Iron-deficiency anemia typically results when the intake of dietary iron is inadequate for hemoglobin synthesis. Iron-deficiency anemia is the most common type of anemia in all age groups, and it is the most common anemia in the world. The most common cause of iron-deficiency anemia in men and postmenopausal women is bleeding from ulcers, gastritis, inflammatory bowel disease, or GI tumors. The most common causes of iron-deficiency anemia in premenopausal women are menorrhagia (i.e., excessive menstrual bleeding) and pregnancy with inadequate iron supplementation. Patients with chronic alcoholism often have chronic blood loss from the GI tract, which causes iron loss and eventual anemia. Other causes include iron malabsorption, as is seen after gastrectomy or with celiac disease.

• Symptoms of anemia
• Symptoms in more severe or prolonged cases: smooth, sore tongue; brittle and ridged nails; angular cheilosis (mouth ulceration)

• Bone marrow aspiration shows a low level or absence of iron.
• Laboratory values, including serum ferritin levels (indicates iron stores), blood cell count (hemoglobin, hematocrit, red blood cell [RBC] count, mean corpuscular volume [MCV]), serum iron level, and total iron-binding capacity.

• Obtain the patient's health history, which may reveal multiple pregnancies, GI bleeding, or pica.
• Search for the cause, which may be a curable GI cancer or uterine fibroids. Rule out other disease states, such as infection or inflammatory conditions.
• Test stool specimens for occult blood.
• People age 50 or older should have periodic colonoscopy, endoscopy, or x-ray examination of the GI tract to detect ulcerations, gastritis, polyps, or cancer.
• Administer prescribed iron preparations (oral, intramuscularly [IM], or IV).
• Have patient continue iron preparations for 6 to 12 months.

See “Nursing Process” under Anemia for additional information.

• Administer iron IM or IV in some cases when oral iron is not absorbed, is poorly tolerated, or is needed in large amounts.
• Administer a small test dose before IM injection to avoid risk of anaphylaxis (greater with IM than with IV injections).
• Advise patient to take iron supplements an hour before meals. If gastric distress occurs, suggest taking the supplement with meals and, after symptoms subside, resuming between-meal schedule for maximum absorption.
• Inform patient that stool will become dark.
• Advise patient to take liquid forms of iron through a straw, to rinse the mouth with water, and to practice good oral hygiene after taking this medication.
• Provide preventive education, because iron-deficiency anemia is common in menstruating and pregnant women.
• Educate patient regarding foods high in iron (e.g., organs and other meats, beans, leafy green vegetables, raisins, molasses).
• Instruct patient to avoid taking antacids or dairy products with iron (diminishes iron absorption).
• Instruct patient to increase vitamin C intake (e.g., citrus fruits and juices, strawberries, tomatoes, broccoli) to enhance iron absorption.
• Provide nutritional counseling for those whose normal diet is inadequate.
• Encourage patient to continue iron therapy for total therapy time (6 to 12 months), even when fatigue is no longer present.

For more information, see Chapter 33 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.