About 8 to 10 per cent of all African Americans carry the sickle cell gene. They are found most often in those of black African descent, but they also occur in persons of Mediterranean (Southern European and North African), Middle Eastern, or Asian Indian ancestry. Sickle cell disease any of the diseases associated with the presence of hemoglobin S, including sickle cell anemia, sickle cell– thalassemia, and the conditions called sickle cell–hemoglobin C and D disease. This can result in some degree of self-care deficit as the fatigue interferes with the patient's ability to carry on regular or enjoyable activities. Physical activity increases demand for oxygen, but if there are not enough circulating erythrocytes to provide sufficient oxygen, patients become physically weak and unable to engage in normal physical activity without experiencing profound fatigue. A bluish tint to the skin (cyanosis) can indicate hypoxia due to inadequate numbers of oxygen-bearing erythrocytes.Īctivity intolerance is a common problem for patients with anemia. (See also jaundice.) Bleeding under the skin and bruises in response to the slightest trauma often are present in anemic and leukemic patients. Jaundice of the skin and sclera can occur as a result of hemolysis and the release of bilirubin into the blood stream, where it eventually finds its way into the skin and mucous membranes. Although pallor of the skin is a sign of anemia, it is not the most reliable sign many other factors can affect complexion and skin color. Anemia can affect many different body systems (see table). In general, these patients do share some common problems requiring special assessment skills and interventions. Assessment of patients with some form of anemia will depend to some extent on the specific type of blood dyscrasia presented. Anemias associated with folic acid deficiency are very common.Įxcessive Destruction of Red Blood Cells (hemolytic anemia): Anemia may also develop related to hemolysis due to trauma, chemical agents or medications (toxic hemolytic anemia), infectious disease, isoimmune hemolytic reactions, autoimmune disorders, and the paroxysmal hemoglobinurias. The combination of poor diet and chronic loss of blood makes for particular susceptibility to severe anemia. To help the blood replenish itself, the health care provider may prescribe medicines containing iron, which is necessary to build hemoglobin, and foods with high iron content, such as kidney and navy beans, liver, spinach, and whole wheat bread.ĭietary Deficiencies and Abnormalities of Red Blood Cell Production (Nutritional Anemia, Aplastic Anemia, and Hypoplastic Anemia): Anemia may develop if the diet does not provide enough iron, protein, vitamin B 12, and other vitamins and minerals needed in the production of hemoglobin and the formation of erythrocytes. These anemias disappear when the cause has been found and corrected. Chronic blood loss, such as excessive menstrual flow, or slow loss of blood from an ulcer or cancer of the gastrointestinal tract, may also lead to anemia. Immediate transfusions are generally required to replace the lost blood. Loss of Blood (Hemorrhagic Anemia): If there is massive bleeding from a wound or other lesion, the body may lose enough blood to cause severe and acute anemia, which is often accompanied by shock. adj., adj ane´mic.Ĭommon Causes of Anemia. Data used to identify anemia types include the erythrocyte indices: (1) mean corpuscular volume (MCV), the average erythrocyte volume (2) mean corpuscular hemoglobin (MCH), the average amount of hemoglobin per erythrocyte and (3) mean corpuscular hemoglobin concentration (MCHC), the average concentration of hemoglobin in erythrocytes. A type called hypochromic microcytic anemia is characterized by very small erythrocytes that have low hemoglobin concentration and hence poor coloration. Anemias can also be classified according to the morphologic characteristics of the erythrocytes, such as size ( microcytic, macrocytic, and normocytic anemias) and color or hemoglobin concentration ( hypochromic anemia). Some types of anemia are named for the factors causing them: poor diet ( nutritional anemia), excessive blood loss ( hemorrhagic anemia), congenital defects of hemoglobin ( hypochromic anemia), exposure to industrial poisons, diseases of the bone marrow ( aplastic anemia and hypoplastic anemia), or any other disorder that upsets the balance between blood loss through bleeding or destruction of blood cells and production of blood cells. The smear from the patient shows variation in the size and shape of erythrocytes and the presence of macro-ovalocytes. Peripheral blood smears from a patient with megaloblastic anemia (left) and from a normal subject (right), both at the same magnification.
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