ANEMIA

Lecturer: Dr.Rachma Kasimbara.,S.Pd.,m.Pd

COMPILED BY:

Yahwa Rizki Syahrani Asmara (221056)

NURSING DEPARTMENT

D3 NURSING STUDY PROGRAM

ITSK RS Dr. SOEPRAOEN MALANG

2023/2024
 PREFACE

Praise the author's gratitude to Allah SWT for all His grace and guidance so that the author can
complete the paper with the title Anemia paper at the Institute of Health Science and Technology Dr. S
oepraoen Hospital Malang in the framework of English course assignments for the 2023/2024 academi
c year.On this occasion, the author would like to thank Mrs. Dr. Rachma Kasimbara, S.Pd, m.Pd. as the
supervisor,My beloved parents and family for their love, support, and hard work so far,

As well as all those who have assisted in the implementation and completion of the paper with t
he title Anemia at the Institute of Health Science and Technology Dr. Soepraoen.

The author realizes that in the preparation of this paper there are still shortcomings and limitations, ther
efore with all humility the author apologizes for these shortcomings and limitations. Hopefully this pap
er is useful for the benefit, advancement of education, and the welfare of us all. Aamiin.

Malang, 27 October 2023

i
 TABLE OF CONTENTS

FOREWORD

TABLE OF CONTENTS

CHAPTER 1 INTRODUCTION

1.1 BACKGROUND..........................................................................

1.2 GOALS.......................................................

1.3 BENEFITS.................................................................................

CHAPTER 2 DISCUSSION

2.1 Definition of Anemia.......................................................

2.2 Factors can cause Anemia....................................................

2.3 Symptoms of Anemia.......................................................

2.4 Prevent Anemia.......................................................

2.5 Treatment Anemia..................................................

Il

CHAPTER I

INTRODUCTION

1.1 Background
Anemia is a condition where the level of hemoglobin (Hb) in the blood
less than normal. The factors that cause iron deficiency anemia are nutritional status
influenced by food patterns, family socioeconomics, environment and status health. Although
anemia is caused by various factors, more than 50% Most cases of anemia throughout the
world are directly caused by lack of iron intake. Iron deficiency can cause disorders or barriers
to growth, both body cells and brain cells. Deficiency in Hb levels in the blood can cause
symptoms of lethargy, weakness, tiredness, fatigue and forgetfulness.As a result, it can reduce
learning, sports and work productivity achievements. Besides Iron deficiency anemia will
reduce the body's resistance and result in fatigue exposed to infection (Masrizal, 2007).
Anemia can cause blood to not bind and transport enough oxygen from the lungs to the rest of
the body. Lack of oxygen will result in difficulty concentrating so that learning achievement
decreases, physical endurance is low which results in getting sick easily due to low body
resistance and resulting in rarely go to school or work. The consequences of this anemia if no
intervention is given Over a long period of time it will cause several diseases such as heart
failure congestive disease, bacterial infections, thalassemia, immune system disorders, and
meningitis
(DILLA Nursari, 2010).
Women suffer from anemia more often than men, especially women
pregnant, young and poor women. This is in accordance with women's physiological needs
which increases during pregnancy and is also a factor in bleeding through menstruation that
occurs each month. 45.7% of women of childbearing age (WUS) in Southeast Asia and 47.5%
in Africa reported suffering from anemia. In Bangladesh 26% of maternal deaths are caused
by anemia and bleeding after giving birth (DILLA Nursari, 2010).
According to Permaesih (2005) anemia in adolescents is a health problem
community because the prevalence is above 20%. Several studies have found The high
prevalence of anemia in adolescents, among others, is the result of research by Saidin,
Permaesih and Leginem, respectively, got 41%, 25% and 88%. According to Rosmalina
(2014), The prevalence rate of anemia in Indonesia, namely among female adolescents by
26.50%, in women of childbearing age by 26.9%, in pregnant women by 40.1%
and in toddlers it was 47.0%. Meanwhile, from the Ministry of Health report, the prevalence
of anemia among young women in Indonesia 30% and among young men 21% (Yunarsih,
2014).According to the 2013 Riskesdas results, it was reported that the population aged 5-14
years old experienced anemia by 26.4%, aged 15-24 years experienced anemia
amounting to 18.4%. Meanwhile, the total population is the total population Women
experience anemia at a higher rate than the male population namely 23.9%. The total
population of Indonesia is anemic
namely 21.7% (Balitbang Ministry of Health of the Republic of Indonesia, 2013).Anemia in
adolescents is a condition of hemoglobin levels in the blood lower than normal values.
Threshold values for anemia according to WHO 2001 is for ages 5-11 years < 11.5 g/L, for
ages 11-14 years ≤ 2.0 g/L, adolescents over 15 years for girls < 12.0 g/L and boys < 3.0
g/L.Adolescent boys and girls in their growing period need it more energy, protein and other
nutrients than other age groups. Sexual maturation in adolescents causes a need for substances
iron increases. Adolescent girls' iron requirements are higher than those of women teenage
boys, because it is needed to replace iron lost in
during menstruation (Permaesih, 2005).
Anemia can reduce an individual's work capacity. People who experience
Anemia often causes headaches and dizziness. Negative impact of anemia is that it can
interfere with mental processes and reduce intelligence, distraction immunity, and reduces the
capacity to learn (Mulyadi and Labenjang, 2014).Anemia can cause decreased learning
achievement and productivity Work. Besides that, it also reduces the body's resistance so that
it is easily affected infection. Anemia can affect a person's level of physical fitness, this
supported by Permaesih's research that 25% of teenagers in Bandung have it less than normal
 physical fitness. This situation affects concentration and learning achievement as well as
influencing work productivity among teenagers.
Considering that the impact that occurs as a result of anemia is very detrimental for the future
in the future, preventive and corrective efforts need to be carried out. For carrying out optimal
prevention and repair efforts requires information complete and precise information about
nutritional status in adolescents and its factors
influence it (Permaesih, 2005).Until now, there is specific information about the rate of
anemia in students schools are still very limited. More anemia prevention programs targeting
pregnant women and mothers giving birth. If we look at the general characteristics of students
schools that are in a period of growth and development with various
Another influencing factor, of course, is that this group is very susceptible to anemia.In
addition, there is no routine health service program for monitoring anemia in students. From
the background and facts above, researchers are interested in researched "Overview of
Hemoglobin Levels in Students of SMP Negeri 2 Kediri Regency Tabanan.”

1.2 Goals
1. General Objectives
The general aim of this research is to determine the level description
hemoglobin in students of SMP Negeri 2 Kediri, Tabanan Regency.
2. Specific Objectives
a. To find out the characteristics of students at SMP Negeri 2 Kediri, Tabanan Regency
b. To measure the hemoglobin levels of students at SMP Negeri 2 Kediri Regency
Tabanan
c. To describe the hemoglobin levels of students at SMP Negeri 2 Kediri Regency
Tabanan based on certain characteristics, namely age, gender and nutrition
(dietary habit)

1.3 Benefits

1. Theoretical Benefits

The results of this research can be used as a reference for development

knowledge about anemia, especially in junior high school students.

2. Practical Benefits
 a. Providing information regarding hemoglobin levels in students at SMP Negeri 2 Kediri.

b. Providing information to the government for further action further regarding nutritional
anemia suffered by students

CHAPTER II

LITERATURE REVIEW

2.1 Understanding

Anemia is a decrease in erythrocyte mass that causes its inability to meet the oxygen needs
of peripheral tissues.
Clinically, anemia can be measured by a decrease in hemoglobin levels, hematocrit, or erythrocyte cou
nt, but the one most often used is hemoglobin level testing (Bakta, 2015).
Anemia or lack of red blood cells is a condition where the number red blood cells or hemoglobin (a pr
otein that carries oxygen) in cells red blood is below normal. The red blood cells themselves contain h
emoglobin which plays a role in transporting oxygen from the lungs and deliver to all parts of the bod
y. (Hasdianah & Suprapto, 2016).

2.2 Signs and Symptomps of anemia

A. Mild Anemia

According to WHO, mild anemia is a condition where the Hb level in the blood between Hb 8 g/dl – 9.
9 g/dl. Meanwhile, based on the Indonesian Ministry of Health, mild anemia, namely when the Hb lev
el is between Hb 8 g/dl - <11 g/dl. Number of cells Low blood pressure can cause reduced oxygen deli
very to every tissue throughout the body so that signs and symptoms appear and can worsening other
medical conditions. In mild anemia generally not causes symptoms because anemia continues slowly s
o that the body adapts and compensates for the changes. Symptoms will appear when anemia continue
s to become more severe. Symptoms of anemia that may appear:

1) Fatigue

2) Decreased energy
3) Weakness
4)Mild shortness of breath

5)Palpitations

6)Looks pale (Damayanti, 2017)

B. Severe Anemia

According to WHO, severe anemia is a condition where the Hb level is low blood below < 6 g/dl. M
eanwhile, according to the Indonesian Ministry of Health, severe anemia, namely when the Hb level
is below <5 g/dl. Some signs that may appear on sufferers of severe anemia, namely:

1)Changes in stool color, including black stools and sticky, smelly stools rotten, maroon in color, or a
ppears bloody if anemia is due blood loss through the digestive tract.
2)Fast heart rate

3)Low blood pressure

4)Rapid respiratory rate

5)Pale or cold skin

6)Yellow skin is called jaundice if anemia is caused by damage to red blood cells

7)Heart murmur

8)Enlarged spleen with certain causes of anemia (Damayanti, 2017)

2.3 Various types of anemia

A.Iron deficiency anemia is a lack of iron intake when eating or slow or chronic blood loss Iron is a co
mponent essential hemoglobin which covers most of the red blood cells.(Kowalak, Welsh, & Mayer, 2
016)
B.Megaloblastic anemia

Anemia occurs due to abnormalities in the process of forming blood cell DNA red caused by a deficien
cy (deficiency) of vitamin B12 and folic acid.
C.Hypoplastic anemia

Anemia that occurs due to an incompetent bone marrow disorder make new blood cells.
D.Aplastic Anemia

Sufferers experience pancytopenia, which is a condition where it occurs deficiency in the number of r
ed blood cells, white blood cells and platelets. Anemia aplastic is often caused by radiation and expos
ure to chemicals.Will however, in most patients the cause is idiopathic, which means the cause is unk
nown. Aplastic anemia may also be associated with
viral infections and with other diseases

2.4 How to Check hemogoblin levels

Checking for anemia can be done by checking hemoglobin levels This is something that is often done
by every laboratory. Inspection Hemoglobin can be done through several methods (Norsiah, 2015).
a.Methodcyanmethemoglobin.

A more sophisticated method is the methodcyanmethemoglobin.On method This hemoglobin is oxidiz

ed by potassium ferrocyanide to become methemoglobin then reacts with cyanide ions to form cyan-m
ethemoglobin red. The color intensity is read with a photometer and compared with standards. Because
comparing electronic devices, the results are better objective.However, today's photometers are still qu
ite expensive, so all the laboratory has it.

b. Sahli Method

The Sahli method is no longer recommended recently due to has a fairly large error ratio, the Sahli met
hod is hemoglobin converted into acid hematin, then the resulting color is compared visually with a sta
ndard in a hemometer and read in a sahli tube. This way is also not good because not all types of hemo
globin can be converted into acid hematin.

c. Microcuvette method
The reaction in the microcuvette is an azide-methemoglobin reaction modified. Erythrocytes hemolyze
and release hemoglobin. Hemoglobin this is converted to methemoglobin and then combined with azid
e dto form azide-methemoglobin. Gradual measurements in the analyzer at where transmittance is mea
sured and absorption of hemoglobin levels is measured. This absorbance directly proportional to hemo
globin levels.
2.5. Hemoglobin and anemia criteria

Hemoglobin is a complex protein, composed of proteins globin, protophyrin and iron. Protophyrin is f
ormed around the mitochondria, the globin It self is formed around ribosomes and iron comes from tra
nsferrin (Dodik, 2014). Hemoglobin levels based on age according to (WHO, 2014) are related with a
nemia in the population of non-pregnant women aged 15 years and over in categorize as follows: Nor
mal (>12 mg/dl), mild (11.0-11.9 mg/dl),moderate(8.0-10.9 mg/dl), severe (<8.0 mg/dl).

2.6 Causes of anemia

According to (Hasdianah & Suprapto, 2016) Common causes of anemia include: iron deficiency, blee
ding, genetics, folic acid deficiency, bone marrow disorders.Broadly speaking, anemia can be caused
by:

a.Increased erythrocyte destruction, for example in systemic disorders immune, thalassemia.

b.Decreased erythrocyte production, for example in aplastic anemia, lack of nutrition.

c.Loss of large amounts of blood, for example due to acute bleeding, chronic bleeding, menstruation, tr
auma

The causes of anemia can be divided into two, namely:

directly or indirectly:

1. Direct cause

These direct causes are direct factors

Affecting hemoglobin levels in a person includes:

A.Menstruation in adolescent girls

Menstruation experienced by young women every month is sala one cause of anemia. Discharge of blo
od from the teenager's body at the time Menstruation causes hemoglobin to be contained in red blood c
ells is also wasted, so that iron reserves in the body will also decrease and that will cause anemia (Dodi
k, 2014).
B.Insufficient food intake for the body.

This factor is related to the food intake that goes into the body body. Such as iron deficiency anemia,
which is a lack of iron intake when eating or slow or chronic blood loss. Iron is a component essential
hemoglobin which covers most of the red blood cells.No An adequate supply of iron in the body result
s in hemoglobin decrease. Folic acid deficiency in the body can be characterized by: an increase in the
size of erythrocytes caused by abnormalities in the process hematopoeisis (Hasdianah & Suprapto, 20
16)
C. Lifestyle is like breakfast.
Breakfast is very important for a teenager because it is breakfast a teenager's energy and thinking patte
rns become undisturbed. No balance between nutrition and activities carried out. Adolescents with nut
ritional status which is good if there is heavy activity there will be no complaints, and if the nutritional
status a teenager is lacking and always doing strenuous activities causes a teenager to be weak, pale, d
izzy, due to nutritional intake what they eat is not balanced with their activities (Yuni & Erlina, 2015).
D. Infections and parasites

Infections and parasites that contribute to the increase in anemia are malaria, HIV infection, and worm
infections. In tropical areas, parasitic infections mainly Hookworms can cause massive blood loss, due
to the worms mines suck blood. Deficiency of specific nutrients such as vitamins A, B6, B12, riboflavi
n and folic acid, common and chronic infectious diseases including HIV/AIDS can also cause anemia.
Malaria in particularPlasmodium falciparumAlso can cause red blood cells to burst. Worm like typeTri
churis trichiura And Schistosoma haematobiumcan cause blood loss(Nestel, 2012).

2. Indirect causes

These indirect causes are indirect factors Affecting hemoglobin levels in a perso
n includes:
A. Knowledge level
Knowledge makes a person's understanding of anemia along with the causes and prevention are getting
better. Someone who Having good knowledge will try to prevent anemia such as consuming foods that
contain lots of iron to maintain Hemoglobin levels are normal.
B. Socioeconomic.
Socioeconomics is related to the capabilities of a family within a family meet the family's food needs b
oth in terms of quantity and quality.Families with a high economic level will find it easy to provide ful
fillment food intake needs for his family with food that meets
balanced nutrition, but things are different if this problem is experienced by families with a low econ
omy, so often the amount of food is limited Priority is given to quality while meeting balanced nutriti
onal needs received less attention.

2.7. Consumption of iron (Fe)

1. Iron
Iron is a mineral which is an organic substance micronutrients required by the body in smaller quan
tities than macronutrients. As one of the building blocks of hemoglobin, iron is vital elements whos
e quantities must remain sufficient (Bakta, 2015).
Iron is an essential micro element for the body, which is necessary in blood formation, namely to synt
hesize hemoglobin. Excess substance Iron is stored as ferritin and hemosiderin in the liver and bone m
arrow back and stored in the lymph and muscles. Iron deficiency will causes a decrease in ferritin leve
ls which is followed by a decrease transferrin saturation or increased protophorifin. If things continue
Iron deficiency anemia will occur, where the hemoglobin level falls below the value normal (Sunita, S
oetardjo, & Moesijanti, 2011)

2. Source of iron (Fe)

Iron in food is in the form of Fe-heme (a source of animal protein) and Fe-nonheme (vegetable protein
source). Iron from vegetable sources is only absorbed by 1 – 2%, while animal sources of iron are more
easily absorbed, namely as much as 10 – 20% (Susetyawati, 2017).Sources of iron come from animal a
nd plant foods, as follows Iron (Fe) can be found in several foods such as:
 Table 1
No Food material Dose Iron (Fe) mg
Source o f iron (Fe)
in food 1 Potato 100 gr 3

2 Beef 100 gr 2
3. Iron (F e) require
ments 100 gr 5
3 Chicken's liver 4 Chick
Iron needs in adolesc
en eggs
1,2
ents are in 100 gr fluenced
5 Oyster
by growth and activi
5
ty physical. 6 100 gr Average r
Squid
ecommend 5 ed iron ad
equacy rat 7 Shell 100 gr e for teen
agers per d 5 ay.
8 Know 100 gr
2
9 Soybeans 10 Peanut 100 gr
2
11 Sesame seeds
100 gr
4
12 Spinach
100 gr
14
13 Tomato 100 gr
2

14 Passion fruit 100 gr

2

15 Avocado 100 gr 3.78

100 gr 1.12

100 gr

Table 2
 Categories of daily iron (Fe) requirements

No Population Iron (Fe) mg

1 Woman 26
(13-15 years old) 26

2 Woman

(>15 years no
pregnant )
Source (AKG, 2019)

4. Factors influencing iron consumption

A.Knowledge will influence a person's mindset in making decisions attitudes and behavior in choosi
ng food. Good teenage knowledge regarding anemia is the main thing in maintaining internal iron re
quirements daily food. A person's level of nutritional knowledge can influence behavior in choosing
food (Merryana & Bambang,2014). Research results (Ngatu & Rochmawati, 2014) state that There is
a relationship between knowledge and the incidence of anemia in young women in SMKN 4 Yogyak
arta.
B.Food taboos can be caused by taboos in society or due to allergies to several types of food, such as
sea fish, eggs, papaya, nuts, etc. There are food restrictions This can affect iron intake. This is very v
ulnerable on nutritional adequacy.

C.A person's eating behavior, in this case teenagers, is influenced by many things things, including f
amily income. Family income plays a very important role. What food is consumed
Teenagers are very dependent on what food is served by the family in this case. This type of food also
really depends on how big it is funds available for purchasing family food. (Notoatmodjo S.,2014).

5. Which inhibits and accelerates internal absorption of iron (Fe).

body.

A.What inhibits the absorption of iron (Fe) are phytic acid, oxalic acid, tannin, calcium, phosphitin a
nd fiber. Phytic acid is found in many ingredients cereal foods, oxalic acid is found in many vegetabl
es, phosphitin found in many egg yolks. This compound will bind iron so iron becomes difficult to a
bsorb.
B.What accelerates the absorption of iron (Fe) are organic acids, such as vitamin C. Vitamin C really
helps the absorption of non-heme iron with functions as a reducer to convert ferric to ferrous. Fero is
an iron compound that is easily absorbed by the body. Apart from that, vitamin C It can also form iro
n ascorbate groups which remain soluble at higher pH high in the duodenum. Thus it is highly recom
mended for Consume foods containing vitamin C to help iron absorption. Organic acids other than vi
tamin C are citric acid.