ANEMIA

ANEMIA
A. Definition Anemia is a term that indicates a low red blood cell count and hemoglobin and hematocrit levels below normal. Anemia is not a disease, but is a reflection of state of a disease or disorder caused bodily functions. Physiologically anemia occurs when there is a shortage of hemoglobin to carry oxygen to the tissues.
B. Pathophysiology Incidence of anemia reflect the loss of marrow failure or excessive red blood cells or both. Marrow failure may occur due to nutritional deficiencies, toxic exposure, tumor invasion or mostly due to unknown causes. Red blood cells can be lost through bleeding or hemplisis (destruction), this may be due to defect of red blood cells that are not in accordance with the resistance of red blood cells that causes destruction of red blood cells. Red blood cell lysis (dissolution) occurs mainly in phagocytic cells or the reticuloendothelial system, mainly in the liver and spleen. Byproduct of this process is bilirubin will enter the bloodstream. Any increase in red blood cell destruction (hemolysis) immediately reflected by an increase in plasma bilirubin (normal concentration ≤ 1 mg / dl, levels above 1.5 mg / dl result in jaundice in the sclera). If the destruction of red blood cells experience in circulation, (the abnormalities hemplitik) then appear in plasma hemoglobin (hemoglobinemia). If the plasma concentration exceeds the capacity of plasma haptoglobin (hemoglobin-binding proteins for free) to tie it all, will diffuse hemoglobin in kidney glomerulus and into the urine (hemoglobinuria). Conclusions about whether an anemia in patients caused by the destruction of red blood cells or red blood cell production is usually inadequate to diperleh basis: 1. reticulocyte count in the blood circulation; 2. the degree of proliferation of young red blood cells in bone marrow and how pematangannya, as seen in the biopsy, and presence or absence of hyperbilirubinemia and hemoglobinemia.
Anemia ↓ decreased blood viscosity ↓ peripheral blood flow resistance ↓ decrease in O2 transport to tissue ↓ hypoxia, pale, weak ↓ increased cardiac load ↓ increased heart work ↓ bad heart C. Etiology: 1. Hemolysis (erythrocytes easily broken) 2. Bleeding 3. Bone marrow suppression (eg by cancer) 4. Nutrient deficiency (nutritional anemia), including iron deficiency, folic acid, pyridoxine, vitamin C and copper
D. Classification of anemia: Classification based on physiological approach: 1. Hipoproliferatif anemia, deficiency anemia is the number of red blood cells caused by a defect of red blood cell production, including: a. Aplastic Anemia  Cause: - Neoplastic agent / sitoplastik - Radiation therapy - Certain antibiotics - Drug konvulsan enthusiasm, thyroid, gold compounds, fenilbutason - Benzene - Viral infections (particularly hepatitis) ↓ Decrease in number of cell eritropoitin (stem cells) in bone marrow Stem cell disorders (disorders division, replication, differentiation) Barriers humoral / cellular ↓ Impaired stem cell in bone marrow ↓ The number of red blood cells produced inadequate ↓ Pancytopenia ↓ Aplastic Anemia
Symptoms: - Symptoms of anemia in general (pale, weak, etc.) - Deficiency of platelets: ekimosis, petekia, epitaksis, gastrointestinal bleeding, urinary tract bleeding, CNS bleeding. Morphological: anemia normositik normokromik b. Anemia in kidney disease Symptoms: - Blood urea nitrogen (BUN) greater than 10 mg / dl - Down 20-30% hematocrit - Red blood cells appear normal on peripheral blood smears The reason is the decrease in survival of red blood cells and deficiency eritopoitin c. Anemia in chronic disease Various chronic inflammatory diseases associated with anemia type normositik normokromik (red blood cells with normal size and color). These disorders include rheumatoid artristis, lung abscess, osteomilitis, tuberculosis and various malignancies d. Iron deficiency anemia Cause: - Inadequate iron intake, increased requirement during pregnancy, menstruation - Impaired absorption (post gastrectomy) - Loss of blood that persist (neoplasms, polyps, gastritis, varices of esophagus, hemorrhoids, etc..) ↓ eritropoesis disorders ↓ Iron absorption from the intestine less ↓ little red blood cells (the amount is less) poor red blood cell hemoglobin ↓ Iron deficiency anemia
The symptoms: - Atrophy of tongue papillae - Tongue pale, red, inflamed - Stomatitis angularis, pain in corner of mouth Morphology: microcytic anemia hipokromik
e. Megaloblastic anemia Cause: - Deficiency of vitamin B12 deficiency and folic acid deficiency - Malnutrition, malabsorption, decreased intrinsic factor (aneia rnis st gastrectomy), parasitic infections, intestinal diseases and malignancies, chemotherapeutic agents, tapeworm infection, eating fresh fish is infected, alcoholics. ↓ Impaired DNA synthesis ↓ Impaired maturation of red blood cell nucleus ↓ Megaloblas (eritroblas large) ↓ Erythrocyte immatur and hipofungsi
2. Anemia hemolitika, namely deficiency anemia red blood cell count caused by destruction of red blood cells: - Effect of certain drugs - Disease Hookin, limfosarkoma, multiple myeloma, chronic lymphocytic leukemia - Glucose 6 phosphate deficiency dihidrigenase - The process of autoimmune - Transfusion reaction - Malaria


↓ Erythrocyte cell mutations / changes in erythrocyte ↓ Antigesn on erythrocyte changes ↓ Considered a foreign object by the body ↓ red blood cells destroyed by the lymphocytes ↓ Hemolytic anemia
E. Signs and Symptoms o Weak, tired, listless and tired o Often complained of dizziness and eye dizzy o Symptoms of advanced form of the eyelids, lips, tongue, skin and palms become pale.
F. Possible Complications arise General complications due to anemia are: o heart failure, o parestisia and o seizures.
G. Special Inspection and Support o Levels of hemoglobin, hematocrit, red blood cell indices, white blood cell study, levels of Fe, the measurement of iron binding capacity, folate, vitamin B12, platelet count, bleeding time, prothrombin time and partial thromboplastin time. o bone marrow aspiration and biopsy. Unsaturated iron-binding capacity of serum o diagnostic examination to determine the presence of acute and chronic diseases as well as the source of chronic blood loss.
H. Performed by Therapy Management of anemia is aimed to find the cause and replace lost blood: 1. Aplastic Anemia: o Bone marrow transplant o Provision of immunosuppressive therapy with globolin antitimosit (ATG) 2. Anemia in kidney disease o In paien dialysis should be treated denganpemberian iron and folic acid o The availability of recombinant eritropoetin 3. Anemia in chronic disease o Most patients are asymptomatic and require no treatment for aneminya, with the successful handling of the underlying abnormality, bone marrow iron used to make blood, so that Hb increases. 4. Iron deficiency anemia in o Wanted causes of iron deficiency o Use of oral iron preparations: feros sulfate, gluconate and fumarate ferosus ferosus.

5. Megaloblastic anemia o vitamin B12 deficiency is treated with vitamin B12, if the deficiency is caused by the unavailability defekabsorbsi or intrinsic factor vitamin B12 can be given by IM injection. o To prevent recurrence of anemia of vitamin B12 therapy should be continued during the life of patients suffering from pernicious anemia or malabsorption that can not be corrected. o The handling of folic acid deficiency anemia with diet and addition of folic acid 1 mg / day, IM in patients with impaired absorption.

II. NURSING DIAGNOSIS AND COLLABORATIVE PROBLEMS THAT MAY ARISE 1. Intolerance bd activity imbalance between supply and demand of oxygen. 2. Imbalance nutrition less than body requirements bd inadekuat food intake. 3. Ineffective tissue perfusion changes in the bond bd O2 with Hb, decrease in Hb concentration in the blood. 4. Risk of infection b / d of secondary immune decline (decline in Hb), invasive procedures 5. PK anemia 6. Less pengatahuan about the disease and its treatment b / d less information. 7. Deficite Syndrome Self Care b.d weakness