Iron Deficiency Anemia

Definition: Anemia caused by inadequate supply of dietary iron.

• The most prevalent nutritional disorder in the United States
• The most common mineral disturbance in the United States

At Risk: Many groups are at risk for developing iron deficiency anemia
• Children ages 12-36 months as a result of cow’s milk being major staple in diet
• Preterm infants because of their reduced fetal iron supply
• Adolescents because of their rapid growth rate combined with poor eating habits

Pathophysiology: Causes of iron deficiency anemia

• Decreased supply of iron
• Impaired absorption of iron
• Body’s need for iron increases
• Synthesis of HGB is affected

Diagnostic Studies:
• History and Physical Examination
1. Check skin, gums, and nailbeds to see whether they are pale or yellowish
2. Feel abdomen to check for enlarged liver or spleen
3. Listen to lungs for rapid or uneven breathing
4. Listen to heart for rapid or irregular heartbeat
• CBC to check for decreased Hemoglobin and Hematocrit levels
• CBC to check for decreased number of RBCs, WBCs, and Platelets
• Serum Iron-measures the amount of iron in the blood
• Serum Ferritin-measures the protein that helps to store iron in the body
• Transferrin Level-measures the total iron-binding capacity
• Fecal Occult Blood Test-determine if internal bleeding is the cause for deficiency

Assessment:
• Lack of energy
• Easy fatigability
• Shortness of breath
• Coldness in feet and hands
• Pallor of skin, gums, and nailbeds
• Enlarged spleen or liver
• Swelling and soreness of the tongue and cracks in the sides of the mouth
• In infants and children, poor appetite
• In infants and children, slowed growth and development
• In infants and children, behavioral problems

Nursing Diagnoses:
• Fatigue related to reduced oxygen-carrying capacity of blood from decreased
 number of RBCs
• Deficient knowledge related to unfamiliarity of disease
• Activity Intolerance related to inadequate oxygen delivery to the tissues

Nursing Interventions: Focuses on increasing amounts of supplemental iron the child

receives. This is best done through dietary counseling and administration of oral iron
supplements
• Dietary iron-rich foods are usually inadequate if used as sole treatment
• In formula-fed infants-give iron-fortified commercial formula and iron-fortified
infant cereal
• In exclusively breast-fed infants-must give iron supplementation after 6 months
• In preterm and low-birth-weight infants-give iron supplementation before 6
months
• Oral iron supplements prescribed for 3 months (Two divided doses between
meals)
• Vitamin C given to facilitate with absorption of iron
• In cases where HGB level fails to raise after 1 month of oral therapy, IV or IM
iron administration is safe and effective, although very painful and expensive
(For IM use Z-track method and do NOT massage site after injection)
• Transfusions are given in severe cases of serious infection, cardiac dysfunction,
or surgical emergency (Packed RBCs given instead of whole blood to reduce
chance of circulatory overload)
• Supplemental oxygen given when tissue hypoxia is severe
• Teach parents that tarry green color of stools is expected finding with adequate
oral iron (absence of this may be a clue to poor administration of iron)
• Iron may be given with meals if vomiting or diarrhea occurs
• Liquid preparations of iron may stain teeth, should be taken with a straw or
through syringe placed towards back of mouth (Brush teeth after administration)

Test Question:
When should iron supplements ideally be given?
A. When the patient feels fatigued
B. On an empty stomach
C. One hour after meals
D. With the first bite of each meal