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

Pathophysiology

The body is constantly trying to maintain an equilibrium of iron content through absorption and loss.  The normal amount of iron in a "70 kg man is about 4 g" but "the body only absorbs 1 mg of iron daily to maintain equilibrium," although the internal requirement is about 20-25 mg because of the turnover of red blood cells, which have a life cycle lasting around 120 days (Harper).  The table below shows the flow maintaining the balance of iron in the blood.
(Harper)

The concentration of iron in the body "is regulated carefully by absorptive cells in the small intestine, which alter iron absorption to match body losses of iron" (Harper).  These cells are shown in the picture below:

These cells have a 2-3 day life cycle, and are sloughed off into the intestinal lumen when they die (Harper).

Iron is absorbed through three different pathways, heme, ferrous, and ferric acid, that are shown in the picture below:
(Harper).
Dietary iron contains both heme and nonheme elements, which are absorbed "noncompetitively into duodenal and jejunal mucosal cells" (Harper).  However, many different factors can cause these pathways to malfunction, as shown in the picture below:
(Harper).
"Either diminished absorbable dietary iron or excessive loss of body iron can cause iron deficiency" (Harper).  Diminished absorbable iron is usually a result of a lack of iron consumption, and hemorrhages are the main cause for a loss of body iron.  When a hemorrhage occurs, "the bone marrow is stimulated to increase production of hemoglobin, thereby depleting iron in body stores. Once they are depleted, hemoglobin synthesis is impaired and microcytic hypochromic erythrocytes are produced" (Harper).

Some other blood loss diseases include hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis.  These are blood loss through the urine, through heart surgery, and through renal disorders (Harper).

Iron deficiency anemia resulting from poor absorption can be caused by either a genetic disorder, having a major surgery performed on the small intestine, or having a DI tract disease (like celiac disease) which may cause absorption problems (Harper).

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

Epidemiology

According to the CDC, the tables below show the prevalence of iron deficiency anemia in the U.S. from 1988 to 2000.



"Iron Deficiency Anemia," by Anthony Lopez et al., published in The Lancet, found on PubMed, confirms these findings from the CDC.  The article agrees that child bearing age women and young children/toddlers are the most at risk for iron deficiency anemia. 


The charts show that the populations most at risk for iron deficiency anemia are toddlers (1-2 yo) and females of child bearing age (12-49).  Iron deficiency anemia is two times higher among non-Hispanic black and Mexican-American females than white women (Iron).  

Table 1.

Prevalence of anaemia, iron deficiency, and iron deficiency anaemia

	Prevalence (%)
Anaemia
General population20	32·9
Men (15–60 years)21	12·7
School-age children (>5 years)21	25·4
Elderly (>60 years)21	23·9
Preschool children (0–5 years)22	43·0
Non-pregnant women and girls (15–49 years)22	29·0
Pregnant women and girls (15–49 years)22	38·0
Iron deficiency
Children (<2 years)23	9·0
Children (3–5 years)24	4·5
Adolescent girls (12–19 years)24	15·6
Women (20–49 years)24	15·7
Pregnant women and girls (12–59 years)25	18·0
Iron deficiency anaemia
General population26	12·2
Hospital-based population27	23·0

"Between 1995 and 2011, worldwide prevalence of anemia decreased by 4–5% in children aged 0–5 years, non-pregnant women, and pregnant women aged 15–49 years" the article reported (Lopez et al).

The United States has the lowest percentage of cases of iron deficiency anemia worldwide.  It is much more common in third world countries. Specifically central and south Asia and andean South America have high percentages of this disease world wide (Lopez et al).

Search Terms: iron deficiency anemia epidemiology
Works Cited:
Iron Deficiency--United States, 1999-2000. (2002, October 11). Retrieved September 28, 2015, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5140a1.htm

Lopez, A ., et al., (2015, August 24). Iron Deficiency Anemia. Retrieved September 28, 2015, from http://www.sciencedirect.com/science/article/pii/S0140673615608650.

Define the Disease

Iron deficiency anemia is "when body stores of iron drop too low to support normal red blood cell (RBC) production" (Harper).  It is "the most prevalent single deficiency state on a worldwide basis" (Harper).  This could occur as a result of "inadequate dietary iron, impaired iron absorption, bleeding, or loss of body iron in the urine" (Harper).

Iron is important for the body because it helps complete metabolic processes like "oxygen transport, DNA synthesis, and electron transport" (Harper).  There are three separate pathways for iron uptake in the small intestine which include a "heme pathway and 2 distinct pathways for ferric and ferrous iron" (Harper).  The absorption of heme and non-heme iron is noncompetitive.  In healthy bodies, iron absorption is regulated by absorptive cells in the small intestine that balance the amount of iron absorbed with the amount of iron lost.  However, when either the body begins to lose iron too quickly or doesn't take in enough digestible iron, this balance can be offset, causing iron deficiency anemia (Harper).

One of the most common reasons for a lack of iron in the diet of people with iron deficiency anemia is limited access to meat (Harper).  Another common reason is hemorrhage, where a person loses a significant amount of blood suddenly.  The body responds by activating the bone marrow to create new hemoglobin to replace the lost blood, thus depleting the iron supply in the body. Other causes include hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis, all different forms of blood in the urine. Additionally, eating starch or clay, extensive surgery on the small bowel, and disease (like celiac disease) can all contribute to the development of iron deficiency anemia (Harper).

Generally, anemia is more common in areas with diets low in meat.  These places all have a higher amount of intestinal parasites, like hookworms, that result in GI tract blood loss.  In countries like the U.S., where this is less of a problem, the main demographics affected are pregnant women and people that have suffered from hemorrhage.  In general, children and particularly infants (especially those on cow milk diets instead of breastmilk) are at a higher risk to develop iron deficiency anemia.  Between men and women, women are much more at risk to develop anemia.  During pregnancy, a woman loses 500 mg of iron.  During each menstruation cycle, a woman can lose 4-100 g of iron.  In comparison, men only lose 1 mg per day during natural losses like sloughing epithelia and secretions from the skin.  Because of women's extra losses, and the fact that they eat less than men, their bodies need to be nearly twice as effective at absorbing iron than men's systems.  This makes it very important to recognize when women are becoming anemic, especially during pregnancy and during early development.  Race has little affect on the appearance of iron deficiency anemia demographically (Harper).

The symptoms of iron deficiency anemia include fatigue, leg cramps, and general lack of strength.  In children, it can lead to slower growth and development.  Although not life threatening in itself, if left untreated, it can lead to the development of pulmonary and cardiovascular disorders that can be life threatening (Harper).

Iron deficiency anemia is easily treated with iron dietary supplements and diet changes.  Some options may be prescribed to treat the causes of the anemia as well, like oral contraceptives to lighten menstruation flow, antibiotics to treat ulcers, or surgery to fix bleeding (especially in GI tract) (Clinic).  Iron deficiency anemia can be prevented by eating iron rich foods, like red meat, beans, and dark leafy vegetables.  It also helps to eat foods rich in Vitamin C, which increases iron absorption, like oranges, broccoli, and kiwi.  Finally, breast feeding infants or feeding them iron fortified formula is the best way to avoid anemia (Clinic).


Works Cited:

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

Clinic, M. (n.d.). Iron deficiency anemia. Retrieved September 14, 2015, from http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/basics/treatment/con-20019327