Support Groups

Support groups can be a very helpful tool for patients with iron deficiency anemia.  These groups provide not only additional educational information about iron deficiency anemia, but they also provide moral support through being a part of a community of people who struggle with similar health problems.  In these groups, people can find others with similar problems related to iron deficiency anemia and see how they have dealt with their treatment.  This sharing of knowledge is very beneficial for patients as they try to find what works best for them.



One support group for iron deficiency anemia is called the Anemia Support Group.  Located at http://www.dailystrength.org/c/Anemia/support-group,this group page provides information about iron deficiency anemia, as well as links to health blogs dealing with iron deficiency anemia.  Additionally, there are discussion posts created by others who had specific questions or problems dealing with different aspects of anemia, such as pernicious anemia, exercising with anemia, and even regarding their confusion about their labs.  These discussions in particular would be helpful for patients with questions about their health care.

Another iron deficiency anemia support group online is found at http://www.drugs.com/answers/support-group/iron-deficiency-anemia/, called Iron Deficiency Anemia Support Group.  This group is specifically used for the asking and answering of patient questions.  The website boasts of having "54 questions and 64 members," and the questions deal with issues like what medications and prescriptions are best, and how to recognize symptoms of iron deficiency anemia.

Finally, http://anemia.supportgroups.com/ is another online support group that provides information about iron deficiency anemia to the public.  It boasts of having 2,945 members, and the website allows for members to post anything from questions to how they are feeling, and for other members to comment on these posts.  This style of website creates a community of support between all people who suffer from iron deficiency anemia, helping people to not feel alone in their suffering.

Support groups are very useful tools for patients with iron deficiency anemia, and health care providers should encourage them to join one.

Apps

In the current culture, there is a high demand for technology that can be used in healthcare. Specifically, when it comes to individualized patient care, having technology that they themselves can use to better manage their health. Thus, apps for phones are a very useful tool for patients with iron deficiency anemia.

For instance, "to help those patients at a higher risk of developing iron deficiency monitor and maintain a healthy iron level, Professor Christian Breymann from the University Hospital of Zurich and Daniel Schöner, PhD, from ETH Zurich, have created myIRONfriend" (First).

This "app is dedicated to tracking iron levels and suggesting foods to combat iron deficiency" (First). Specifically, myIRONfriend "may be particularly useful for vegetarians or vegans to highlight alternative iron-rich products to replace meat and dairy groups absent from their diet. Only foods with relevant iron content figure in the list, providing an easy overview of good iron sources for the user’s daily meals" (First).

Another app that can be used by patients to help manage their iron deficiency anemia is an app called, appropriately, Iron Deficiency Anemia, made by Droid Clinic. This app has "complete information" of the disease, including "signs, symptoms, causes, treatment, diagnosis, epidemiology" and more (Iron). This app is specifically for Android phone users.



Finally, another app for managing iron deficiency anemia for iOS (iPhone, iPad, iPod) and Android devices is The Iron Deficiency Anaemia (IDA) Algorithm. This app is an "educational tool designed to increase your understanding of the diagnosis, investigation and management of iron deficiency anemia" (IDA).

All of these apps provide people with a resource for educational information about iron deficiency anemia that will allow them to better understand and manage their condition appropriately.

Works Cited:

The First Patient Smartphone App for the Prevention of Iron Deficiency in Women. (2015). Retrieved November 26, 2015, from http://ironresource.europeanironacademy.org/gyn-obs/first-patient-smartphone-app-prevention-iron-deficiency-women#

IDA App. (n.d.). Retrieved November 28, 2015, from https://bloodsafelearning.org.au/resource-centre/other-resources/ida-app/

Iron-deficiency Anemia - Android Apps on Google Play. (n.d.). Retrieved November 28, 2015, from https://play.google.com/store/apps/details?id=com.disease.irondeficiency

Nursing Care

When providing nursing care for a patient with iron deficiency anemia, the most important aspect is making sure the patient and the family are well informed about the condition and the ways it can be corrected.

After the patient and family are educated about the causes of iron deficiency anemia, they can start taking the steps to fix the nutritional gaps with diet planning.  Nurses (or dietitians/nutritionists) can help with the creation of a meal plan that includes lots of food with iron, as well as Vitamin C.

If a doctor deems it necessary for a patient to also be taking iron supplements, a nurse can create a medication plan for the patient to follow that is the correct dosage and fits their lifestyle.

It is important for nurses to be able to recognize the signs and lifestyles that could point to iron deficiency anemia as a problem.  Additionally, it is important to know when basic diet changes or iron supplementation will not be, like in cases of hemorrhage that may require surgical consultation (Harper).

In the long term, follow up is necessary with patients to make sure they are responding to either their diet changes or medication.  The iron supplementation can be adjusted to better fit the needs of the patient if the original prescription does not work perfectly (Harper).


Works Cited:
Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.
http://emedicine.medscape.com/article/202333-overview#a7

Dietary Treatment Guidelines

Choosing iron-rich foods can reduce the risk of iron deficiency anemia, and help to correct the problem.

Foods rich in iron include:

Red meat
Pork
Poultry
Seafood
Beans
Dark green leafy vegetables, such as spinach
Dried fruit, such as raisins and apricots
Iron-fortified cereals, breads and pastas
Peas

Additionally, people can enhance the "body's absorption of iron by drinking citrus juice or eating other foods rich in vitamin C at the same time that you eat high-iron foods" (Iron).

Vitamin C is found in:

Orange juice
Broccoli
Grapefruit
Kiwi
Leafy greens
Melons
Oranges
Peppers
Strawberries
Tangerines
Tomatoes

People (usually older) on a "tea and toast" diet need to be educated about the gaps in their nutrition (Iron).

In infants, iron deficiency anemia can be avoided by feeding them either breast milk, or iron enriched formula.  Additionally, most baby cereals are iron enhanced (Iron).

However "on a worldwide basis, diet is the major cause of iron deficiency. However, to suggest that iron-deficient populations correct the problem by the addition of significant quantities of meat to their diet is unrealistic" (Harper).  In these cases, iron supplementation to existing food sources is required.


Works Cited:

Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.
http://emedicine.medscape.com/article/202333-overview#a7

Iron deficiency anemia. (n.d.). Retrieved November 23, 2015, from http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/basics/prevention/con-20019327

Treatment

The main treatment for iron deficiency anemia is oral iron supplements.  "Oral ferrous iron salts are the most economical and effective medication for the treatment of iron deficiency anemia"(Harper).  A usual dosage is 65 mg three times a day, but this can be decreased to lessen side effects.  These side effects include "stomach upset and pain, constipation or diarrhea, nausea, and vomiting"(Iron).  Taking the iron tablets with food can decrease symptoms, but it can also decrease the absorption of the iron into the body.  If possible, the iron tablets should be taken on an empty stomach (Iron).  Additionally, "patients should avoid tea and coffee and may take vitamin C (500 units) with the iron pill once daily" to increase absorption (Harper).

Below is a chart showing the different kinds of oral iron supplements:
(Treating)

In patients who either can't absorb iron, or do not respond to the oral iron tablets, parenteral iron is a good option.  It "has been used safely and effectively in patients with inflammatory bowel disease (eg, ulcerative colitis, Crohn disease), as the ferrous sulfate preparations may aggravate the intestinal inflammation" (Harper).  However, perenteral iron is more expensive and has a greater morbidity than the oral tablets, so in general the tablets are safer (Harper).

Another option for patients who do not respond to the oral tablets are ferric carboxymaltose injections.  Approved in 2013 by the FDA, this treatment has also been shown to work for patients with non – dialysis-dependent chronic kidney disease (Harper).

High dosage of oral iron supplements, more than 45 mg, is not recommended, especially for women who are pregnant or nursing (Iron).

If the iron deficiency anemia is caused by an internal hemorrhage, managing the hemorrhage is a possible treatment to stop continued anemia.  This may include surgery on "neoplastic or nonneoplastic disease of the gastrointestinal (GI) tract, the genitourinary (GU) tract, the uterus, and the lungs" (Harper).

A transfusion of packed RBC is also an option, specifically "for patients who either are experiencing significant acute bleeding or are in danger of hypoxia and/or coronary insufficiency" (Harper).



Works Cited:
Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.
http://emedicine.medscape.com/article/202333-overview#a7

"Iron." WebMD. WebMD. Web. 19 Oct. 2015. <http://www.webmd.com/vitamins-supplements/ingredientmono-912-iron.aspx?activeingredientid=912&activeingredientname=iron>.

"Treating Iron Deficiency." Treating Iron Deficiency. Web. 19 Oct. 2015. <http://www.pharmacytimes.com/publications/issue/2011/june2011/treating-iron-deficiency>.

Signs and Symptoms

Patients with iron deficiency anemia may report the following:

• Fatigue and diminished capability to perform hard labor

• Leg cramps on climbing stairs

• Craving ice (in some cases, cold celery or other cold vegetables) to suck or chew

• Poor scholastic performance

• Cold intolerance

• Reduced resistance to infection

• Altered behavior (eg, attention deficit disorder)

• Dysphagia with solid foods (from esophageal webbing)

• Worsened symptoms of comorbid cardiac or pulmonary disease

Findings on physical examination may include the following:

• Impaired growth in infants

• Pallor of the mucous membranes (a nonspecific finding)

• Spoon-shaped nails (koilonychia)

• A glossy tongue, with atrophy of the lingual papillae

• Fissures at the corners of the mouth (angular stomatitis)

• Splenomegaly (in severe, persistent, untreated cases)

• Pseudotumor cerebri (a rare finding in severe cases 

Children and adolescents with iron deficiency anemia were at higher risk for the following:

Unipolar depressive disorder

Bipolar disorder

Anxiety disorder

Autism spectrum disorder

Attention-deficit/hyperactivity disorder

Tic disorder

Delayed development

Mental retardation

Often, patients can pin point when general symptoms, like fatigue and cold intolerance, began to occur (Harper).

Pica, the craving for non food items like clay, chalk, paper, or dirt, is also a result of iron deficiency anemia, and is the link between iron deficiency anemia and lead poisoning.  This can be sign of advanced iron deficiency anemia.

(11 Reasons)

Work Cited:

Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.

http://emedicine.medscape.com/article/202333-overview#a7

"11 Reasons You're Always Tired and How to Fix It - Dr. Axe." Dr Axe. 25 Mar. 2015. Web. 19 Oct. 2015. <http://draxe.com/always-tired/>.

Diagnosis and Prognosis

Iron Deficiency Anemia can be diagnosed using the following tests:

• Complete blood count

• Peripheral blood smear

• Serum iron, total iron-binding capacity (TIBC), and serum ferritin

• Evaluation for hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis

• Hemoglobin electrophoresis and measurement of hemoglobin A 2 and fetal hemoglobin

• Reticulocyte hemoglobin content

Tests useful for establishing the etiology of iron deficiency anemia and excluding or establishing a diagnosis of another microcytic anemia include the following:

• Stool testing

• Incubated osmotic fragility testing

• Measurement of lead in tissue

• Bone marrow aspiration

CBC results in iron deficiency anemia include the following:

• Low mean corpuscular volume (MCV)

• Low mean corpuscular hemoglobin concentration (MCHC)

• Elevated platelet count (>450,000/µL) in many cases

• Normal or elevated white blood cell count

Peripheral smear results in iron deficiency anemia are as follows:

• RBCs are microcytic and hypochromic in chronic cases

• Platelets usually are increased

• In contrast to thalassemia, target cells are usually not present, and anisocytosis and poikilocytosis are not marked

• In contrast to hemoglobin C disorders, intraerythrocytic crystals are not seen

Results of iron studies are as follows:

• Low serum iron and ferritin levels with an elevated TIBC are diagnostic of iron deficiency

• A normal serum ferritin can be seen in patients who are deficient in iron and have coexistent diseases (eg, hepatitis or anemia of chronic disorders

"Chronic iron deficiency anemia is seldom a direct cause of death; however, moderate or severe iron deficiency anemia can produce sufficient hypoxia to aggravate underlying pulmonary and cardiovascular disorders" (Harper).  Overall, iron deficiency anemia is easily treated and can ultimately be cured.  However, as it is usually connected with other underlying health issues, like neoplasia or hear disorders,  it can be a sign of something much more serious that cannot be cured as easily (Harper). 

Works Cited:

Harper, J. (n.d.). Iron Deficiency Anemia. Retrieved September 14, 2015.

http://emedicine.medscape.com/article/202333-overview#a7