HYPOPROLIFERATIVE ANEMIA

• The bone marrow does not produce adequate numbers of erythrocytes.

• Decreased erythrocyte production is reflected by a low or inappropriately normal reticulocyte
count. Inadequate production of erythrocytes may result from marrow damage due to medications
(e.g., chloramphenicol [Chloromycetin]), chemicals (e.g., benzene), or from a lack of factors (e.g.,
iron, vitamin B12, folic acid, erythropoietin) necessary for erythrocyte formation.
 HYPOPROLIFERATIVE ANEMIA
• IRON DEFICIENCY ANEMIA - is the most common type of anemia in all age groups, and it is
the most common anemia in the worldtypically results when the intake of dietary iron is
inadequate for hemoglobin synthesis.
- Iron deficiency can also occur when total body iron stores are
adequate, but the supply of iron to the bone marrow is inadequate; this type is referred to as
functional iron deficiency
Clinical Manifestations: smooth, red tongue; brittle and ridged nails; and angular cheilosis.
These signs subside after iron replacement therapy
 HYPOPROLIFERATIVE ANEMIA
• IRON DEFICIENCY ANEMIA
• Assessment:
• Pallor
• Weakness
• Fatigue
• Irritability
• Poor focus
• RBC are smaller than the
usual size (microcytic)
• RBC are decreased in
red color (hypochromic)
• Diagnostic Findings - bone marrow aspiration - to assess how a patient’s blood cells are
being formed and to assess the quantity and quality of each type of cell produced within the
marrow. Normal bone marrow is in a semifluid state and can be aspirated through a special large
needle. In adults, bone marrow is usually aspirated from the iliac crest (The posterior superior iliac
crest – because no vital organs or vessels nearby) and occasionally from the sternum.

• The patient is placed either in the lateral position with one leg flexed or in the
• prone position. A. Bone marrow aspiration. B. Inserting a Jamshidi biopsy needle. C. Dispensing
the bone marrow core
• Diagnostic Findings – CBC – Hematrocit and Hemoglobin levels are low.

• Medical Management:
• Iron deficiency anemia is a sign of a curable GI cancer or of uterine fibroid tumors – further tests are to
be done
• Oral iron supplementation (6 to 12 months) is considered to be the primary mode of treating iron
deficiency anemia (ferrous sulfate, ferrous gluconate, and ferrous fumarate)

• Nursing Management:
• Preventive education - helps the patient select a healthy diet
• Food sources high in iron include organ meats (e.g., beef or calf’s liver, chicken liver), other meats, beans
(e.g., black, pinto, and garbanzo), leafy green vegetables, and raisins. Taking iron-rich foods with a source of
vitamin C (e.g.,orange juice) enhances the absorption of iron.
continuation:
• Nursing Management:
• Instruct patient to take oral iron supplements:
• Take iron on an empty stomach (1 hour before or 2 hours after a meal), preferably with orange
juice or other forms of vitamin C. Iron absorption is reduced with food, especially dairy
products.
• Prevent gastrointestinal distress by using the following schedule if more than one tablet a day
is prescribed: Start with only one tablet per day for a few days, then increase to two tablets per
day, then three tablets per day. This method permits the body to adjust gradually to the iron.
• Increase the intake of vitamin C (citrus fruits and juices, strawberries, tomatoes, broccoli) to
enhance iron absorption.
• Eat foods high in fiber to minimize problems with constipation; add stool softener if needed.
• Remember that stools will become dark in color, and constipation
• Rinse the mouth thoroughly afterward due to foul aftertaste and to prevent teeth staining.
• Do not give with milk or antacids because these items can decrease absorption
 HYPOPROLIFERATIVE ANEMIA
• ANEMIA in RENAL DISEASE – patients with Chronic Kidney Disease becomes anemic if
glomerular filtration rate (GFR) is less than 30mL/min/1.73 2
• anemia contributes to increased cardiac output, reduced oxygen utilization, decreased
concentration and cognitive function, reduced immune responsiveness, and reduced libido

• ANEMIA OF INFLAMMATION – anemia caused by chronic diseases,aging, infection,

and malignancy. The anemia is usually mild to moderate and nonprogressive. Anemia on these
case does not require treatment but what is needed is the treatment of the underlying disorder.

• APLASTIC ANEMIA – is a rare disease caused by a decrease in or damage to marrow stem

cells, damage to the microenvironment within the marrow, and replacement of the marrow with
fat. This results to marrow aplasia This is associated with significant neutropenia and
thrombocytopenia. Aplastic anemia also occurs when a medication or chemical is ingested in toxic
amounts.
 • Signs and Symptoms: fatigue, pallor, dyspnea, lymphadenopathy, splenomegaly, retinal hemorrhages
• CBC reveals pancytopenia (a decrease in all myeloid stem cell–derived cells) with a neutrophil
count less than 1500/μL, hemoglobin less than 10 g/dL, and platelets less than 50,000/μL
• Presence of petechiae, purpura, bleeding pallor, weakness, tachycardia and fatigue
• A bone marrow aspirate shows an extremely hypoplastic or even aplastic (very few to no cells)
marrow replaced with fat.
• MEDICAL MANAGEMENT - hematopoietic stem cell transplant (HSCT)
- immunosuppressive therapy - antithymocyte globulin
(ATG) and cyclosporine or androgens
- Supportive therapy - transfusions of PRBCs and
platelets as necessary
• NURSING MANAGEMENT
• assess carefully for signs of infection and bleeding
• monitor for side effects of therapy
• Stress the importance of their immunosuppressive therapy - no abrupt cessation
 HYPOPROLIFERATIVE ANEMIA
• MEGALOBLASTIC ANEMIA – deficiencies of vitamin B12 (PERNICIOUS ANEMIA - due to a
lack of intrinsic factor in stomach secretions causing mal absorption of Vit B12) or folic acid
(essential for normal DNA synthesis). Those who eats less vegetable (folic acid) & meat (vit b12)
- identical bone marrow and peripheral blood changes
occur
- The erythrocytes that are produced are abnormally
large and called megaloblastic red cells
- nonlymphoid leukocytes, platelets are also abnormal
- bone marrow analysis reveals hyperplasia (an
abnormal increase in the number of cells), and the
precursor erythroid and myeloid cells are large and bizarre in appearance.
Continuation:
• MEGALOBLASTIC ANEMIA – only fewer erythroid and myeloid mature cells leave the bone
marrow since they are already been destroyed – causing pancytopenia
• CLINICAL MANIFESTATION - extremely pale, confused, progressive paresthesias in the
extremities (particularly numbness and tingling in the feet and lower legs) and has difficulty
maintaining their balance because of damage to the spinal cord, and they also lose position sense
(proprioception)
• DIAGNOSTICS FINDINGS – Checking of the Serum levels of Folate and Vit B 12
• MEDICAL MANAGEMENT
FOLATE DIFICIENCY: Folate deficiency is treated by increasing the amount of folic acid
in the diet and administering 1 mg of folic acid daily. (Folic acid intramuscularly for patients with
malabsorption problems)
VIT B12 DIFICIENCY: vitamin B12 replacement through supplements/ fortified soy milk
or injections of vitamin B12 intramuscularly.
Continuation:
• NURSING MANAGEMENT
- inspection of the skin, mucous membranes, and tongue
- ensuring safety- check ambulation and should assess the patient’s gait and stability, as well
as the need for assistive devices (e.g., canes, walkers) and for assistance in managing daily
activities.
- encourage eating small amounts of bland, soft foods frequently – because of mouth and
tongue soreness