Medizines

The basic physiologic defect caused by anemia is a decrease in the oxygen-carrying capacity of blood and consequently a reduction in the amount of oxygen available to the tissues. Most of the clinical manifestations are directly attributable to tissue hypoxia. Muscle weakness and easy fatigability are common, although children seem to have a remarkable ability to function quite well despite low levels of hemoglobin.

The skin is usually pale to a waxy pallor in severe anemia. Cyanosis is typically not evident; because it is the result of the quantity of deoxygenated hemoglobin and/or red blood cells, not inadequate oxygen saturation of existing hemoglobin. The doctor should also keep in mind that skin pigmentation can alter one's assessment of kin pallor.

Central nervous system manifestations inclined headache, dizziness, light- headedness, irritability, slowed thought processes, decreased attention span, apathy, and depression. Growth retardation resulting from decreased cellular metabolism and coexisting anorexia is a common finding in chronic severe anemia. It is frequently accompanied by delayed sexual maturation in the older child.

The effects of anemia on the circulatory system can be profound. A reduction is hemoglobin concentration that results in decreased oxygen-carrying capacity of the blood is associated with a compensatory increase in heart rate and cardiac output. Initially this greater cardiac output compensate for the lower oxygen-carrying capacity of the blood, since blood replenished with oxygen returns to the tissues at a faster than normal rate.

Diagnostic evaluation
Several tests can be used to the levels of RBC and hemoglobin. These are routine hematological laboratory procedures. Other tests used to diagnose the underlying cause of anemia are included elsewhere in the discussion of the particular disorder.

Therapeutic management
The objective of medical management is to reverse the anemia by treating the underlying cause. For example, in nutritional anemia the specific deficiency is replaced. In blood loss caused by hemorrhage, packed red blood cells or whole blood is given. In cases of severe anemia supportive medical care may include oxygen therapy restoration of adequate blood volume, intravenous fluids and bad rest.

Nursing considerations
Since anemia is not a disorder but a symptom of some underlying problem, nursing care is related to determining the cause, fostering appropriate supportive and therapeutic treatments, and decreasing tissue oxygen requirements.

Assist in establishing a diagnosis. Although, the physical examination yields valuable evidence regarding the severity of the anemia and some indication of its possible etiology, diagnosis primarily rests on hematological blood studies and a careful history.

Prepare child for laboratory tests. Explain to older children the need for repeated veni-punctures or finger-sticks for blood analysis. Particularly why a sequence of tests is required. Allow children to play with laboratory equipment and/or participate with test. Older children may enjoy looking at blood smears under a microscope or at pictures of blood cells.

Observe for signs of shock and hypoxia from repeated blood samples. Explain to parents reason for replacing withdrawn blood and necessity of performing tests.

Minimize physical exertion. Assess child's level of physical tolerance. Anticipate and assist child in those activities of daily living that may be beyond his tolerance. Provided diversional play activities that promote rest and quiet but prevent boredom and withdrawal choose an appropriate roommate of similar age and interests and one who requires restricted activity.

Minimize emotional stress. Anticipate child's irritability, short attention span, and fretfulness by offering to assist him in activities rather than waiting for him to ask. Assess parents' awareness of child's need for dependency to conserve strength. Explain to older children and parents reason for behavioral changes caused by anemia. Encourage parents to remain with child.

Place child in room with noninfectious children; restrict visitors with active illnesses. Advice visitors (and hospital personnel) to practices good hand washing. Report any temperature elevation to physician. Observe for leukocytosis. Maintain adequate nutrition.

Alert ancillary hospital personnel regarding child's physical tolerance and need for assistance during activity. Keep side rails raised and use safety restraints when applicable.

Be alert to signs of heart failure from excessive cardiac demands of from cardiac over load during blood transfusion. Practice all precautions. Check blood with another nurse and physician to ensure correct blood group/ type with that of child. Run blood slowly and remain with child for infusion of initial 50ml. Stop blood immediately if any untoward reaction occurs. Attach blood to piggy back setup with normal saline or other intravenous solutions to maintain open venous line. Observe for signs and symptoms of reaction.

Those who suffer from Anemia either have a reduced number of red blood cells or a reduced amount of hemoglobin (the component of red blood cells that attaches to oxygen and transports it in the blood). Since there is less oxygen available to the cells in the body, Anemics have less energy to perform normal functions. The most common cause of Anemia is iron deficiency... iron is used to make hemoglobin. Most Anemics are on medication for life. We are interested in fixing the nutritional deficiencies underlying the condition to heal the ailment completely.
Iron is a trace mineral of vital importance to the body. Although there is only about a teaspoon of it in your body at any one time, it is essential in the formation of Hemoglobin, the red pigment of blood. There are two types of iron: Heme and Non-Heme. Now, Heme is more easily absorbed by the gastro-intestinal tract (10-30%) while Non-Heme is only about1-10% absorbed. Heme is available in the tissues of animals. That's right, the more available source of iron is found in meats and dairy than in plants. But we suggest only obtaining your iron from vegetable sources. Why?
The interesting fact is that despite a less absorbable form of iron, vegetarians are no more likely to suffer from iron deficiency than non-vegetarians. Draper and Wheeler have stated there is no indication of increased prevalence of iron deficiency amongst vegetarians. Anderson found the iron status of long-term vegetarian women to be adequate, despite a high intake of fiber and phytate which INHIBITS the absorption of iron!
In fact, because iron can be stored in the body, too much iron can cause problems. Too much iron consumption leads to the production of free radicals (a molecule with an extra electron that will steal a negatively charged hydrogen electron from DNA, tissues, or organs which causes disease and aging). High levels of iron have also been found in association with heart disease and cancer. The buildup of iron in the tissues has been associated with a rare disease known as hemochromatosis, a hereditary disorder of iron metabolism that causes bronze skin pigmentation, cirrhosis of the liver, diabetes, and heart disorders. All of this leads us to the conclusion that despite animal foods, you should never get your iron from a supplement. First, the pill will not have all of the other organic nutrients (copper, manganese, molybdenum, Vitamin A, and the B complex) necessary to absorb the iron safely. Second, in pills, you will get something like ferrous oxide (oxidized iron: In other words, RUST).

Symptoms:
Weakness, fatigue, overall pallor, dizziness, pale lips and eyelids, depression, pale and brittle nails, and coldness of the extremities
Recommendations:

• An all natural whole food supplement can be helpful. VITAFORCE(TM) is extremely abundant in organic iron and has extraordinary blood building properties. Iron is up to 16 times more absorbable if taken with Vitamin C and this is properly balanced naturally in VITAFORCE(TM). It is also extremely rich in all the other nutrients necessary for healthy blood.
• If you are anemic, then drink juices rich in chlorophyll. Chlorophyll is responsible for the green pigment in plants (called the "blood" of plants). Chlorophyll has almost the exact same chemical makeup of hemoglobin (less one iron molecule), both are responsible for carrying oxygen in the blood. Since the chemical makeup is almost identical, chlorophyll can quickly and easily be converted to hemoglobin. If the juices are rich in organic iron, then you have all the qualities for a blood transfusion. For example, the fresh organic juice of carrots, beets and beet greens dramatically increases the red blood cell count in the body. Dark leafy vegetables and especially They have extraordinary blood-building properties.
• Other foods that contain iron are asparagus, bananas, beets, dulse, kelp, whole grains (esp. millet & kamut), leafy greens, raisins, parsley, peas, plums, squash, prunes, purple grapes, broccoli, and yams.

Things to Avoid:

• All inorganic supplemental forms of iron; none of the iron supplements use organic iron, so you cannot absorb any of it and it gets pissed away or lodged in your tissues where it can cause disease.
• Caffeine and tannins (in tea), and calcium inhibit iron absorption. So, avoid coffee and tea.
• Beer, candy bars, dairy products (milk, cheese, butter, ice cream, etc...), and soft drinks. Additives in these foods interfere with the absorption of iron.
• Foods containing oxalic acids inhibit the absorption of iron. Eat only in moderate amounts; almonds, cashews, chocolate, cocoa, soda, and most nuts and beans.

References:1) James F. Balch, M.D, Phyllis A. Balch, C.N.C, "Prescription for Nutritional Healing," (1997)
2) Anderson, B. et al. The iron and zinc status of long-term vegetarian women. Am J of Clin Nutr v.34 (6),(1981):p.1042-1048.3) Draper, A. & Wheeler, E. The diet and food choice of vegetarians in Greater London. Center of Human Nutrition, London.(1989)

By Scott Malin