Iron Deficiency Anemia and Anemia of Chronic Disease Sample

Anemia is defined is defined as hemoglobin levels below two standard deviations for age and gender of the patient. Globally, the common cause of Anemia disease is Iron deficiency anemia (IDA), which is due to deficiency of iron which is an essential component of hemoglobin (Joosten, 2017). Anemia of chronic disease is the second most prevalent cause of anemia after IDA and mostly seen in admitted patients as their current illness elicit an immune or inflammatory response that reduces the uptake of iron at various sites. The above anemias are often confused with each other and they must be distinguished for proper management of the patient (U.S. National Library of Medicine, 2019)

Investigations

Laboratory evaluation will help distinguish the two types of anemia. Primarily, anemia of chronic disease which is mostly a diagnosis of exclusion. The red blood cell indices in iron deficiency anemia will show reduced mean corpuscular volume (MCV) in relation to severity of anemia, reduced serum iron, reduced serum ferritin, a raised “total iron binding capacity (TIBC), increased soluble transferrin receptor” and an increased serum transferrin level (Joosten, 2017). On other hand, anemia of chronic disease will show a normal MCV initially before reducing in the later stages, reduced serum iron and TIBC, normal or raised serum ferritin, reduced or normal level of serum transferrin and normal levels of soluble transferrin receptor,

Serum ferritin, which is a reliable measure of total iron stores can be misleading in patients with ACD because it is also produced by the liver in copious amounts as a result of inflammation. In such cases, one expects to see elevated levels of such inflammatory markers as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Hepcidin is currently being proposed as the most accurate serological marker for differentiation of IDA from anemia of chronic disease.

The levels are raised in ACD and low in IDA. However, the standard method of differentiation of the two types of anemia is bone marrow aspiration and biopsy with staining for iron. The test shows diminished bone marrow iron stores and erythroblast iron in IDA. For ACD, the test reveals the presence of bone marrow iron stores with absent erythroblast iron.

Blood Transfusion or Not

In my view, the practitioner should not transfuse the patient. This is because the anemia is moderate (hemoglobin 9.5 g/dl) and cardiac decompensation was ruled out during physical examination. Blood transfusion is mostly indicated as a short-term solution for severe anemia (hemoglobin<6.5 g/dl) with cardiac decompensation.

Medications

This patient will benefit from intravenous iron replacement therapies including iron sucrose, ferrous gluconate and iron dextran complex and erythropoietin stimulating agents such as epoetin alfa and darbepoetin alfa. This is because the patient has an underlying kidney disease.

Considerations for Erythropoietin Stimulating Agents Use.

It is essential that iron stores are adequate during ESA treatment. This is because iron deficiency results in ESA resistance. Moreover, the clinician should watch out for signs and symptoms of an inflammatory state as it also results in ESA resistance. Long-term treatment with ESAs has been attributed to hypertension and therefore, systemic blood pressure should be monitored (Wiciński et al., 2020). In addition, hemoglobin levels should be maintained between 11.5g/dl- 13.0g/dl to avoid worsening cardiovascular outcomes (Wiciński et al., 2020).

Follow Up

The patient requires a close monitoring of her vital signs (pulse, BP, respiratory rate, and level of oxygen saturation), renal function tests including urea and electrolytes and creatinine clearance to check the integrity and function of the kidneys and serial hemoglobin checks to determine the severity of anemia. The patient needs a collaborative referral to improve her health as her condition is multidisciplinary.

Collaborative Patient Education

The patient’s condition requires integrated services of herself, emergency physician, cardiologist, nephrologist, hematologist, family members and nurses all with the aim of improving her health outcome. All these parties must be organized in such a way that the unmet needs of the client are addressed without losing the client.

To avoid producing a fragmented portrait of the patient or creating frustration and confusion to the client, the involved parties should come up with a plan based on Watson’s theory. The theory advocates for transpersonal caring for better patient outcomes. Further, by establishing the primary care provider for this patient, a caring and trusting relationship will emerge between the patient and the healthcare providers thus ensuring patient’s privacy.

The emergency physician will educate the patient on danger signs and symptoms of her condition and should organize for a follow up with a hematologist for further examination. The family members should be advised on the patient’s condition in order to support and provide a protective environment to the client. The cardiologist will educate the patient on diet modification and importance of avoiding strenuous work. Moreover, the nephrologist should educate the patient on the role of kidney and the signs and symptoms of deranged kidney function which provides a teaching and learning session to the patient.

The nurses are central to the treatment of the patient and part of their education to the patient includes inspiring the patient, instilling hope and honor. In addition, they should express altruistic values such as love and kindness to the client. In the plan also, the patient will be allowed to express her feelings both negative and positive and practice her spiritual life freely. The patient will also be educated on the need to adhere to any medications prescribed.

References

U.S. National Library of Medicine. (2019). Anemia of Inflammation and Deficiency Anemia. Retrieved from https://doi.org/10.31525/ct1-nct04071067
Joosten, E. (2017). Iron deficiency anemia in older adults: A review. Geriatrics & Gerontology International, 18(3), 373-379. https://doi.org/10.1111/ggi.13194
Wiciński, M., Liczner, G., Cadelski, K., Kołnierzak, T., Nowaczewska, M., & Malinowski, B. (2020). Anemia of Chronic Diseases: Wider Diagnostics—Better Treatment?. Nutrients, 12(6), 1784. https://doi.org/10.3390/nu12061784