D59.9 Acquired Hemolytic Anemia: Iron Deficiency Anaemia
Evaluation
History
Although iron deficiency anemia is a laboratory diagnosis, obtaining a detailed history can be useful in facilitating the recognition of the condition. A patient’s history can help define the etiology of anemia and the duration of illness. Iron deficiency anemia is a gradual progression, with a minute amount of blood loss; thus, numerous cases remain asymptomatic and cannot be detected until the iron stores are depleted. Consequently, the production of red cells is compromised, causing fatigue and other symptoms to present.
The examination of the patient’s history includes interrogating for pagophagia, a symptom that presents with moderate iron deficiency where individuals develop the craving to suck or chew. Clinicians should be keen to establish a preference for cold celery and other raw vegetables. Additionally, the patient may express the development of leg cramps when doing uphill; this trend presents with patients suffering iron deficiency.
Another examination of a patient’s history seeks to establish the onset of first symptoms. This provides medical professionals with a chance to estimate the duration of the condition. The presentation of fatigue and diminished capacity to perform cumbersome tasks attributes to the deficiency of circulating hemoglobin—the development of fatigue points at the depletion of crucial protein elements that require iron in their functioning.
A comprehensive natural history examination considers the possibility of bleeding. Thus, physicians must interrogate any incidences of bleeding that are the common cause of blood loss. Bleeding from most orifices may precipitate the onset of anemia. It is also crucial to establish rates of excessive menstrual bleeding. This is necessary because significant variation in volumes of menstrual blood can result in iron deficiency in the body. It is also crucial to obtain specific information about the history of clots, cramps, and the application of pads and tampons
Physical examination
The physical examination for anemia seeks to identify the production of a non-specific pallor of the mucous membranes. Abnormalities in the epithelial tissue are associated with iron deficiency anemia. Defects may include angular stomatitis, oesophageal webbing, gastric atrophy, glossitis, and koilonychia. An examination of the optic fundi for the presentation of icterus, splinter hemorrhage, comma signs in the conjunctiva vessels, or telangiectasia is crucial to inform the next course of action.
A methodical investigation for palpable enlargement of lymph nodes can be crucial to determine the likelihood of infection or neoplasia. Bilateral edema can be vital to unearth causal cardiac, hepatic, or renal conditions (Hempel & Bollard, 2016, p. 1068). Also, unilateral edema can portend lymphatic obstruction because of the fatality that cannot be observed. Besides, it is crucial to conduct a rectal and pelvic examination to identify the possibility of tumors or infections that may precipitate the development of anemia.
It is imperative to perform a neurological examination using the exams of vibratory senses and position sense. It also encompasses scrutiny of cranial nerves and testing the tendon reflexes. Another crucial physical examination involves the heart. Any changes in the heart can provide essential information to inform the next level of action. An enlarged heart may be evidence of the period or intensity of anemia. At the same time, murmurs may be the initial presentation of bacterial endocarditis, which provides crucial leads on the etiology of iron deficiency anemia.
Differential Diagnoses
Alpha Thalassemia
Alpha thalassemia encompasses a collection of hereditary anemia with varying clinical outcomes. Common characteristics include limited manufacture of one or more globin links that make up the hemoglobin. A closely monitored process of globin chain making ensures the quotient of alpha chains to non-alpha chains maintains at 1.00. However, thalassemia alters this process, which disrupts the equilibrium (Harewood & Azevedo, 2020). The inhibited production of alpha-globin translates to excess beta chains creating weaker chains and the onset of the clinical condition. Similarly, the disrupted secretion of beta-globin gene products presents with more severe disease, the beta-thalassemia
Beta Thalassemia
This condition encompasses a cluster of hereditary disorders that manifest with inherited insufficiency during the amalgamation of beta-globin chains. Beta thalassemia, in its homozygous state, leads to acute transfusion-dependent anemia. However, in its heterozygous state, minor thalassemia results in the mild microcytic anemia. Thalassemia intermedia refers to the presenting condition with clinical severity that falls between that of thalassemia minor and thalassemia major (Needs, Gonzalez-Mosquera, & Lynch, 2020). Patients with this condition often do not require a specific form of intervention. Intervention treatment includes iron chelation, long-term transfusion therapy, allogeneic, splenectomy, hematopoietic, and supportive measures.
Hereditary Spherocytosis
Hereditary spherocytosis (HS) is a chromosomal hemolytic ailment that is connected with the numerous transmutations that cause defects in the red blood cell membrane proteins. The iconic morphology of HS is the
microspherocyte that presents with depletion of RBC membrane surface area with irregular osmotic flimsiness in vitro. The interrogation of HS provides crucial insights into the properties and duties of the cell membrane and the functions of the spleen to regulate RBC integrity (Zamora & Schaefer, 2019). Clinically, HS manifests with marked heterogeneity that ranges from an asymptomatic condition to fulminant hemolytic anemia. In severe cases, individuals with this condition occur as neonates. At the same time, those with mild HS may not require medical intervention until adulthood after environmental stressors force the manifestation of the disorder. Severe complications associated with HS include megaloblastic or aplastic crisis, cholecystitis, hemolytic crisis, and cholelithiasis. Standard treatment for HS includes splenectomy. However, it can be deferred effectively among patients with mild, uncomplicated HS. Splenectomy translates to full regulation of HS besides the typical autosomal receding variation of the condition.
Treatment Plan
Intervention for iron-deficiency anemia relies on the cause and severity of the condition. Treatment may range from medical supplements, surgeries, procedures, and dietary interventions. In severe cases, patients may require intravenous iron therapy (IV) or a blood transfusion.
Iron supplements
Physicians may prescribe iron supplements for persons with iron deficiency. This is the most common and effective intervention strategy for this condition. The treatment period lasts between three to six months to allow adequate time to replenish the iron stores (Strauss & Auerbach, 2018, p. 293). Iron pills may be recommended during pregnancy. However, this therapy may not be effective if the condition is a result of particular rare genetic complications such as TMRPSS^ gene mutation.
Procedures
Iron therapy (IV iron).
Alternative forms of treatment to replenish the iron levels may cause the physician to recommend a corrective procedure such as iron therapy. Intravenous iron is sometimes administered through a blood vessel to elevate the level of iron in the body. The benefit of applying IV iron is rapid action to replenish the iron store in the body (Long & Koyfman, 2018, p. 619). This mode of treatment is preferred for persons with severe iron-deficiency anemia or with underlying chronic conditions such as celiac disease or kidney disorder. Upon introduction to therapy, individuals may develop flashes of headaches and vomiting, among other mild side effects that disappear within a day or two.
Red blood cell transfusion.
This procedure is recommended for persons with a severe condition of iron-deficiency anemia. Doctors may recommend this procedure as the quickest means to restore the number of red blood cells and iron levels in the body. This treatment is also effective for persons with serious complications of anemia, such as chest pains.
Surgery.
In some cases, surgery may be necessary to correct bleeding at different sites. May include procedures like a colonoscopy or upper endoscopy.
Teaching
Teaching forms a crucial part of intervention and management for various conditions. In the management of iron-deficiency anemia, nursing professionals require to educate the patient, family, and caregivers about crucial aspects to monitor to facilitate the recovery process. Providing information about the disease, how it is acquired and managed, can be effective in managing the condition. Also, informing the patient’s family that a member could likely to develop the disease and guiding them about the symptoms to watch out for enhances the capacity of managing the condition. Besides, physicians may train patients and family members’ vital practices to ensure the wellbeing of individuals.
Nursing professionals can educate the patient, family, and caregivers about the need to limit mobility. Although restriction of movement is not necessary, it may be a crucial management strategy for persons with severe iron-deficiency anemia and active cardiopulmonary condition until the condition is resolved to replenish the iron stores. Nurses also have a role in informing patients about various forms of practices that are crucial for the management of the condition, such as bed-rests to improve health with evidence of coronary insufficiency. Although these practices do not apply in all cases, it is vital to provide individuals with crucial training depending on the severity of anemia and comorbid conditions.
Nurses also provide teachings about the need to quit strenuous activities and the significance of maintaining strict dietary measures. Patients need counseling about the importance of improving diet by accessing at least one nutritious meal a day.
Medicare
The most effective and most economical form of medical intervention entails treatment with oral ferrous iron salts. Among the numerous salts utilized to intervene for iron-deficiency anemia, ferrous sulfate is the most suitable(Warner & Kamran, 2020). However, other common forms of iron salts are rapidly absorbed and indicate lower morbidity.
Another medication intervention for iron-deficiency anemia includes the application of carbonyl iron. Physicians prescribe the use of this dose due to its higher safety levels besides the use of parenteral reserve iron for persons with the poor oral absorption or increasing anemia. However, this method is quite expensive and presents higher morbidity than oral forms of iron.
Some iron products can effectively replenish the iron store, especially for expectant mothers due to the anticipated demands of the fetus and the loss occasioned during delivery (Mirza, Abdul-Kadir, Breymann, Fraser, & Taher, 2018, p. 733). These products include ferrous sulfate, carbonyl iron, ferric citrate, iron sucrose, iron dextran complex, ferric carboxymaltose, ferrous gluconate, ferrous fumarate, Accrufer, Monoferic, and ferumoxytol.
Research Article
Anemia, Iron Deficiency: Matthew J. Warner and Muhammad T. Kamran.
According to Warner and Kamran (2020), anemia refers to a hemoglobin value level that is below the standard deviation for two means that encompass the age and gender of a patient. The article identifies iron deficiency as the most common cause of anemia worldwide that causes microcytic and hypochromic red cells on the peripheral smear. Treatment for anemia mainly involves reversing the underlying condition together with replenishing the iron stores. The document also presents valuable information about effective intervention using oral supplementation. Besides, the article explains the various circumstances that may require intravenous administration. The novelty of this article lies in the comprehensive information it provides about etiology, epidemiology, pathophysiology, and histopathology of the condition. In addition, the research presents vital information about the historical and physical examination that is crucial to inform the course of treatment. Lastly, this article is effective in guiding practitioners and patients on the differential diagnosis, prognosis, complications, treatment, and possible measures of deterrence. Arguably, this information is critical for persons who require basic information about the condition to gain insights about causes, symptoms, and intervention strategies. This article serves its relevance because it is published within the past five years, making it a valuable source of information about the subject. Therefore, those who wish to learn about iron-deficiency anemia can resort to Warner and Kamran’s publication for insights into the condition.
References
Harewood, J., & Azevedo, A. M. (2020). Alpha thalassemia (Hemoglobin H disease) – StatPearls – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441826/
Hempel, E. V., & Bollard, E. R. (2016). The evidence-based evaluation of iron deficiency anemia. Medical Clinics of North America, 100(5), 1065-1075. doi:10.1016/j.mcna.2016.04.015
Long, B., & Koyfman, A. (2018). Emergency medicine evaluation and management of anemia. Emergency Medicine Clinics of North America, 36(3), 609-630. doi:10.1016/j.emc.2018.04.009
Mirza, F. G., Abdul-Kadir, R., Breymann, C., Fraser, I. S., & Taher, A. (2018). Impact and management of iron deficiency and iron deficiency anemia in women’s health. Expert Review of Hematology, 11(9), 727-736. doi:10.1080/17474086.2018.1502081
Needs, T., Gonzalez-Mosquera, L. F., & Lynch, D. T. (2020). Beta thalassemia – StatPearls – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531481/
Strauss, W., & Auerbach, M. (2018). Health-related quality of life in patients with iron deficiency anemia: Impact of treatment with intravenous iron. Patient Related Outcome Measures, Volume 9, 285-298. doi:10.2147/prom.s169653
Warner, M. J., & Kamran, M. T. (2020, May 14). Anemia, iron deficiency – StatPearls – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448065/
Zamora, E. A., & Schaefer, C. A. (2019). Hereditary Spherocytosis – StatPearls – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539797/