Anemias

Anemia items ask why the client is short of breath on one flight of stairs and which vitamin or hemoglobinopathy is behind it. Clotting failure, DIC, and transfusion reactions live in Bleeding and transfusion — this chapter owns deficiency anemias and sickle-cell crisis care.

What anemia does at the bedside

Hemoglobin carries oxygen. When it is low — from blood loss, underproduction, or destruction — tissues extract what they can and the heart works harder. Clients look pale, tire easily, get tachycardic, and may be dyspneic on exertion. Nursing basics are rest with clustered care, oxygen as ordered, fall precautions if dizzy, and diet/med teaching matched to the cause. Treating “fatigue” with forced ambulation contests fails the stem when saturation and pulse say the reserve is gone.

• Assess activity tolerance and pace care.
• Report chest pain or syncope — anemia can unmask cardiac ischemia.
• Find the driver: bleed, diet, malabsorption, marrow, hemolysis, or inherited hemoglobin.

Iron deficiency

Iron deficiency is the exam’s workhorse anemia. Blood loss (GI, menstrual) or poor intake empties iron stores, new red cells shrink (microcytic, hypochromic), and oxygen delivery falls. Clients report fatigue, pallor, exertional dyspnea, and sometimes pica or brittle nails. Fixing the count without hunting the bleed (especially occult GI blood in adults) misses the real disease.

Oral iron teaching is precise because absorption is picky. Give on an empty stomach when tolerated, with vitamin C-containing juice. Expect dark stools and possible constipation — dark stool from iron is not a GI bleed by color alone. Liquid iron stains teeth; use a straw. Do not stack the dose onto milk, calcium, tea, or antacids at the same moment. Parenteral iron appears when oral fails or losses are large — watch for infusion reactions per protocol.

B12 and folate: same big cells, different nerves

Both B12 and folate deficiency produce megaloblastic anemia — large, immature red cells and a falling hemoglobin. The split that saves lives on the exam is neurologic. B12 deficiency (including pernicious anemia from lost intrinsic factor) adds paresthesias, ataxia, proprioception loss, and glossitis. Folate deficiency looks hematologically similar without that same classic neuro package. Alcohol use, poor intake, pregnancy demand, and malabsorption are common folate stems.

Pernicious anemia

Pernicious anemia is B12 deficiency from lack of intrinsic factor — oral absorption in the terminal ileum fails, so parenteral or high-dose pathways appear as ordered. Neurologic damage can become permanent; numbness and gait change are not “just aging.” Replace B12 promptly and keep neuro checks in the plan. Do not treat suspected B12 deficiency with folate alone — folate can perk up the blood count while neuropathy worsens.

Diet teaching supports replacement: animal products for B12 when the gut can absorb; leafy greens and fortified foods for folate. Pregnancy folate prevention stems belong with prenatal care, but the absorption/teaching logic is the same.

Sickle cell disease

Sickle hemoglobin polymerizes under stress. Cells deform, sticky aggregates occlude microvasculature, and ischemic pain crises follow. Triggers include infection, dehydration, cold, high altitude, acidosis, and stress. The vaso-occlusive crisis is not “drug-seeking theater” — it is tissue ischemia. Bedside priorities are hydration, oxygenation as ordered, aggressive pain control (believe the pain), and warmth. Ice causes vasoconstriction and is a classic wrong answer on a vaso-occlusive limb.

1. Pain crisis: fluids, O₂ as ordered, analgesia, warmth, treat infection.
2. Fever in sickle cell: emergency evaluation — functional asplenia raises invasive infection risk.
3. Acute chest (chest pain, tachypnea, hypoxia, new infiltrate pattern): escalate now.
4. Neuro change: stroke pathway — do not wait for the next pain dose.

Teaching includes daily hydration, infection prevention, vaccination as ordered (encapsulated organisms matter after splenic loss), and avoiding known triggers. Hydroxyurea and chronic transfusion programs appear as ordered disease-modifying pathways — nursing focus is adherence, toxicity watch, and iron-overload monitoring when transfusions accumulate. Splenic sequestration and aplastic crisis patterns show as sudden anemia and hypovolemia — volume support and escalate. Priapism is a urologic emergency, not a privacy issue to ignore.

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