Anemia is a widespread disease affecting up to one-third of the global population. The prevalence increases with age and is more common in women of reproductive age, pregnant women, and the elderly. Apart from age and sex, the race is also an important determinant of anemia, with the prevalence increasing in the African-American population (Xiao, 2022).
Anemia is strictly defined as a decrease in red blood cell (RBC) mass. Anemia is not a diagnosis, but a presentation of an underlying condition. Most clients experience some symptoms related to anemia when hemoglobin drops below 7.0 g/dL (Xiao, 2022).
The pathophysiology of anemia varies greatly depending on the primary cause. In acute hemorrhagic anemia, it is the restoration of blood volume with intracellular and extracellular fluid that dilutes the remaining RBCs, which results in anemia. A proportionate reduction in both plasma and red cells results in falsely normal hemoglobin and hematocrit. RBCs are produced in the bone marrow and released into circulation. Approximately 1% of RBCs are removed from circulation per day. An imbalance in the production, removal, or destruction of RBC leads to anemia (Xiao, 2022).
The etiology of anemia depends on whether the anemia is hypoproliferative or hyperproliferative.
- Hypoproliferative microcytic anemia has a mean corpuscular volume (MCV) of less than 80 fL, which includes conditions such as iron deficiency anemia, anemia of chronic disease, sideroblastic anemia, thalassemia, and lead poisoning.
- Hypoproliferative normocytic anemia has an MCV of 80 to 100 fL and occurs in renal failure, aplastic anemia, pure red cell aplasia, and multiple myeloma.
- Hypoproliferative macrocytic anemia has an MCV of >100 fL and is caused by alcohol, liver disease, hypothyroidism, folate, vitamin B12 deficiency, and medications.
- Hemolytic anemia with extravascular hemolysis occurs when red cells are prematurely removed from the circulation by the liver and spleen, while intravascular hemolysis occurs when red cells lyse within the circulation and is less common.
The prevalence of anemia is more than 20% of individuals who are older than 85 years. Approximately one-third of clients in the nursing home population have a nutritional deficiency as the cause of anemia, such as folate and vitamin B12 deficiency. Mild iron deficiency anemia is seen in women of childbearing age, usually due to poor dietary intake of iron and monthly loss of menstrual cycles (Xiao, 2022). Race is a factor in nutritional anemias and anemia associated with untreated chronic illnesses to the extent that socioeconomic advantages are distributed along racial lines in a given area. Overall, anemia is twice as prevalent in females as in males. This difference is significantly greater during the childbearing years due to pregnancies and menses (Maakaron & Besa, 2021).
Too often, healthcare professionals rush into the physical examination without looking at the client for an unusual habitus or appearance of underdevelopment, malnutrition, or chronic illness. These findings can be important clues to the underlying etiology of the disease and provide information related to the duration of the illness. Symptoms may include:
- Restless legs
- Shortness of breath, especially upon exertion
- Chest pain
- Reduced exercise tolerance
- Pallor of the palms, conjunctivae, or mucous membranes
The purpose of establishing the etiology of anemia is to permit selection of a specific and effective therapy.
- Anemia due to acute blood loss. Treated with IV fluids, crossmatched PRBCs, and oxygen.
- Anemia due to nutritional deficiencies. Treated with oral or IV iron, B12, and folate.
- Anemia due to defects in the bone marrow and stem cells. Conditions such as aplastic anemia require bone marrow transplantation.
- Anemia due to chronic disease. Anemia in the setting of renal failure, respond to erythropoietin.
- Anemia due to increased red blood cell destruction. Treated by replacement of valves in hemolytic anemia, removal of medications that cause the anemia, splenectomy, blood transfusions, exchange transfusions, or antifibrinolytic agents.
Nursing Diagnosis for Anemia
Risk for Infection
Abdominal pain / headaches / bone or joint pain / muscle cramping / dyspnea / tachypnea / history or recurrent infections / swollen gums / fever / leukemic infiltrates in the dermis
Alterations in mature WBCs
Bone marrow suppression
Risk for Deficient Fluid Volume
Spontaneous, uncontrollable bleeding / changes in menstrual flow / fever / decreased skin turgor / dry oral mucous membranes / tachycardia / hypotension / shortness of breath / muscle cramping
Kidney stone formation
Tumor lysis syndrome
Reports of bone or nerve pain / guarding behaviors / facial grimacing / alteration in muscle tone / tachycardia / increased blood pressure / shortness of breath / decreased ROM / narrowed self-focus
Enlarged organs and lymph nodes
Fear and anxiety
Tension and restlessness
Increased intolerance to pain
Verbal report of fatigue / weakness / exertional discomfort / dyspnea / abnormal heart rate / decreased BP
Isolation due to bed rest
Imbalance in oxygen supply and demand
Verbalization of problem / request for information / statement of misconception / need for further information / lack of recall / questions
Development of preventable complications
Lack of exposure to resources
Inaccurate follow-through of instructions
Impaired Gas Exchange
Dyspnea / use of accessory muscles / restlessness / confusion / tachycardia / cyanosis / hypoxia
Decreased oxygen-carrying capacity of the blood
Decreased blood flow to the peripheries
Inadequate cell nutrition
Abnormal RBC structure
Intolerance of strenuous physical activities
Increased blood viscosity
Ineffective Tissue Perfusion
Diminished peripheral pulses / tachycardia / dyspnea / hypotension / decreased mentation / restlessness / decreased capillary refill / general pallor / angina / tingling in extremities / bone pain / visual disturbances / delayed wound healing
Impaired Physical Mobility
Reports of pain / limited joint ROM / reluctance to move / inability to perform ADLs / guarding of joints / gait disturbances / generalized weakness
Recurrent bone infections
Pain and discomfort
Kyphosis of the upper back
Lordosis of the lower back
Risk for Impaired Skin Integrity
Decreased skin turgor / dry, scaly, or itchy skin / dry oral mucous membranes / erythema of pressure points
Delayed wound healing
Chronic disease process
Inadequate primary defenses
Imbalanced Nutrition: Less than Body Requirements
Weight loss / weight below normal for age, height, and body build / decreased triceps or skinfold measurement / changes in gums or oral mucosa / decreased tolerance to activities / weakness / loss of muscle tone
Impaired oral intake
Inability to absorb nutrients necessary for the formation of normal RBCs
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis Company.
Maakaron, J. E., & Besa, E. C. (2021, September 27). Anemia: Practice Essentials, Pathophysiology, Etiology. Medscape Reference. Retrieved November 25, 2022, from https://emedicine.medscape.com/article/198475-overview#a1
Xiao, R. (2022, August 8). Anemia – StatPearls. NCBI. Retrieved November 25, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK499994/