NCLEX Review Guide: Iron-Deficiency Anemia

Understanding Iron-Deficiency Anemia

• Iron-deficiency anemia occurs when the body lacks sufficient iron to produce healthy red blood cells, resulting in microcytic, hypochromic anemia.
• Most common type of anemia worldwide, particularly affecting women of childbearing age, children, and elderly populations.
• Iron is essential for hemoglobin synthesis - without adequate iron, RBCs become small and pale with reduced oxygen-carrying capacity.

Signs & Symptoms

• Early signs: Fatigue, weakness, irritability, and decreased exercise tolerance due to reduced oxygen delivery.
• Progressive signs: Pallor (especially conjunctiva, nail beds, palms), tachycardia, and dyspnea on exertion.
• Advanced signs: Restless leg syndrome, pica (craving non-food items like ice, starch), and koilonychia (spoon-shaped nails).

Common Etiologies

• Blood loss: GI bleeding (peptic ulcers, colorectal cancer), heavy menstrual periods, or frequent blood donations.
• Inadequate intake: Poor dietary iron sources, vegetarian diets without proper supplementation, or eating disorders.
• Increased demand: Pregnancy, lactation, periods of rapid growth (infancy, adolescence), or chronic illness.
• Malabsorption: Celiac disease, gastric bypass surgery, or concurrent use of proton pump inhibitors.

Laboratory Values

• Ferritin is the most specific test for iron deficiency, reflecting total body iron stores.
• TIBC (Total Iron Binding Capacity) increases when iron stores are low, as the body produces more transferrin to capture available iron.

Pharmacological Interventions

• Oral iron supplements: Ferrous sulfate 325mg TID is first-line treatment, providing 65mg elemental iron per dose.
• Administration guidelines: Take on empty stomach with vitamin C to enhance absorption, avoid with dairy, coffee, or antacids.
• IV iron therapy: Reserved for patients with malabsorption, intolerance to oral iron, or severe deficiency requiring rapid correction.

1. Assess baseline hemoglobin and iron studies
2. Educate patient on proper iron administration
3. Monitor for side effects (GI upset, constipation, dark stools)
4. Recheck labs in 4-6 weeks to assess response
5. Continue therapy 3-6 months after normalization to replenish stores

Nutritional Interventions

• Iron-rich foods: Red meat, poultry, fish, beans, lentils, tofu, fortified cereals, and dark leafy greens provide dietary iron sources.
• Absorption enhancers: Vitamin C-rich foods (citrus, tomatoes, bell peppers) taken with iron-rich meals increase absorption up to 4-fold.
• Absorption inhibitors: Calcium, tannins (tea, coffee), phytates (whole grains), and antacids can reduce iron absorption by up to 50%.

• Pitfall: Assuming all anemia is iron deficiency - always check ferritin and TIBC to differentiate from anemia of chronic disease.
• Pitfall: Stopping iron therapy when hemoglobin normalizes - continue 3-6 months longer to replenish iron stores.
• Study tip: Remember that reticulocyte count is the first lab to improve (within 1-2 weeks) before hemoglobin rises.