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Introduction
Anemia, as defined by Moz (2006), is health condition that involves an absolute decrease in red blood cells (RBCs) in proportion to total blood volume, or an absolute decrease in hemoglobin in relation to blood volume . Iron deficiency or depletion in the body is significantly responsible for the emergence of anemia which may be in form of physiological impairments effect on the functioning of several organ systems. The magnitude of the condition may however be detected through subjecting a patient to various blood tests, although medical history and advanced assessment may also be used to detect the same.
The Pathophysiology of Anemia
Basically, there are different types of anemia; however, the most common one is Iron Deficiency Anemia (IDA) which is mainly caused by reduction or loss of blood leading to inadequate iron in the body (Woteki et al, 1992, p. 117). In other words, the condition may result from consumption of food that is deficient of iron mineral thus rendering the blood to have fewer amounts of red blood cells. From a different perspective, the disease may result from poor institution emanating from adverse economic conditions, thus the condition is normally prevalent in low income families, and to a larger extent, in the less developed countries. Lastly, some medical conditions such as inflammatory or bleeding disorders as well as poor absorption of iron in the blood may have a contributing factor in the occurrence of the disease.
According to Lichtin (2008), a healthy man should have 3.5grams of iron in the body while a healthy woman should have 2.5 grams of iron, the difference being contributed by the smaller body size, lower androgen levels and dearth of stored iron in a woman. The pathophysiology of Iron deficiency anemia is basically composed of various aspects including iron absorption, iron transport and usage, iron storage and recycling, iron deficiency and etiology.
Iron Absorption: iron is usually absorbed in the body from consumed food, and is usually concentrated and easily absorbed from foods that contain meat. However, iron that is contained in foods without heme must be reduced to ferrous state through the action of gastric secretions in order to be absorbed, although ascorbic acid is known to accelerate the rate of absorption of this type of iron. Therefore, any breakdown in absorption rate or failure of absorption mechanism will automatically contribute to the occurrence of iron deficient anemia.
Iron transport and usage: According to Lichtin (2008), transferrin is the element responsible for transportation of the iron in the body, specifically from the intestinal mucosal cells to specific receptors such as erythroblasts, placenta cells and liver cells. Any breakdown in the transportation sequence or synthesis of transferrin will disrupt the balance of iron thus causing IDA.
Iron storage and recycling: any iron that is not used up is usually transferred to a storage pool that contains ferritin, located in liver, bone marrow and spleen, as well as hemesiderin, primarily located in the liver. However, ferritin stores a ready to use iron mainly because it is soluble unlike hemesiderin which is insoluble. This process also involves recycling and conservation of iron by the transferrin, mainly from the aging and dying red blood cells. However, failure in this process is likely to affect the level of iron in the body thus causing the disease.
Iron deficiency: whenever iron intake is inadequate to meet the body iron demand, the reserves of iron in the bone marrow get depleted. This depletion leads to impairment of red blood cells synthesis, thus causing anemia.
Etiology: blood loss through bleeding or prolonged menstruation may cause depletion of iron from the body. This problem may extend up to lactation period due to increased demand of iron yet dietary intake may not adequately meet the demand.
Interview experience
Case Study of a pregnant mother
I asked several questions to identify possible signs and symptoms of iron deficiency anemia like, How do you feel after performing a minor tasks?, For how long has the feeling of fatigue persisted?, What kind of diet do you often take?, What stage of pregnancy are you? Depending on the answers given, I was able to make inferences of the possibility of the iron deficiency anemia. I therefore, recommended a well designed, randomized control trial to be carried out.
The nursing interventions identified during the interview
There are two main recommendations for preventing and combating iron deficiency in people of all ages.
Primary prevention: This involves ensuring an adequate intake of iron; however, proof of being effective on women who are about to give birth is not quite explicit. Moreover, iron supplementation is limited leading to the second form of intervention.
Secondary prevention: Early screen testing followed by periodic screening among women of childbearing age is recommended for several reasons. One of them is that most women tend to consume limited iron through food, yet they lose a lot of blood from prolonged menstruation.
Recommendations
There are several recommendations given for this disorder. First, in primary Prevention, patients should consume food rich in iron e.g. liver, and eat food that is rich in Vitamin C such as fruits and vegetables to improve iron absorption. In case of iron absorption in infants, it is important to practice exclusive breastfeeding of the newborn for the first 6 months and then use of additional iron supplement after exclusive breastfeeding e.g. milk.
In secondary prevention, patients should be encouraged to take the newborn for universal screening upon attaining 9 and 12 months,6 months later, and annually from age 2-5 years. Before six months, they should go for selective screening in case of pre-term and low birth-weight infants.
Other general recommendations that would help to minimize patients risk of developing anemia include promoting good oral care to help the patient avoid gum diseases and accompanying blood loss; ensuring the patient maintains a humidified mucous membrane if he/she is using oxygen; encouraging the patient to avoid aspirin or non-steroidal anti-inflammatory drugs which can cause bleeding; encouraging patients with alcohol-related anemia to stop drinking.
After-Care Follow Up
Each one of us can play a vital role in helping a patient with or at a risk of developing anemia by giving good patient care. We need to be on guard for suspicious symptoms of anemia so as to be able to employ the necessary interventions and save a life. It is therefore advisable to encourage the patient to confide in a close person e.g. a family member for better monitoring of vital signs and laboratory tests.
I would evaluate the effectiveness of the interventions employed by recommending several laboratory checks to monitor whether there is any improvement. The laboratory tests would include a complete blood cell count, a reticulocyte count and a peripheral blood smear to ensure proper patient after-care.
References
Lichtin, A. (2008). Iron Deficiency Anemia. Web.
Moz, T. (2006). Its in the Blood: helping your Anemic Patients Thrive. Medical Center, Volume 2, Number 1. Saranac Lake, N.Y. (Attached material).
Woteki, C. E. et al. (1992). Eat for life: the Food and Nutrition Boards guide to reducing your risk of chronic disease. Washington, National Academy Press.
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