Iron Deficiency Anemia Flashcards
Anemia
-decrease in hgb, resulting in decrease O2 carrying capacity of blood
Clinical Presentation of Acute Onset Anemia
- tachycardia
- lightheadedness
- breathlessness
Clinical Presentation of Chronic Onset Anemia
- fatigue, weakness, faintness
- HA
- vertigo
- loss of skin tone
- pallor
- sensitivity to cold
Lab Evaluation for Anemia
- CBC with RBC indices
- reticulocyte count
- stool sample for occult blood
Normal Serum Iron Levels
M 55-160
F 40-155
Normal Ferritin
M 20-500
F 20-200
Normal TIBC
250-400
Normal Retic Count
0.5-1.5%
Normal Folic Acid Levels
> 3.5
Normal B12 Levels
200-700
What are some common causes of IDA?
- inadequate dietary intake (EtOH, poor nutrition, anorexia)
- inadequate absorption from GI tract
- increased iron demands (infancy, pregnancy)
- blood loss
- certain dzs (RA, malignancies, renal dz)
Signs and Sxs of IDA
- koilonychia (spooning of fingernails)
- angular stomatitis
- glossitis
- pica
Lab Findings in IDA
- low serum iron
- low ferritin
- high TIBC
- hgb, hct, RBC normal early, but decrease late
Treatment of IDA
- find and tx underlying cause
- give iron to correct anemia and replace stores
- dietary supplementation
- oral or parenteral iron preparations
- blood transfusions
Dietary Supplementation of Iron: what works and what doesn’t
- heme iron in meat/poultry absorbed 3x better than non-heme iron from veggies and iron supplements
- gastric acid and ascorbic acid increase absorption of non-heme iron
- milk and tea decrease iron absorption
Where in GI system does maximum iron absorption take place?
- maximum in duodenum
- less in small intestine
How should iron be taken?
- best absorbed when taken w/o food or other meds
- better tolerated w/ smaller, more frequent doses
Typical Dosing Regimen for IDA
-ferrous sulfate 324-325 mg TID
Why is ferrous gluconate better tolerated than ferrous sulfate?
-has less iron in it than ferrous sulfate (by about 1/2)
Oral Iron AEs
-GI: dark feces, abd pain, heartburn, N/V/C
What might absence of AEs with iron indicate?
-nonadherence
What can pts do if oral iron is not tolerated?
- take with meals
- decrease total daily dose
Monitoring for IDA Treatment
- reticulocytosis 7-10 days after therapy starts
- hgb increase of <2g/dL over 3 weeks is unacceptable and should be evaluated further
- rate of hgb increase slows as hgb normalizes
How long is iron therapy needed?
-at least 2-3 months to restore then 3-6 months more to avoid relapse
