Anemia
ANEMIA
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Introduction
· Anemia is a common
medical condition characterized by a deficiency in the number or quality of red
blood cells (RBCs) or hemoglobin, which impairs the ability of the blood to
carry adequate oxygen to the body’s tissues.
· It can result from
various underlying causes, including nutritional deficiencies, chronic
diseases, genetic disorders, or acute blood loss.
· Anemia can
significantly impact an individual's health, leading to fatigue, weakness, and
other complications if left untreated.
Definition
· Anemia is defined
as a condition in which the hemoglobin concentration in the blood is lower than
normal, considering age, gender, and physiological status.
· According to the
World Health Organization (WHO), anemia is diagnosed when hemoglobin levels
fall below 13 g/dL in men, 12 g/dL in non-pregnant women, and 11 g/dL in
pregnant women.
Classification
Anemia
can be classified based on various criteria:
1.
Morphological Classification:
·
Microcytic Anemia: Characterized by small red blood
cells. Example: Iron-deficiency anemia.
·
Normocytic Anemia: Red blood cells are of normal
size. Example: Anemia of chronic disease.
·
Macrocytic Anemia: Characterized by large red blood
cells. Example: Vitamin B12 or folate deficiency anemia.
2.
Etiological Classification:
·
Nutritional Deficiency Anemia: Caused by lack
of essential nutrients. Example: Iron, vitamin B12, or folate deficiency
anemia.
·
Hemolytic Anemia: Due to increased destruction of
red blood cells. Example: Sickle cell anemia, thalassemia.
·
Aplastic Anemia: Due to bone marrow failure. Example:
Idiopathic aplastic anemia.
·
Hemorrhagic Anemia: Caused by acute or chronic blood
loss. Example: Post-traumatic anemia.
3.
Pathophysiological Classification:
·
Production Defects: Impaired production of RBCs.
Example: Iron deficiency anemia.
·
Destruction Defects: Increased destruction of RBCs.
Example: Autoimmune hemolytic anemia.
·
Loss Defects: Excessive loss of RBCs. Example:
Gastrointestinal bleeding.
Pharmacokinetics
The
pharmacokinetics of anemia treatment depends on the specific medication used:
1.
Iron Supplements:
·
Absorption: Iron is absorbed primarily in the
duodenum and proximal jejunum. Absorption is enhanced by vitamin C and
decreased by calcium, phytates, and tannins.
·
Distribution: Iron binds to transferrin in the blood
and is transported to the bone marrow, liver, and spleen.
·
Metabolism: Iron is not metabolized but is stored in
the form of ferritin or hemosiderin.
·
Excretion: Iron is excreted minimally through urine
and feces, with most loss occurring via bleeding.
2.
Vitamin B12 Supplements:
·
Absorption: Vitamin B12 is absorbed in the ileum
after binding to intrinsic factor produced by the stomach.
·
Distribution: It binds to transcobalamin II and is
transported to tissues, particularly the liver.
·
Metabolism: Vitamin B12 undergoes enterohepatic
circulation.
·
Excretion: Excess vitamin B12 is excreted in urine.
3.
Folate Supplements:
·
Absorption: Folate is absorbed in the small
intestine.
·
Distribution: Folate is distributed widely throughout
the body.
·
Metabolism: It is metabolized in the liver to active
forms like tetrahydrofolate.
·
Excretion: Excess folate is excreted in urine.
Mechanism of Action
1.
Iron Supplements: Iron replenishes body stores and
increases hemoglobin production, thereby enhancing oxygen transport capacity of
the blood.
2.
Vitamin B12: It is crucial for DNA synthesis and red
blood cell maturation. Deficiency impairs erythropoiesis, leading to macrocytic
anemia.
3.
Folate: Similar to vitamin B12, folate is
essential for DNA synthesis and cell division. Its deficiency leads to impaired
red blood cell production and macrocytic anemia.
Uses
·
Iron Supplements: Treatment and prevention of
iron-deficiency anemia.
·
Vitamin B12: Treatment of vitamin B12 deficiency
anemia, pernicious anemia, and megaloblastic anemia.
·
Folate: Treatment of folate-deficiency anemia
and as a supplement in pregnancy to prevent neural tube defects.
Adverse Effects
1.
Iron Supplements:
·
Gastrointestinal
disturbances: nausea, constipation, diarrhea.
·
Dark
stools.
·
Risk
of iron overload in patients with conditions like hemochromatosis.
2.
Vitamin B12:
·
Generally
well-tolerated.
·
Rarely,
allergic reactions.
3.
Folate:
·
Generally
well-tolerated.
·
Large
doses can mask vitamin B12 deficiency.
Contraindications
1.
Iron Supplements:
·
Hemochromatosis.
·
Hemosiderosis.
·
Active
gastrointestinal bleeding without diagnosis.
2.
Vitamin B12:
·
Known
hypersensitivity to vitamin B12 or cobalt.
3.
Folate:
·
Untreated
vitamin B12 deficiency, as folate supplementation can mask symptoms.
Role of Nurse in Anemia
1.
Assessment:
·
Perform
thorough patient history and physical examination.
·
Assess
for signs and symptoms of anemia (fatigue, pallor, shortness of breath).
2.
Education:
·
Educate
patients about the importance of adherence to prescribed treatments.
·
Provide
dietary counseling to include iron-rich, folate-rich, and vitamin B12-rich
foods.
3.
Administration of Treatment:
·
Administer
oral or intravenous iron supplements as prescribed.
·
Administer
vitamin B12 injections for patients with absorption issues.
·
Ensure
proper dosage and administration of folate supplements.
4.
Monitoring:
·
Monitor
hemoglobin and hematocrit levels.
·
Watch
for adverse effects of treatment.
·
Assess
for improvement in clinical symptoms.
5.
Support and Follow-up:
·
Provide
emotional support to patients coping with chronic anemia.
·
Schedule
regular follow-up visits to monitor progress and adjust treatment as needed.
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