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Hematologic Disorders: Iron Deficiency Anemia

small and pale cells in Iron Deficiency Anemia
  • the most common anemia in infancy and childhood
  • occurs when the intake of dietary iron is insufficient, preventing proper hemoglobin formation
  • results in small (hypocytic) and pale (hypochromic) red blood cells due to stunted hemoglobin
  • caused by the following:
    • in infants-->diet lacking in iron, low birth weight, born to mothers with iron deficiency during pregnancy, structural defects such as chalasia and pyloric stenosis
    • in toddlers-->chronic blood loss due to gastrointestinal polyps, ulcerative colitis, Crohn's disease, parasitic infestation, and chronic epistaxis
    • in adolescents-->faulty diet and overconsumption of snack foods

Assessment Findings
  • pallor, fatigue, irritability
  • shortness of breath, lightheadedness, headache
  • cold hands and feet
  • pica in children (craving for non-nutritive substances)
  • Poor appetite
  • history of iron-deficient diet
  • diagnostic tests:
    • RBC normal or slightly reduced
    • Hgb below normal range : (see below for normal values)
        • Newborns: 17-22 gm/dl
        • One (1) week of age: 15-20 gm/dl
        • One (1) month of age: 11-15gm/dl
        • Children: 11-13 gm/dl
    • Hct (hematocrit) below normal
Medical Management
  1. iron preparations in liquid form-->for infants and younger children
  2. IM (intamuscular) iron-->for severe cases
  3. iron supplements (ferrous sulfate tablets)--> for mild to moderate cases; irritating to the stomach so some patients may need to take supplements with food
  4. Vitamin C, in orange juice or tablet form, helps increase iron absorption.
  5. stool softener as needed-->iron supplements can be constipating
Nursing Management
  1. for infants 4-6 months, add iron to formula, food, or vitamins
  2. for children able to follow instructions, have them take iron using a straw as iron preparations stain teeth and skin
  3. asminister IM iron as ordered:
    • use different needles when withdrawing and administering-->to avoid tissue-staining
    • use Z-tack injection technique
      • best site: gluteus medius; any IM site except deltoid
      • needle size: 2-3 in. long, 20-22g
      • 45-deg angle is sufficient for infants
      • pull skin away laterally with non-dominant hand, wait 10 secs after injection before withdrawing needle, release skin, do not massage
      • encourage activity but no vigorous movements and constricting garments
      • observe for: fever, headache, urticaria (hives, itchy patches), sterile abscesses, anaphylactic shock,pain at the injection site, hypotension
  4. provide health teachings (to parents) on foods high in iron
  5. encourage increased fluid intake and foods high in fiber as appropriate
Prognosis

The prognosis for treating and curing iron deficiency anemia is excellent. With treatment, the outcome is likely to be good. In most cases the blood counts will return to normal in 2 months.

Prevention

In infants and young children, Iron Deficiency Anemia can be prevented by the use of fortified foods. For older patients, adequate amounts of iron (red meat, lover, egg yolk) should be included in the diet. If needed, iron supplements should be taken.

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