery plasma. Albumin is also the most significant contributor to the osmotic
 pressure of blood; that is, its presence holds water inside the blood vessels and
draws water from the tissues, across blood vessel walls, and into the bloodstream.
This in turn helps to maintain both blood volume and blood pressure. Albumin
normally accounts for approximately 54 percent of the total plasma protein content,
in clinical levels of 3.5–5.0 g/dL blood.
 The second most common plasma proteins are the globulins. A heterogeneous
group, there are three main subgroups known as alpha, beta, and gamma globulins.
The alpha and beta globulins transport iron, lipids, and the fat-soluble vitamins A,
D, E, and K to the cells; like albumin, they also contribute to osmotic pressure. The
gamma globulins are proteins involved in immunity and are better known as
an antibodies or immunoglobulins. Although other plasma proteins are produced
by the liver, immunoglobulins are produced by specialized leukocytes known as
plasma cells. Globulins make up approximately 38 percent of the total plasma
protein volume, in clinical levels of 1.0–1.5 g/dL blood.
 The least abundant plasma protein is fibrinogen. Like albumin and the alpha and
beta globulins, fibrinogen is produced by the liver. It is essential for blood clotting.
Fibrinogen accounts for about 7 percent of the total plasma protein volume, in
clinical levels of 0.2–0.45 g/dL blood.

PATHOPHYSIOLOGY
 ANEMIA

Modifiable Factors Non Modifiable Factors

Low in Iron Age and Gender

Excessive alcohol consumption Medical conditions

Poor diet Menstruating/Pregnant

Low Iron in the body

Bone marrow needs iron to make hemoglobin

Can’t produce enough hemoglobin for red blood cells

 Decrease hemoglobin

Insufficient oxygen delivery to the tissue

ANEMIA

LABORATORY AND DIAGNOSTIC EXAM

 Patient may have various blood tests and other tests or procedures to find out what type
of anemia you have and how severe it is.
Complete Blood Count
Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC
measures many parts of your blood. The test checks your hemoglobin and hematocrit
levels. Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the
body. Hematocrit is a measure of how much space red blood cells take up in your blood.

A low level of hemoglobin or hematocrit is a sign of anemia. The normal range of these
levels might be lower in certain racial and ethnic populations. The CBC also checks the
number of red blood cells, white blood cells, and platelets in your blood. Abnormal
results might be a sign of anemia, another blood disorder, an infection, or another
condition. Finally, the CBC looks at mean corpuscular volume (MCV). MCV is a
measure of the average size of your red blood cells and a clue as to the cause of your
anemia. In iron-deficiency anemia, for example, red blood cells usually are smaller than
normal.

Other Tests and Procedures

 If the CBC results show that you have anemia, you may need other tests, such as:
 Hemoglobin electrophoresis. This test looks at the different types of hemoglobin in your
blood. The test can help diagnose the type of anemia you have.
 A reticulocyte count. This test measures the number of young red blood cells in your
blood. The test shows whether your bone marrow is making red blood cells at the
correct rate.
 Tests for the level of iron in your blood and body. These tests include serum iron and
serum ferritin tests. Transferrin level and total iron-binding capacity tests also measure
iron levels.
Because anemia has many causes, patient also might be tested for conditions such as
kidney failure, lead poisoning (in children), and vitamin deficiencies (lack of vitamins,
such as B12 and folic acid).
If the doctor thinks that patient have anemia due to internal bleeding, he or she may
suggest several tests to look for the source of the bleeding. A test to check the stool for
blood might be done in doctor's office or at home.

If blood is found in the stool, patient may have other tests to find the source of the
bleeding. One such test is endoscopy. For this test, a tube with a tiny camera is used to
view the lining of the digestive tract.
The doctor also may want to do bone marrow tests. These tests show whether patient
bone marrow is healthy and making enough blood cells.
MEDICATION/TREATMENT
Anemia treatment depends on the cause.
 Iron deficiency anemia - Treatment for this form of anemia usually involves taking
iron supplements and changing your diet.
If the cause of iron deficiency is loss of blood, other than from menstruation, the
source of the bleeding must be located and the bleeding stopped. This might involve
surgery.

Vitamin deficiency anemias - Treatment for folic acid and vitamin C deficiency
involves dietary supplements and increasing these nutrients in your diet.

If your digestive system has trouble absorbing vitamin B-12 from the food you eat,
patient might need vitamin B-12 shots. At first, patient might have the shots every
other day. Eventually, patient need shots just once a month, possibly for life,
depending on your situation.

Anemia of chronic disease - There's no specific treatment for this type of anemia.
Doctors focus on treating the underlying disease. If symptoms become severe, a blood
transfusion or injections of a synthetic hormone normally produced by patient kidneys
(erythropoietin) might help stimulate red blood cell production and ease fatigue.
 Aplastic anemia - Treatment for this anemia can include blood transfusions to boost
levels of red blood cells. Patient might need a bone marrow transplant if the bone
marrow can't make healthy blood cells.

Anemias associated with bone marrow disease - Treatment of these various diseases
can include medication, chemotherapy or bone marrow transplantation.

Hemolytic anemias - Managing hemolytic anemias includes avoiding suspect

medications, treating infections and taking drugs that suppress the immune system, which
could be attacking red blood cells. Depending on the cause of hemolytic anemia, patient
might be referred to a heart or vascular specialist.

Sickle cell anemia - Treatment might include oxygen, pain relievers, and oral and
intravenous fluids to reduce pain and prevent complications. Doctors might also
recommend blood transfusions, folic acid supplements and antibiotics.
A cancer drug called hydroxyurea (Droxia, Hydrea, Siklos) also is used to treat sickle
cell anemia.
 Thalassemia - Most forms of thalassemia are mild and require no treatment. More
severe forms of thalassemia generally require blood transfusions, folic acid
supplements, medication, removal of the spleen, or a blood and bone marrow stem cell
transplant.

NURSING CARE PLAN FOR ANEMIA

ASSESSMENT NURSING BACKGROUND PLAN OF INTERVENTION RATIONALE EVALUATION
DIAGNOSIS KNOWLEDGE CARE
Subjective: Activity Low Iron Short Term Independent Independent After 8 hours of
intolerance Goal: continuous
“Nanghihina related to Bone marrow 1.Establish 1.To gain nursing
ako, kadalasan imbalance can not produce Within 8 rapport to the patient trust intervention,
hindi ko between hours of client and and patient reveals
HgB
matapos ang oxygen supply continuous confidence. an increase in
significant
mga gawain and demand nursing activity
as evidenced Decrease HgB others. tolerance,
ko” as intervention,
verbalized by by general patient will demonstrating a
the patient. weakness Insufficient O2 be able to reduction in
2. Monitor and 2.To provide a physiological
delivery to the demonstrate
a increase in record vital signs. baseline data signs of
tissue
activity for future intolerance and
Objective: tolerance comparison. laboratory
Anemia
including values within
Vital signs activities of 3. Assess 3.Influences normal range.
taken as daily living, patient’s ability choice of
follows: display to perform intervention or
laboratory normal task or needed
BP: 90/80 values within activities of daily assistance.
normal
living.
Temp: 36.9C range.
4. To know
4. Note changes neurological
PR: 75bpm Long Term
Goal: in balance, gait changes
disturbance, and associated
RR: 18cpm
After months muscle with vitamin
Greater need of nursing weakness. B12
for sleep and interventions, deficiency,
rest the patient: affecting
patient safety
Generalized
weakness -Is free from or risk of
weakness injury.
and risk for 5.Recommend
complication quiet atmosphere. 5. To enhance
has been rest to lower
prevented.
body’s oxygen
requirements.

6. To enhance
6.Elevate the lung expansion
head of the bed. to maximize
oxygenation
for cellular
uptake.

7. To promote
7.Plan activity gradual return
progression with to normal
patient, including activity level
activities that the and improved
patient views muscle tone or
essential. stamina
without undue
fatigue.

Dependent Dependent

1.Monitor 1. To identify
 deficiencies in
laboratory RBC
studies. HgB or components
HcT and RBC affecting
count, and ABG oxygen
transport and
. treatment
needs or
response to
therapy.

RECOMMENDATIONS
Medications Instruct the patient about the importance of
compliance in medications.

Exercise Instruct the patient to do ROM activities and exercise

 regularly.

Treatment Instruct and remind the patient to increase vit. C

intake, drink more water, and eat more green
vegetables.

Health Teaching Instruct and remind the patient to plan his/her day
with daily activities and include rest periods.

Out Patient Follow Up Instruct the patient to be sure to make and go to all
appointments, and call the doctor if he/she having
problems.

Diet Instruct the patient to eat iron-rich foods.

Spiritual Support Always pray continually and give thanks in all

circumstances.