Definitions

Condition in which the hemoglobin concentration is lower than normal
- 12.6-17.4
Reflects the presence of fewer than the normal number or erythrocytes
Results in decrease amount of oxygen delivered to the tissues
Sign of an underlying disorder
Classification
- Hypoproliferative: Deficit in RBC production
  - MCV—size of the RBC
  - Iron deficiency
    - low MCV
    - low reticulocytes
    - low Iron, % saturation, ferritin
    - high TIBC
  - B12 deficiency
    - high MCV
    - low vitamin B22
    - Megaloblastic anemia
  - Folate deficiency
    - high MCV
- Bleeding: RBC loss
  - Acute blood loss (GI, trauma, menstrual cycle), ¯ MCV
- Hemolytic: excess RBC destruction
  - Sickle cell – RBC abnormal shaped & bone marrow attempts to produce more, and they will become more sickled & too young & the body will hemolysis & hypoxia (triggering kidney to produce RBC by stimulating the liver to produce young RBC) in the body will occur & jaundice & anemia

Diagnostic studies: General

CBC
- RBC indices
Iron Studies
- Serum iron level
- Total iron binding capacity
- Ferritin
- ^ when looking for Iron deficiency
Vitamin B12
Folate Level (folic acid levels)
Haptoglobin & Erythropoietin Levels
Bone Marrow Aspiration
Other tests for underlying chronic illness, malignancy, blood loss
MCV --> mean corpuscular volume – size of erythrocyte
- So you can do the labs and if the MCV shows a change can it be diagnosed by that?

Complications: General

Heart failure
Paresthesia
Delirium
gradual HBG loss 50%
cardiopulmonary collapse with acute HBG loss 30%
- does this usually happen after SX?
activity, disease & life style may increase symptoms

Geriatric Considerations

Impacts functioning
- Decreased mobility
- Increased depression
- Increased risk for falling
- Delirium (esp. hospitalized)
Clinical manifestations
- Fatigue
- Dyspnea
- Confusion

Assessment:

Health History
- Medications
- Alcohol intake
  - BC alcohol needs a lot to be digested
- Family history
Nutritional Assessment
- Intake of iron & nutrients (B12 & folic acid) BC different PT with cultures have different diets & if malnourished
Cardiac Status
- HF (pushing of blood is compromised causing issues on the blood)
Gastrointestinal System
- Because of bleeding loss without being noticed
Neurological Examination

Clinical Manifestations:

Weakness, fatigue, and general malaise
Pallor skin and mucous membranes
- No HBG within the system
Tachycardia (BC trying to compensate for the HBG loss), palpitations, dyspnea, dizziness, and orthopnea
Nausea, vomiting, anorexia, and glossitis
Paresthesia, ataxia, poor coordination, and confusion
Jaundice—in megaloblastic or hemolytic anemia
Tongue smooth & red—iron deficiency
Beefy, red, & sore – megaloblastic anemia
Angular chelilosis (ulcerated corners of the mouth)—both
Carve ice, dirt (pica), starch—iron
Identify anemia in dark skin?

Diagnosis

Nursing Diagnosis:
- Fatigue
- Imbalanced nutrition, less than body requirements
- Ineffective tissue perfusion
Collaborative problems/potential complications:
- Heart Failure
- Angina
  - Chest pain—BC parts of the myocardia may be blocked causing pain
- Paresthesia
- Confusion
- Injury related to falls
- Depressed mood
  - PT goes into further anemia, because they aren’t doing much

Planning/Goals

Interventions:

Managing Fatigue
- Prioritizing and balancing activities
- Maintain physical activity and exercise
Maintaining Adequate Nutrition
- Healthy diet
- Dietary supplements
  - I.e. vitamins & multivitamins but NOT iron, B12, or folic acid because that needs to be monitored by the physician
  - Many PT do not like iron because they can become constipated
Activity Intolerance
- Replace lost volume
- Supplemental oxygen
  - Because with cardiopulmonary distress O2 is important
  - O2 is the main thing with anemia
Promoting Compliance
- Patient/family teaching
Monitoring/managing Complications

Evaluations:

Expected Outcomes
- Reports less fatigue
- Attains and maintains adequate nutrition
- Maintain adequate perfusion
- Absence of complications

	Created by Brittnee Gonzalez about 5 years ago

General, Iron Deficiency, B12 deficiency, Folate deficiency, Sickle cell anemia, Aplastic anemia, & neutropenia