Case Study – Iron Deficiency Anemia

Case Study – Iron Deficiency Anemia

Iron deficiency anemia is a common hematological disorder characterized by inadequate iron levels, leading to reduced hemoglobin synthesis and impaired oxygen transport. The underlying causes of the condition can be low intake of nutrients in diets, acute or chronic loss of blood, and disorders that interrupt nutrient absorption (Warner & Kamran, 2023). Iron deficiency affects the synthesis of hemoglobin because iron is an important component in its formation. These result in microcytic and hypochromic red blood cells, which have limited capacity to transport oxygen. Moreover, iron is involved in the production of Adenosine triphosphate in the mitochondria; therefore, its insufficiency may lead to metabolism disorders and manifest as fatigue and weakness. Sarah’s complaints of fatigue, dizziness and pallor can be due to reduced oxygen supply to tissues, resulting in hypoxia with corresponding compensation through increased heart and respiratory rate.

Sarah’s lab findings are characteristic of iron deficiency anemia, as indicated by low hemoglobin, low ferritin and high total iron-binding capacity. These findings support the body’s effort to raise levels of iron absorption due to its deficiency (Ems et al., 2023). Other possible causes of anemia in a teenage female include anemia of vitamin B12 or folate, anemia of chronic diseases and hemolytic anemia. These can be distinguished by evaluating mean corpuscular volume, reticulocyte count and other biochemical tests, such as vitamin B12 and folate, which were not abnormal in Sarah’s case.

Iron is advised to be taken daily for at least three to six months to replace the depleted iron stores. The outcome of the treatment can be determined by following Sarah’s hemoglobin level and the reticulocyte count in four to six weeks (Nguyen & Tadi, 2023). Without treatment, the condition worsens into iron deficiency anemia with complications like impaired mental health, weak immunity and possible heart complications due to the increased workload of the heart muscle. Sarah must learn how to manage her menstrual cycle, increase the intake of foods that contain iron, and combine non-heme iron with vitamin C.

Due to Sarah’s age, the physician should involve her and her family in the discussions about her condition in a supportive and confidential way. Explaining to her that she is fatigued and that it affects her performance can help her to be more compliant with the treatment plan. According to Jafari et al. (2023), some of the barriers to compliance may be side effects that come with iron supplements on the gastrointestinal system or restricted diets. Iron can be consumed with food when necessary. However, it is also useful to discuss other liquid forms of supplementation or other ways of using supplements to support the need for consistent treatment.

References

Ems, T., Huecker, M. R., & St Lucia, K. (2023, April 17). Biochemistry, iron absorption. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448204/

Jafari, A., Hosseini, Z., Tehrani, H., & Alami, A. (2023). Evaluation of the barriers and facilitators of iron supplementation program among adolescent females. Clinical Nutrition ESPEN, 56, 36–42. https://doi.org/10.1016/j.clnesp.2023.04.024

Nguyen, M., & Tadi, P. (2023). Iron supplementation. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557376/

Warner, M. J., & Kamran, M. T. (2023, August 7). Iron deficiency anemia. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448065/

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Directions: Read the attached case study and answer “Discussion Questions”. Question and answer format is appropriate for this assignment. However, the document should contain an APA formatted title and reference page, and all references should be cited in the body of the paper.

Case Study – Iron Deficiency Anemia

Patient Profile:

Name: Sarah Thompson
Age: 16 years
Sex: Female
Presenting Complaint: Fatigue, dizziness, pallor, and shortness of breath
Past Medical History: Generally healthy with no chronic conditions, menstrual cycle began at age 12
Family History: Mother has a history of iron deficiency anemia
Social History: Non-smoker, no alcohol use, active in sports (soccer)
Chief Complaint and History:

Sarah presents to the clinic complaining of increased fatigue over the past three months. She reports feeling unusually tired and having difficulty concentrating at school. Recently, she has also experienced dizziness, especially when standing up quickly, and shortness of breath after physical activity. Her mother notes that she looks paler than usual.

Sarah’s menstrual periods are heavy and have become more irregular over the past few months, and she has been using over-the-counter pain medications (ibuprofen) to manage the associated cramping.

Physical Examination:

General Appearance: Pale, fatigued, appearing slightly short of breath
Vital Signs:
BP: 110/70 mmHg
Heart rate: 98 beats/min, regular
Respiratory rate: 20 breaths/min
Temperature: 98.2°F (36.8°C)
Cardiovascular: Tachycardia, no murmurs
Respiratory: Clear breath sounds bilaterally
Gastrointestinal: Abdomen soft, non-tender
Skin: Pale, especially in the conjunctiva
Neurological: Alert and oriented, no focal deficits
Laboratory Tests:

Complete Blood Count (CBC):
Hemoglobin: 9.2 g/dL (Normal: 12–16 g/dL for females)
Hematocrit: 28% (Normal: 36–46%)
Mean Corpuscular Volume (MCV): 72 fL (Normal: 80–100 fL)
Red Blood Cell Count (RBC): 3.5 million cells/μL (Normal: 4.2–5.4 million cells/μL)
Reticulocyte Count: 1.8% (Normal: 0.5–1.5%)
Iron Studies:
Serum Iron: 25 µg/dL (Normal: 50–170 µg/dL)
Ferritin: 10 ng/mL (Normal: 30–200 ng/mL)
Total Iron Binding Capacity (TIBC): 450 µg/dL (Normal: 250–450 µg/dL)
Vitamin B12 and Folate: Normal
Peripheral Blood Smear: Microcytic, hypochromic red blood cells
Diagnosis:

Iron Deficiency Anemia (IDA)

The laboratory findings suggest iron deficiency anemia. Sarah’s low hemoglobin, low hematocrit, and microcytic, hypochromic red blood cells on the peripheral blood smear point to IDA. The low serum ferritin and low serum iron levels further support this diagnosis. The elevated total iron-binding capacity (TIBC) indicates that the body is trying to increase iron absorption due to the deficiency.

Discussion:

Cellular Reasoning:
Pathophysiology of Iron Deficiency Anemia (IDA):
In IDA, there is a decrease in the availability of iron for hemoglobin synthesis. Hemoglobin is critical for transporting oxygen, and when iron is insufficient, the production of hemoglobin is impaired, leading to hypochromic, microcytic red blood cells that are less efficient at oxygen transport. This causes the clinical symptoms of fatigue, pallor, and shortness of breath due to decreased oxygen delivery to tissues.
Role of Iron in the Body:
Iron is a key component of hemoglobin in red blood cells, and it is crucial for oxygen binding and transport. Iron is also involved in numerous metabolic processes and cellular functions, including energy production. In the absence of adequate iron, the body cannot produce sufficient hemoglobin, leading to anemia.
Effects on Other Organ Systems:
Iron deficiency can affect other organ systems, particularly the cardiovascular and respiratory systems. The heart may work harder to compensate for the decreased oxygen-carrying capacity of the blood, leading to tachycardia. The respiratory rate may increase to help supply more oxygen to tissues.
Diagnostic Criteria:
Laboratory Diagnostic Criteria for Iron Deficiency Anemia:
Hemoglobin: Less than the normal range (e.g., <12 g/dL for females)
MCV: Low (microcytic anemia)
Serum Ferritin: Low (less than 30 ng/mL is indicative of iron deficiency)
Serum Iron: Low
TIBC: Elevated
Peripheral Blood Smear: Microcytic, hypochromic cells
Clinical Symptoms:
Fatigue, pallor, shortness of breath, dizziness, and irritability
Possible history of heavy menstrual bleeding or poor dietary intake of iron
Treatment Plan:
Iron Supplementation:
Oral iron supplementation is the first-line treatment for iron deficiency anemia. Sarah should be started on ferrous sulfate 325 mg orally once or twice daily. Iron should be taken on an empty stomach for optimal absorption, though it can be taken with food if gastrointestinal upset occurs.
Dietary Modifications:
Encourage Sarah to increase dietary iron intake. Foods rich in heme iron (found in red meat, poultry, and fish) and non-heme iron (found in plant-based foods such as beans, lentils, spinach, and fortified cereals) should be incorporated. Vitamin C-rich foods (e.g., citrus fruits) can enhance the absorption of non-heme iron.
Monitoring:
Follow-up CBC in 4-6 weeks to assess the effectiveness of treatment. Reticulocyte count should begin to rise within a few days of initiating iron therapy. If Sarah’s symptoms persist despite adequate iron supplementation, further investigation (such as testing for gastrointestinal bleeding or evaluating menstrual health) may be needed.
Addressing Menstrual Health:
Heavy menstrual bleeding may be contributing to Sarah’s iron deficiency. It may be necessary to refer Sarah to a gynecologist for further evaluation of her menstrual cycle, especially if she is experiencing menorrhagia (excessive menstrual bleeding).
In Severe Cases:
If oral iron supplementation is ineffective or poorly tolerated, parenteral iron therapy (e.g., iron dextran or ferric carboxymaltose) may be considered. Blood transfusions are rarely required unless hemoglobin levels are dangerously low (<7 g/dL) or there is significant symptomatic anemia.
Discussion Questions:

Cellular Mechanisms:
How does iron deficiency specifically impair hemoglobin synthesis and the function of red blood cells?
What role does iron play in the production of ATP and overall cellular energy metabolism?
How might Sarah’s symptoms (fatigue, dizziness, pallor) be explained at the cellular level?
Diagnostic Criteria:
How do the lab findings (low hemoglobin, low ferritin, high TIBC, microcytic anemia) correlate with the diagnosis of iron deficiency anemia?
What other causes of anemia might you consider in a teenage female, and how would you differentiate them from IDA?
Treatment and Management:
What is the recommended duration of iron supplementation for this patient, and how would you assess her response to treatment?
What are the potential complications if iron deficiency anemia is left untreated?
How can you educate Sarah about managing her menstrual health and improving her iron intake through diet?
Ethical and Social Considerations:
Considering Sarah’s age and social environment, how would you approach discussing her condition and treatment plan with her and her family?
What might be some barriers to adherence to treatment, and how can you help Sarah overcome them?
Conclusion:
Iron deficiency anemia is a common condition in adolescent females, often exacerbated by menstrual blood loss and inadequate dietary intake of iron. Early identification and appropriate treatment with iron supplementation, dietary modifications, and addressing underlying causes such as heavy menstrual bleeding are essential to improving patient outcomes. This case study provides an opportunity to explore the pathophysiology, diagnostic criteria, and treatment strategies for anemia in a teenage female, as well as to engage in critical thinking regarding management and patient education.