Anaemia - Iron deficiency

• Iron deficiency is the most common of the anaemias

• Iron deficiency anaemia develops when iron is insufficient to produce haemoglobin

• Those with iron deficiency anaemia should be provided with supplements to correct anaemia and replenish body stores

• Iron deficiency anaemia can have an impact on the individual's ability to perform the activities of living

Anaemia is a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness. It is the most common disorder of the blood. Iron deficiency anaemia occurs in 2–5% of adult men and postmenopausal women in the developed world; this condition is a common cause of referral to gastroenterologists. Gastrointestinal blood that is lost as a result of colonic cancer or gastric cancer, as well as malabsorption associated with coeliac disease, are the most important causes. Iron deficiency anaemia is the most common form of anaemia in the UK.

The blood

Blood is considered to be a type of connective tissue: even though it has a different function in comparison to other connective tissues, it does have an extracellular matrix. It is composed of plasma and blood cells. Blood cells are comprised of three components: the erythrocytes, also known as red blood cells; the leukocytes, also called

Anaemia

When a person has anaemia, this means that they have fewer red blood cells than normal, or they have less Hb than normal in each red blood cell and this will result in a reduction in the amount of O2 being transported around the body.

Anaemia is defined as:

There are many causes of anaemia. The average size of the red cells can provide clues as to the cause of some anaemias. The average size of the red blood cells is smaller than normal with this type of anaemia.

Iron deficiency anaemia

In the UK, this is the most common form of anaemia and is due to lack of iron: iron is required to create

Signs and symptoms of iron deficiency anaemia

The common symptoms often related with anaemia are associated with the reduced amount of oxygen in the body. As a result of this, the person may feel tired, be lethargic, feel faint and dizzy and become easily dyspnoeic. Other symptoms can include headaches, palpitations, chest pain, tachycardia, altered taste, cool peripheries (hands and feet) and tinnitus; the person may have a smooth or sore tongue and the individual can appear pale (Figure 3).

Other signs can develop, depending on the underlying cause

Investigations and tests

A detailed health history should be obtained, including information about diet (to identify poor iron intake) and a medical history to determine, for example, if there is a family history of iron deficiency anaemia. A physical examination should be undertaken leading to the recognition of the condition and help to establish the cause. However, iron deficiency anaemia is primarily a laboratory diagnosis. The outcome of the history taking, the physical examination and the laboratory results will help to determine the types of investigations and tests that will be required.

The most common investigation is a full blood count. Another type of blood test is a blood smear. This is when a thin film of blood is microscopically examined to look for abnormal shapes of cells, as well as cells with pale centres. Infecting parasites such as the malaria parasite can be seen when a blood smear test is performed.

Another

Treatment and care

For most people with iron deficiency anaemia, the aim of treatment should be to restore haemoglobin concentrations and red cell levels to normal and to replenish iron stores.

Iron deficiency should be treated with oral iron therapy and the underlying cause should be corrected, so the deficiency does not reappear. Where the cause cannot be identified or corrected, the person may have to receive supplemental iron on an ongoing basis.

All people with iron deficiency anaemia should have iron supplementation in order to correct anaemia and replenish body stores; 200 mg ferrous sulfate is give three times per day 1 hour before meals (Timby and Smith, 2014). Parenteral iron can be used when oral preparations are not tolerated. Blood transfusions should be reserved for patients with, or at risk of, cardiovascular instability due to the degree of the anaemia (Goddard et al, 2011). 

The nurse must work with other healthcare professionals such as the dietician to help the person resolve any dietary deficiencies. Iron medications should be taken on an empty stomach, unless there is a history of gastric upset; if this occurs, then it should be taken with, or immediately after, meals. The person should be advised to avoid taking iron medication at the same time as antacid, as this will interfere with iron absorption. Iron is more readily absorbed when taking vitamin C; drinking orange juice, for example, will enhance absorption.

The person should be warned that on an iron supplement the stool might be black or dark green. Constipation may occur as a result of taking iron preparations and processes should be put in place to ensure that this does not occur or the adverse effects are minimised (LeMone et al, 2011).

Intramuscular injection of iron is effective. It is,

References

Goddard AF, James MW, McIntyre AS. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60(10): 1309–16. htps://doi.org/10.1136/gut.2010.228874 

LeMone P, Burke KM, Bauldorff G. Medical-surgical Nursing: Critical Thinking in Patient Care. Chelmsford; Pearson: 2011

Pasricha SR, Flecknoe-Brown SC, Allen KJ et al. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust. 2010;193(9): 525–32. https://doi.org/10.5694/j.1326-5377.2010.tb04038.x

Solomons NW, Schumann K. Intramuscular administration of iron dextran is inappropriate for treatment of moderate pregnancy anemia, both in intervention research on underprivileged women and in routine prenatal care provided by public health services. Am J Clin Nutr. 2004;79(1): 1–3. https://doi.org/10.1093/ajcn/79.1.1

Timby BK, Smith NE. Introductory medical-Surgical Nursing. (11th edn). Philadelphia (PA); Lippincott: 2014

Waugh A. Ross and Wilson Anatomy and Physiology in Health and Illness. (12th edn). Edinburgh; Elsvier: 2014

World Health Organisation. Worldwide Prevalence of Anaemia 1993–2005. 2008. www.who.int/vmnis/publications/anaemia_prevalence/en/ (accessed 12 March 2014)