c

c 



 is a clinical condition that results from an insufficient supply of healthy red
blood cells (RBCs),

, to oxygenate the body·s tissue adequately; hypoxia results. The
anemias are classified by either the etiology or the morphology of the specific anemia. It is caused
in one of the three ways: 1) decrease production of healthy RBCs, 2) increase RBC destruction
(
), or 3) loss of blood.

The production of RBCs,


, takes place in the bone marrow. The
requirements for healthy RBCs include precursor cells, 

, and adequate supplies of
iron, vitamin B12, folic acid, protein, pyridoxine, and traces of copper. If any of these factors is
missing, the RBCs will be fragile, misshapen, of abnormal size, lacking hemoglobin, or too few.
Increase destruction of RBCs can be due to extrinsic causes such as physical trauma while
intrinsic causes may include defective hemoglobin. Anemia may also be due to acute blood loss,
most commonly seen in trauma or vessel rupture.

Morphologic classification is based on erythrocyte size, shape, and color. Morphologic

categories include normocytic/normochromic (normal size and color), macrocytic/normochomic
(large size, normal color), and microcytic/hypochomic (small size, pale color).



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c 
|ecrease production may be due to (1) decrease synthesis of normal hemoglobin, as
seen in iron deficiency anemia and thalassemia; (2) defective | A synthesis, as seen in
megaloblastic anemia resulting from cobalamin (vitamin B12) and folate deficiency; or (3)
reduced availability of erythrocyte precursors as seen in aplastic anemia.

ð? c  

 
  !c" is a chronic, hypochromic, microcytic anemia
resulting from an insufficient supply of iron in the body. Without iron, hemoglobin
concentration in the RBCs is reduced and the cells are unable to oxygenate the body·s
tissues adequately, resulting in anemia. Major risk factors for I|A include (1)
insufficient dietary intake of iron, (2) blood loss, (3) impaired absorption of iron, and
(4) excessive demands for RBC production as a result of hemolyis.

#?
  
  is a group of genetic disorders that result in inadequate normal Hb
production. Whereas I|A affects heme synthesis, thalassemia disrupts the synthesis
of globin. These disorders include alpha-thalassemia, a relatively benign and
asymptomatic condition; beta-thalassemia minor, a mild to moderate form of
microcytic anemia; and beta-thalassemia major, a severe, microcytic, hypochromic
anemia that may be fatal. These disorders also cause hemolysis. All are chronic
conditions. 

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% & 
 are a group of disorders caused by impaired | A synthesis
resulting in defective RBCs. These anemia share the morphology of megaloblasts
(large, abnormal, and premature RBCs) in the blood and bone marrow. They are
caused by deficiencies of cobalamin (vitamin B12) and folic acid.

 a.? &    !'   ð#" 

( 
  
  is an autoimmune
disorder characterized by the absence of intrinsic factor (IF) in gastric secretions,
leading to malabsorption of cobalamin (vitamin B12).

&? [ ) 

 
  Inadequate amounts of folate in the diet is the
usual cause of folate deficiency, with the disorder developing most often in the
poor, pregnant women, and in chronic alcoholics. Because folate helps in the
synthesis of | A, a folate deficiency results in fewer cell divisions and,
therefore, decrease red blood cell production. A deficiency in folate during
pregnancy is also associated with birth disorders call neural tube defects, such as
spina bifida.

*?   
  is caused by failure of the bone marrow, leading to insufficient
production of peripheral blood elements. The marrow failure is due to primary
defects in, or damage to, the stem cell or marrow microenvironment. Aplastic anemia
may be either hereditary or acquired.

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c 

ð? 
 
  is an end result of many conditions that lead to hemolysis.
Hemolysis, the premature destruction of erythrocytes, can result from physical
damage, intrinsic membrane defects, abnormal Hb, erythrocytic enzymatic defects,
immune destruction of RBCs by macrophages, or hypersplenism. Anemia occurs
when the bone marrow fails to replace RBCs at the rate they are destroyed.

#? +
 
 
  Vickle cell disease (VC|) is a group of inherited disordes of
mutant hemoglobin (HbV) that causes the characteristic sickling of RBCs. Vickling
occurs only under conditions of low oxygenation. The abnormally shaped RBCs
become trapped in capillaries, causing organ damage from infarcts and tissue
hypoxia, or are damage in transit, leading to severe anemia. 

[ c 
c,[
 c-  


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)

 
+
   - Fatigue, weakness
 - Malnutrition, Economic constraints, - Vhortness of breath


 poor dentition, poor appetite - Pallor (earlobes, face, palms and

c  (



: Almonds, mouth, nail bed, conjunctiva)
 asparagus, beans, carrots, cauliflower, - Brittle spoon-like nails
 celery, liver, egg yolk, soybeans - Cheilosis (sore at the corners of
c 



 !#") the mouth)
- GI tract (most common site) bleeding, - Cheilitis (inflammation of the
most common in men; Accidents lips)
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)
&   
- Vmooth and sore tongue,
- |iarrhea, celiac disease, gastrectomy, Glossitis (inflammation of the
tannates (in tea and coffee), carbonates, tongue)
antacid magnesium trisilicate, eating - |izziness
clay and starch. - Pica (clay or starch)
!*".
'
)

)  - Angular stomatitis (inflammation
) 


 

 of the mucosa of the mouth)





 !ð"? -


 -? Pain
-? Mediterranean, African, Voutheast -? Failure to thrive
Asia origin -? Frequent infections
—? Those who inherit alpha-genes -? |iarrhea
have alpha thalassemia. -? Vplenomegaly
—? Those who inherit one beta-gene -? Hepatomegaly
have thalassemia minor; two beta- -? Jaundice
genes have thalassemia major. -? Bone marrow hyperplasia

%
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 !ð"? c  
)

 
+
/ Rare
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 !'
 ð#"
 with cobalamin but common with 

(
 


a.? &

  folate. -? Pallor, slight jaundice with a
!'
 ð#" !#"? %

)

&   complaint of weakness


( 

 -? Vmooth, sore, beefy red tongue

 

-? Purine analogs (azathioprine), (glossitis)
pyrimidine analogs (5-FU), -? |iarrhea
b.? [) ribonnucleotide reductase -? Paresthesia (altered sensation




inhibitors (hydroxyurea), such as numbness or tingling
anticonvulsants (phenytoin), and in the extremeties)
oral contraceptives. -? Impaired proprioception
!$"? %


+
 
 (difficulty identifying one·s

 position in space, which may
-? itrous oxide, cholestyramine, progress to difficulty with
para-aminosalicylic acid, balance)
neomycin, metformin, phenformin, -? Fair-haired or prematurely
and colchicine gray
!*"? -

)
 -? GI : weight loss, appetite loss,
-? Imerslund-Grasbeck syndrome nausea, vomiting, abdominal
(defects in the ileal receptors of IF), distension, diarrhea
hereditary trascobalamin II (TCII) -? eurologic disorder:
deficiency Paresthesia (altered sensation
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)
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 % such as numbness or tingling

)
 1

1-c in the extremeties), poor gate,
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   memory loss, cognitive




 problems, depression
!2"? -c))
 &? [)



-? Gastric atrophy, geastrectomy,
gastric stapling, bypass for
pancreatic insufficiency of
protease, which release Cbl from r
binders so Cbl can bing with IF
-? Pallor, progressive weakness,
fatigue
-? Vhortness of breath, cardiac
palpitations
-? Glossitis, Cheilosis
!3"? 4 %
5  )
 -? GI: same as in Pernicous
Anemia
-? eurological symptoms in
Vitamin B12 deficiency are not
seen in folic acid deficiency



 !ð"? 

)
 -? Fatigue, weakness, headache
-? Fanconi syndrome, dyskeratosis -? |yspnea, rapid heart rate
congenital, Vhwachman- -? Pallor
|iammond syndrome, Pearson -? Frequent infections
syndrome, |iamond-blackfan
 syndrome, Amegakaryocytic -? Unexplained bruising, easy
thrombocytopenia (absent radius bruising
[TAR] syndrome) -? osebleeds, bleeding gums
!#"? 6
) -? Heavy menses
-? High-dose radiation and -? Blood in the stool
chemotherapy drugs (e.g., -? Prolonged bleeding from cuts
antimetabolites, alkylating agents) -? Vkin rash
-? Toxic chemicals: hair and aniline -? Bone pain
dyes, herbicides and insecticides, -? Foot swelling
benzene and its derivatives -? Fever
(gasoline, mothballs, paint and
varnish removers, dye-cleaning
solutions and household cleaners)
-? Certain drugs: chloramphenicol,
sulfonamides, quinacrine,
phenylbutazone, anticonvulsants
(Phenytoin and Mephenytoin),
gold compounds, streptomycin,
tripenelamine, meprobamate,
carbon tetrachloride, arsenic.
-? Autoimmune disorders such as
systemic lupus eryhtematosus
-? Infectious agents: hepatitis,
Epstein-Barr virus, human
immunodeficiency virus,
parvovirus, military tuberculosis,
and mycobacterial infections
-? |iseases of the bone marrow:
leukemia, graft-versus-host
disease. Eosinophilic fasciitis, and
fulminant hepatitis
-? Preganacy (rare like autoimmune)
-? Idiopathic (an environmental
etiology is rarely identified)
?  c Hemolysis can result from: The client with hemolytic anemia
c  !ð"? 

)
))
 may suffer all the general


 -? Intracorpuscular defects (G-6-P|) manifestations of anemia.


c  !#"? 6
)
 ) 
 -? Immune reactions -? Pallor, severe fatigue, malaise,



 -? Toxic chemicals: arsenic, lead weakness, light-headedness
copper, and certain snake venoms -? Fever
-? |rugs: penicillin, ampicillin, -? Exertional dyspnea
cephalothin, methicillin, -? Headache
phenylbutazone, phenacetin, -? Vertigo
quinine, quinidine, and L-dopa -? Vensitivity to cold
-? Parasitic disease that disruots RBC -? Weight loss
membrane (malaria, Clostridium -? Glossitis
welchii) -? Cheilosis
-? Physical damage to the RBC -? Cheilitis
membrane: hemodialysis, heart- -? Paresthesias
lung machines and prosthetic -? Confusion
cardiac valves -? Loss of balance
 -? Mental depression
-? |ry skin, brittle nails, spoon-
shaped concave nails
+



 !ð"? -


 -? Pallor
-? Areas of the world where malaria -? Jaundice
is endemic: Africa, Mediterranean, -? Fatigue
Middle East, India -? Irritability
-? Large joints and surrounding
tissue may become swollen
during crisis
-? Priapism (abdominal, painful
continuous erection of the
penis) may occur if the penile
vein are obstructed
-? Pain


c77c
c 

Anemia diminishes the capability of individuals who are affected to perform physical
labor. This is a result of one's muscles being forced to depend on anaerobic metabolism. The lack
of iron associated with anemia can cause many complications, including hypoxemia, brittle or
rigid fingernails, cold intolerance, impaired immune functioning, and possible behavioral
disturbances in children. Hypoxemia resulting from anemia can worsen the cardio-pulmonary
status of patients with pre-existing chronic pulmonary disease. Brittle or rigid fingernails may be
a result of abnormal thinness of nails due to insufficient iron supply. Cold intolerance occurs in
one in five patients with iron deficiency anemia, and becomes visible through numbness and
tingling. Impaired immune functioning leading to increased likelihood of sickness is another
possible complication. Finally, chronic anemia may result in behavioral disturbances in children
as a direct result of impaired neurological development in infants, and reduced scholastic
performance in children of school age. Behavioral disturbances may even surface as an attention
deficit disorder.

c- c

)
/
ð? 

) !"is a series of tests used to evaluate the composition
and concentration of the cellular components of blood. It measures the following:
´? The number of red blood cells (RBCs)
´? The number of white blood cells (WBCs)
´? The total amount of hemoglobin in the blood
´? The fraction of the blood composed of red blood cells (hematocrit)
´? The mean corpuscular volume (MCV) ³ the size of the red blood cells
CBC also includes information about the red blood cells that is calculated from
the other measurements:
—? MCH (mean corpuscular hemoglobin) - the average mass of hemoglobin per red
blood cell in a sample of blood.
—? MCHC (mean corpuscular hemoglobin concentration) - the average mass
of hemoglobin per red blood cell in a sample of blood.
 The platelet count is also usually included in the CBC.
 %
 &
/
(1) Apply pressure on the venipuncture site after obtaining a sample (done by RMT).
(2) Observe for bleeding.
(3) Explain the purpose of the procedure.
(4) Vecure laboratory request prior to examination.
#? 
 8  is the withdrawal of specimen of bone marrow. The sites
are posterior superior iliac crest fro adults and proximal tibia for children.
 %
 &
/
(1) Vecure consent.
(2) Inform the client that the procedure may cause discomfort and pain.
(3) Position the client in a prone or lateral position.
(4) Monitor and maintain pressure dressing over punctured site for 10 minutes.
(5) Assess for discomfort.
(6) Administer prescribed pain meds.

$? 

 )
s a blood test that gives information about the number and
shape of blood cells.
*?  %9

is a urine test done to evaluate whether vitamin B12 is being
absorbed by the body.
 %
 &
/
(1) Instruct the patient to fast, may drink water, before starting the test, then eat normally for the
next 24 hours.
(2) You may ask the client to stop taking any medications for it may affect the test.
(3) Instruct the client to have not undergone any parenteral (intramuscular injection) of vitamin
B12 3 days prior to the test.
(4) Instruct the client to wash their genital/perineal thoroughly with clean water and wipe with
clean towel before obtaining urine sample.
0?  

 is the aspiration of amniotic fluid from the uterus. It is done at 14 to
16 weeks of pregnancy.

.

)
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c 
  
  &    [ )   
 +


)

 ð# 

 
  
  
 
  - to - - - - - -
&(
 - - (beta trait - - - - -
+)
 Mic/H Mic/H Mac/ Mac/ / / Vickle cells
%


 or - - - - + +
 

 or - - - +
, - - + +
 - - - to - to
 - - + + +

c  - + -? With mal- + or +
absoption

c + + - or -

 - to +
[
 
&  or - + -? Indirect +
bilirubin
  8 Absence Megalo- Megalo- -
 
 of hemo- blasts blasts Aplastic:
siderin remain-
ing cells
normal

 -Trans- Hb electro- -Verum vit. -Verum -WBC -Folate +Hb V, Hb
ferrin phoresis, B12 Folate electro-
saturation Amnio- phoresis,
centesis + Vchilling -Hapto-
globin, +
Fibrinogen,
+ Urobili-
nogen,
+ Vterco-
bilinogen,
Amnio-
centesis

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Oxygen therapy may be prescribed for clients with severe anemia because their
blood has a reduced capacity for oxygen. Oxygen helps to prevent tissue hypoxia and
lessen the workload of the heart as it struggles to compensate for the lower Hb levels.
#? 
 
Vubcutaneous injections of erythropoietin can be given to treat anemias of
chronic disease because this drug increases the production of RBCs. For this drug to be
effective, the client must have bone marrow capable of producing RBCs and sufficient
nutrients for the production of RBCs.
$? c 
 


Iron can be given to augment oral intake in cases where the need for iron is
immediate or the demands are beyond dietary measures. The oral form of iron should
used because it is inexpensive and convenient. It is usually given for mild forms of
anemia.
*? )
   
Blood transfusions are valuable in treating anemia resulting from acute blood
loss. It may also befit clients with severe chronic anemia (Hb <6 g/dL) who have
responded poorly to other forms of therapy. Packed RBCs may be given to clients who
have lost blood in surgery or due to trauma.