Medical Surgical


Anemia is a condition of lower-than-normal red blood cell (RBC)  count and hemoglobin (Hgb) level. It is often not a specific disease state but a sign of an underlying disorder. Anemia results in a diminished amount of oxygen delivery to body tissues.  There are many different kinds of anemia, but all can be classified as being due to a decrease in the production of RBC’s (hypoproliferative), excessive destruction of RBC’s  (hemolytic), or a loss of RBC’s (eg. gastrointestinal bleeding). Other etiologic factors  include deficits in iron and nutrients, hereditary factors, and chronic diseases. Complications of severe anemia include heart failure, paresthesias, confusion, and other problems specific to type of anemia.


Several factors influence symptom of development from anemia, including its severity, speed of development (the faster the onset, the more severe the symptoms), and duration (eg. its chronicity; long-term anemia may produce few or no symptoms); the patient’s metabolic requirements and concurrent disorders or disabilities (eg. cardiopulmonary disease); and special complications or features of the condition that produced the anemia. Pronounced symptoms of anemia include the following:

  • Dyspnea, chest pain, muscle pain or cramping, tachycardia
  • Weakness, fatigue, general malaise
  • Pallor of the skin and mucous membranes (sclera, oral mucosa)
  • Jaundice (megaloblastic or hemolytic anemia)
  • Smooth, red tongue (iron-deficiency anemia)
  • Beefy-red, sore tongue (megaloblastic anemia)
  • Angular cheilosis (ulceration of the corner of the mouth)
  • Brittle, ridged, concave nails and pica (unusual craving for starch, dirt, ice) in patients with iron-deficiency anemia


  • Complete hematologic studies (eg. Hgb, hematocrit, reticulocyte count, and RBC indices, particularly mean corpuscular volume)
  • Iron studies (serum iron level, total iron-binding capacity, percentage saturation, and ferritin)
  • Serum vitamin B12 and folate levels, haptoglobin and erythropoietin levels
  • Bone marrow aspiration and biopsy
  • Other studies as indicated to determine underlying illness

Gerontologic Considerations

Anemia is the most common hematologic condition affecting elderly people. In this population, bone marrow typically has a decreased ability to respond to the body’s need for blood cells. The inability to increase blood cell production  adequately in cases of increased need seriously affects cardiopulmonary function. Because elderly people with a concurrent cardiac or pulmonary problem may be unable to tolerate anemia, a prompt, through evaluation of the anemia is warranted.


The goal is to correct or control the cause of the anemia and replace lost or destroyed RBC’s by transfusing packed RBC’s. In elderly patients it is important to identify and treat the cause of anemia rather than considering it a consequence of aging.


Handbook for Brunner and Suddarth’s

Textbook of Medical-Surgical Nursing 11th edition

Joyce Young Johnson

Lippincott Williams & Wilkins pp.35-37