IRON DEFICIENCY ANAEMIA- simple ways to prevention

Iron deficiency anaemia

Definition

Iron deficiency anaemia is the most common cause of anaemia where too little iron and ↓ Haemoglobin level in the body which leads to ↓ Oxygen delivery to tissues.

It is the most common anaemia worldwide

Anatomy & Physiology

• Iron absorbed mainly in the duodenum part of the small intestine.
• Iron is required to make haemoglobin which help to make RBC.
• RBC life span = 120 days

Causes of Iron Deficiency Anaemia

1.    Increased Iron Loss (MOST COMMON)

• Heavy menstrual bleeding
• GI bleeding (ulcer, hemorrhoids, cancer)
• Hookworm infestation

2.    Inadequate Intake

• Poor diet intake.
• Malnutrition individual.
• Unplanned vegetarian diet

3.    Increased Demand

• Pregnancy
• Lactation
• Infancy & adolescence

4.    Malabsorption

• Celiac disease
• Post-gastrectomy

Pathophysiology of iron deficiency anaemia

Poor dietary intake / Poor absorption / Increased demand / Chronic blood loss
↓
Decreased iron availability in the body
↓
Depletion of iron stores (liver, spleen, bone marrow)
↓
Insufficient iron for haemoglobin synthesis
↓
Decreased haemoglobin production
↓
Impaired red blood cell production in bone marrow
↓
Formation of microcytic, hypochromic red blood cells
↓
Reduced oxygen-carrying capacity of blood
↓
Decreased oxygen delivery to tissues
↓
Tissue hypoxia

Clinical Manifestations

General Symptoms

• Fatigue
• Weakness
• Dizziness
• Headache

Skin & Nails

• Pallor
• Brittle nails
• Spoon-shaped nails (koilonychia)

Oral Changes

• Glossitis (smooth red tongue)
• Angular stomatitis

Pica

• Craving ice, clay, starch, chalk

Remember– Pica + pallor + fatigue = iron deficiency anaemia

Diagnostic Evaluation

1.    CBC

• ↓ Haemoglobin
• ↓ Haematocrit
• ↓ MCV (microcytic)

2.    Iron Studies

Test	IDA Result
Serum iron	↓
Ferritin	↓↓↓
TIBC	↑
Transferrin saturation	↓

Remember- Ferritin = best indicator of iron stores

3.    Peripheral Blood Smear

• Small, pale RBCs

Medical Management

Oral Iron Therapy (First Line)

• Give Ferrous sulphate / fumarate / gluconate

iron and folic acid (IFA) therapy

Population	Purpose	Iron Dose (elemental)	Folic Acid Dose	Frequency	Notes / Source
Children (6–59 months)	Prevention (public health)	20 mg	100 mcg	Biweekly	NIPI / national programme for school/adolescents; age-specific syrup dosing for younger children (National Health Mission)
Children (6–59 months) – Treatment of IDA	Treatment	3–6 mg/kg/day	Not usually specific unless folate deficiency suspected	Daily	Clinical approach (3–6 mg/kg/day elemental iron) (Royal Children’s Hospital)
Children (5–10 years)	Prevention	45 mg	400 mcg	Weekly	NIPI / national programme (National Health Mission)
Children & Adolescents (10–19 years)	Prevention	100 mg	500 mcg	Weekly	NIPI / national programme (National Health Mission)
Adults (non-pregnant) – prophylaxis/treatment	Treat diagnosed IDA	60–120 mg (often 60–100 mg)	400 mcg	Daily	WHO’s recommended daily IFA for women/fair for adults; clinical treatment varies with severity (World Health Organization)
Pregnant Women – prophylaxis (WHO)	Prevent maternal anemia	30–60 mg	400 mcg (0.4 mg)	Daily	WHO daily supplementation recommendation (World Health Organization)
Pregnant Women – prophylaxis (India/NIPI)	Prevent anemia in pregnancy	100 mg	500 mcg	Daily for ≥100 days	National programme (starting ~14–16 weeks gestation) (National Health Mission)
Pregnant Women – treatment of IDA	Treat iron deficiency anemia	120 mg	400 mcg	Daily until Hb normalizes	Clinical guideline for anemia treatment (NCBI)
Older Adults (>60 years) – treatment	Treat diagnosed IDA	60–120 mg (as tolerated)	400–600 mcg	Daily	No specific guideline: clinical practice uses adult doses adjusted based on tolerance and comorbidity (ScienceDirect)

Nursing Teaching

• Take on empty stomach if tolerated
• Take with vitamin C
• Avoid milk, tea, antacids
• Black stools are normal
• Constipation common
• Continue iron 3–6 months after Hb normalizes

Parenteral Iron

Used when:

• Oral iron not tolerated
• Malabsorption
• Severe deficiency

Note- Monitor for allergic reactions

Blood Transfusion

• Only for severe or life-threatening anaemia

Dietary Management

1.    Iron-Rich Foods

2.    Heme Iron (Best absorbed):

• Red meat
• Liver
• Fish

3.    Non-Heme Iron:

• Spinach
• Beans
• Lentils
• Dates
• Jaggery

4.    Improves Absorption

• Vitamin C (orange, lemon)

5.    Decreases Absorption

• Tea
• Coffee
• Milk

Nursing Care Plan (NCP) –

NCP 1: Fatigue

Related to: Decreased oxygen-carrying capacity
Evidenced by: Weakness, lethargy

Goals:

• Improved energy
• Able to perform ADLs

Interventions:

• Schedule rest periods
• Assist with activities
• Monitor Hb & ferritin

NCP 2: Imbalanced Nutrition

Related to: Inadequate iron intake

Interventions:

• Educate on iron-rich diet
• Encourage vitamin C intake
• Dietitian referral

NCP 3: Activity Intolerance

Related to: Reduced oxygen delivery

Interventions:

• Gradual activity increase
• Monitor HR & SpO₂
• Stop activity if dyspnoea occurs

NCP 4: Knowledge Deficit

Related to: Iron therapy

Interventions:

• Explain long duration of therapy
• Teach side effects
• Stress adherence importance