iron deficiency anemia

   Iron deficiency anemia

Iron deficiency anemia caused by lack of sufficient iron for synthesis of hemoglobin.

Etiology

1. Increased blood loss

Due to epistaxis, parasite Infestation, polyps

2. Insufficient iron intake

If iron intake is insufficient, after maternal supply exhausted, iron deficiency can result.

3. Insufficient iron supply during pregnancy

Infant born to anemic mother.

Inadequate supply of ion from mother during intrauterine life. 

If baby is preterm or lost blood before or during birth process, prone to iron deficiency anaemia.

4. Impaired iron absorption

Due to; malabsorption Syndrome

Chronic Diarrhea

Intake of antacids and tea after meals

Iron absorption and metabolism

Iron required for hemoglobin synthesis supply by two sources;

1. Ingestion of iron rich food

2. Recycling of iron from broken RBCs.

Dietary iron absorbed in small intestine, passed into blood stream or stored in intestinal epithelial cells as ferritin. 

Iron in blood bind to iron transport molecules; transferrin and transferred to RBC and combine with hemoglobin in bone marrow.

If iron isn't used for hemoglobin formation, stored as ferritin or hemosiderin.

Pathophysiology

Due to etiological factor

Iron is insufficient for hemoglobin synthesis

Production of hemoglobin Decreased

Due to less production of hemoglobin, newly formed RBCs become microcytic (smaller) and contain less hemoglobin (hypochromic). 

Result in decreased hemoglobin levels and reduced oxygen carrying capacity of blood. 

Involve three stages;

Iron supply depleted, iron supply for Erythropoiesis.

Iron supply for Erythropoiesis reduced without development of anaemia.

Spinal stage development of anaemia, with microcytic and hypochromic RBCs.

Clinical features

Common clinical sign for iron deficiency anaemia is pallor.

When hemoglobin level falls below 5-6gm/dl, develop;

1. Irritability

2. Constipation

3. Weakness/ exhaustion

4. Poor attention span

5. Tachycardia

6. Cardiac enlargement

Thickening or enlargement of the of heart due to increased workload.

7. Long lasting or chronic iron deficiency anamia caused epithelial changes sucha as; angular stomatitis, spoon shaped nails (koilonychia) atrophic glossitis.

Diagnostic Evaluation

1. History of child

2. Blood test;

Hemoglobin level

Hemotocrit

MCV

Reticulocyte

Serum ferritin concentration

Serum iron value

Total iron binding capacity (TIBC)

3. Peripheral blood smear

RBC vary in shape; poikiloytosis 

RBC vary in size; anisocytosis 

4. Stool test

Presence of occult blood indicate bleeding from gastrointestinal tract.

Management

1. Oral iron therapy

Therapeutic dose 6mg/kg/day of iron supplements given orally in 3 divided dose to provide optimal amount iron needed for hemoglobin synthesis.

2. Parenteral iron therapy 

Iron dextran containing 50 mg/ml of elemental iron, administered Z-track method,  IM injection.

Iron given intravenously also, by dissolving it in 250-500 ml of saline, infused slowly over 6- hours. Initially small dose given to sensitivity test.

3. Blood transfusion

When hemoglobin level below 4mg/dl, only packed red cell given slowly. 

Also frusemide 1-2mg/kg intravenously administerd to prevent circulatory overload.

Nursing Management of Patients on Iron Therapy

1. Proper administration of iron supplements

Iron medication given between meals.

Iron medication not administerd with milk or tea, reduce iorn absorption.

Iron medication can given with form of ascorbic acid (vitamin C) such as citrus fruit or juice, 

Vitamin C helps in iron absorption.

Liquid iron given to infant with medicine dropper or syringe placed towards back of mouth to prevent teeth staining.

Older children can drink through straw and then rinse mouth or brush teeth after drinking medicine, to prevent teeth discoloration.

2. Side effects of iron therapy

Side effect of oral iron therapy include; abdominal cramps, nausea, vomiting, Diarrhea or constipation.

Iron given with meals, to prevent gastrointestinal irritation.

3. Improving dietary iron intake

Meat, liver, kidney, egg yolk, green leafy vegetables, fruits.

Time of weaning, iron rich diet given to infant.

Food prepared in iron utensils, to increase iron content of food.