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Anemia 1 Iron Deficiency AnemiaElisabeth A. FandrichMontana Tech, Nursing Department NURS 1566 Core Concepts of Adult Nursing Noel Mathis RN, BSN, MSNMay 2, 2008Iron Deficiency Anemia
 
Anemia 2Anemia is the condition of having too few circulating red blood cells or components of thered blood cells. Red blood cells usually make up 40-45% of the total blood volume. This percentage is called hematocrit. The most important function of red blood cells is to carry oxygenfrom the lungs to the tissues of the body. Hemoglobin is a molecule contained within red bloodcells. Each molecule of hemoglobin contains iron which binds with oxygen in areas of highoxygen concentration (the lungs), and releases oxygen in areas of low oxygen concentration (thecapillaries). This iron contained within the hemoglobin is what gives blood its red color.Hemoglobin also helps remove carbon dioxide from the body. An enzyme called carbonicanhydrase is contained within the hemoglobin. This enzyme is the catalyst which speeds up themolecular breakdown of carbon dioxide into hydrogen ions and bicarbonate ions. The hydrogenions bind with the hemoglobin, and the bicarbonate ions enter the blood plasma. The majority of carbon dioxide is removed through the blood in this way. The remaining amount of carbondioxide is carried intact by the hemoglobin to the lungs where it is expelled from the body.Anemias are classified in two ways. The first is by size and hemoglobin content of the red blood cells. The second is by mechanism or cause. Iron deficiency anemia is classified asmicrocytic hypochromic. To further classify iron deficiency anemia, the cause must be known.There are several potential causes of iron deficiency anemia. The most obvious reason for  being iron deficient is inadequate dietary intake of iron. Other reasons are poor absorption of iron by the body, blood loss (including heavy menstrual bleeding and gastrointestinal bleeding) and lossof iron through the urine (hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis). Thistype of anemia is also associated with use of aspirin and NSAIDs, celiac disease, lead poisoning,and certain types of cancers. At the time I assessed 351
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,W,E, the cause of her anemia wasunknown. Gastrointestinal bleeding was suspected in this patient after a hemooccult stool sample
 
Anemia 3came back positive for blood. A diagnostic procedure was planned, but I was unable to obtain theresults.Common symptoms of iron deficiency anemia include pallor, fatigue, irritability, weakness,shortness of breath, brittle nails, pain of the tongue, pica, frontal headache, anorexia, and bluishsclerae. If the condition is mild, the patient may be asymptomatic. 351
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,W,E presented to theemergency department at 2330 April 27, 2008 complaining of abrupt onset of “heartburn”,substernal chest pressure and headache. She described that it came on at approximately 2030 thatevening. It persisted until arrival at the emergency department. She described the pain and pressure as moderate intensity and that it did not radiate. There was associated nausea, shortnessof breath and diaphoresis. She denied vomiting.A complete assessment including history and physical along with laboratory studies of  blood, stool and urine are used to diagnose this condition. Common lab studies ordered are CBC, peripheral smear, serum iron, total iron-binding capacity (TIBC), serum ferritin, MCV, MCHC,stool occult blood, testing for hemoglobin in the urine without the presence of red blood cells andhemoglobin electrophoresis. Other procedures used diagnostically are bone marrow aspirationand measurements of tissue lead concentrations. Pertinent lab results for 351
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,W,E were asfollows on admission: WBC 11.63 ↑ (normal:3.5-10 K/uL ), RBC 4.13 ↓ (normal: 4.2-5.40M/uL), Hgb 10.5 ↓ (normal: women 12-16 g/100 mL), Hct 31.5 ↓ (normal: women 36-46%),serum glucose 170 ↑ (normal: 65-110), CK 253 ↑ (normal: 22-235 u/L), CKMB 1.6 normal(normal: 0-6 ng/mL), Toponin I <0.02 normal (normal: 0.0-0.40 ng/mL), MCV 76.3 ↓ (normal:82-98 fl), MCH 25.5 ↓ (normal: 27.0-33.0 pg), MCHC 33.4 normal (normal: 32.0-36.0 gm/dL),and RDW 16.6 ↑ (normal: 11.5-14.5%). Further tests were ordered the next day after the resultsof the initial lab tests were known. Stool occult blood tested positive (normal: negative), ionizedcalcium 4.49 ↓ (normal: 4.75-5.63 mg/dL), serum iron 13 ↓ (normal: 25-165 uf/dL), ferritin 5 ↓
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