A CASE ANALYSIS OF

ANEMIA

BY: GUIRIGAY, REBECCA S. 3Nu05

SUBMITTED TO: MRS. BUATIS

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100ml and in women as hemoglobin of less than 12.0 gram/100ml. These definitions may vary slightly depending on the source and the laboratory reference used. Risk factors for developing anemia: Elderly patients Presence of comorbid conditions Type of cancer, especially lung, breast, ovary, head and neck, and non-Hodgkins lymphoma Advanced stage of cancer Prior treatment Treatment regimen that includes paclitaxel, carboplatin, cisplatin, topotecan, or CHOP

ETIOLOGY
Blood Loss Blood loss is the most common cause of anemia, especially iron-deficiency anemia. Blood loss can be short term or persist over time. Heavy menstrual periods or bleeding in the digestive or urinary tract can cause blood loss. Surgery, trauma, or cancer also can cause blood loss. If a lot of blood is lost, the body may lose enough red blood cells to cause anemia. Lack of Red Blood Cell Production Both acquired and inherited conditions and factors can prevent your body from making enough red blood cells. "Acquired" means you aren't born with the condition, but you develop it. "Inherited" means your parents passed the gene for the condition on to you. Examples of acquired conditions and factors that can prevent your body from making enough red blood cells include diet, hormones, some chronic (ongoing) diseases, and pregnancy. Aplastic anemia also can prevent your body from making enough red blood cells. This condition can be acquired or inherited.

Diet A diet that lacks iron, folic acid (folate), or vitamin B12 can prevent your body from making enough red blood cells. Your body also needs small amounts of vitamin C, riboflavin, and copper to make red blood cells. Conditions that make it hard for your body to absorb nutrients also can prevent your body from making enough red blood cells. Hormones Your body needs the hormone erythropoietin (eh-rith-ro-POY-eh-tin) to make red blood cells. This hormone stimulates the bone marrow to make these cells. A low level of this hormone can lead to anemia. Diseases and Disease Treatments Chronic diseases, like kidney disease and cancer, can make it hard for your body to make enough red blood cells. Some cancer treatments may damage the bone marrow or damage the red blood cells' ability to carry oxygen. If the bone marrow is damaged, it can't make red blood cells fast enough to replace the ones that died or were destroyed. People who have HIV/AIDS may develop anemia due to infections or medicines used to treat their diseases. Pregnancy Anemia can occur during pregnancy due to low levels of iron and folic acid and changes in the blood. During the first 6 months of pregnancy, the fluid portion of a woman's blood (the plasma) increases faster than the number of red blood cells. This dilutes the blood and can lead to anemia. Aplastic Anemia Some infants are born without the ability to make enough red blood cells. This condition is called aplastic anemia. Infants and children who have aplastic anemia often need blood transfusions to increase the number of red blood cells in their blood. Acquired conditions or factors, such as certain medicines, toxins, and infectious diseases, also can cause aplastic anemia.

High Rates of Red Blood Cell Destruction Both acquired and inherited conditions and factors can cause your body to destroy too many red blood cells. One example of an acquired condition that can do this is an enlarged or diseased spleen. The spleen is an organ that removes wornout red blood cells from the body. If the spleen is enlarged or diseased, it may remove more red blood cells than normal, causing anemia. Examples of inherited conditions that can cause your body to destroy too many red blood cells include sickle cell anemia, thalassemias, and lack of certain enzymes. These conditions create defects in the red blood cells that cause them to die faster than healthy red blood cells. Hemolytic anemia is another example of a condition in which your body destroys too many red blood cells. Inherited conditions can cause this type of anemia. Acquired conditions or factors also can cause hemolytic anemia. Examples include immune disorders, infections, certain medicines, or reactions to blood transfusions.

SIGNS AND SYMPTOMS

Cognitive dysfunction Hypoxia weakness Shortness of breath Dizziness Headache Coldness in the hands and feet Pale skin Chest pain

PATHOPHYSIOLOGY

Unknown etiology

DIAGNOSTIC EXAMS
Physical Exam Your doctor will do a physical exam to find out how severe your anemia is and to check for possible causes. He or she may:

Listen to your heart for a rapid or irregular heartbeat Listen to your lungs for rapid or uneven breathing Feel your abdomen to check the size of your liver and spleen

The doctor also may do a pelvic or rectal exam to check for common sources of blood loss.

MEDICAL MANAGEMENT
Dietary Changes and Supplements
Iron

Spinach and other dark green leafy vegetables Tofu

Peas; lentils; white, red, and baked beans; soybeans; and chickpeas Dried fruits, such as prunes, raisins, and apricots Prune juice Iron-fortified cereals and breads Breakfast cereals with added vitamin B12 Meats such as beef, liver, poultry, and fish Eggs and dairy products (such as milk, yogurt, and cheese)

Vitamin B12

Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers Folic Acid

Bread, pasta, and rice with added folic acid Spinach and other dark green leafy vegetables Black-eyed peas and dried beans Beef liver Eggs Bananas, oranges, orange juice, and some other fruits and juices

Vitamin C Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones. If you're taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work. Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes.

Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach.

Medicines

Antibiotics to treat infections.

Hormones to treat heavy menstrual bleeding in teenaged and adult women. A man-made version of erythropoietin to stimulate your body to make more red blood cells. This hormone has some risks. You and your doctor will decide whether the benefits of this treatment outweigh the risks. Medicines to prevent the body's immune system from destroying its own red blood cells.

Chelation (ke-LAY-shun) therapy for lead poisoning. Chelation therapy is used mainly in children. This is because children who have iron-deficiency anemia are at increased risk of lead poisoning.

Procedures
Blood Transfusion A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient's blood. Blood and Marrow Stem Cell Transplant A blood and marrow stem cell transplant replaces your faulty stem cells with healthy ones from another person (a donor). Stem cells are found in the bone marrow. They develop into red and white blood cells and platelets. During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells. For more information, go to the Diseases and Conditions Index Blood and Marrow Stem Cell Transplant article. Surgery If you have serious or life-threatening bleeding that's causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer.

If your body is destroying red blood cells at a high rate, you may need to have your spleen removed. The spleen is an organ that removes wornout red blood cells from the body. An enlarged or diseased spleen may remove more red blood cells than normal, causing anemia.

NURSING MANAGEMENT
Side rails up Position the patient (fowlers) Promote bed rest Provide quiet and calm environment Provide assistance in ambulation

Encourage patient to eat recommended die Monitor pulse rate blood pressure and respiratory rate Monitor intake and output Provide oxygen as indicated