Family Nurse Practitoner Concept Map
Iron Deficiency Anemia (IDA)
Etiology (Risk Factors)
Clinical Manifestations (Physical Exam
Findings)
Prevalence
Severity (Morbidity & Mortality)
Labs & Diagnostics
Pathophysiology
Treatment
Most common nutritional disorder worldwide (affects
10-20% of the population) (McCance &
Huether, 2023)
Living in poverty & developing countries (McCance & Huether,
2023)
Increased requirements during pregnancy & excessive menstrual
bleeding (McCance & Huether, 2023)
Progression causes more severe structural & functional
changes in epithelial tissue (McCance & Huether, 2023)
Early symptoms: shortness of breath, weakness, fatigue, & pallor of mucous membranes, skin, & palm
creases (pale earlobes, palms, & conjunctivae) (McCance & Huether, 2023)
Dietary deficiency (McCance & Huether, 2023)
Impaired iron absorption (McCance & Huether, 2023)
Chronic blood loss (McCance & Huether, 2023)
Increased iron requirements (McCance &
Huether, 2023)
Chronic diarrhea (McCance & Huether, 2023)
Premenopausal females; adolescents & women of
childbearing age (McCance & Huether, 2023)
Infants, children, & adolescents (McCance & Huether, 2023)
IDA secondary to bleeding from GI diseases (i.e. duodenal or gastric ulcers, hiatal hernias, esophageal
varices, hemorrhoids, cirrhosis, cancer, or IBS) (McCance &
Huether, 2023)
Surgical procedures & trauma (McCance & Huether, 2023)
Parasite infestations (McCance & Huether, 2023)
H. pylori infections impair uptake of iron (McCance & Huether, 2023)
Children exposed to unsafe toxins in resource-poor conditions (i.e. exposure to & absorption of lead
prevents addition of iron to heme molecules), contributing to IDA (McCance & Huether, 2023)
A hypochromic-microcytic (small erythrocytes & low hemoglobin
concentration) anemia caused by iron store depletion (McCance &
Huether, 2023)
Depleted iron stores do not meet hemoglobin production needs as a
result of excess blood loss & inadequate dietary
intake (McCance & Huether, 2023)
Iron deprivation for erythrocytes & other tissues (McCance & Huether, 2023)
Inadequate iron (Fe) delivery to meet body's needs in cases with sufficient iron stores (McCance &
Huether, 2023)
Inability to maintain heme synthesis produces relative or
functional iron deficiency (McCance & Huether, 2023)
Systemic iron balance regulated by hepcidin peptide. Hepcidin inhibits iron
transfer to plasma through binding with feroportin, endocytosis, & degradation
(McCance & Huether, 2023)
Iron is contained in hemoglobin & stored for
future hemoglobin synthesis (McCance & Huether, 2023)
Stage I: Decreased iron stores in bone marrow
(serum iron & hemoglobin remain normal) (McCance &
Huether, 2023)
Stage II: Iron-deficient erythropoiesis occurs,
due to diminished transportation of iron
to bone marrow (McCance & Huether,
2023)
Stage III: Hemoglobin-deficient cells enter circulation to replace normal erythrocytes that have
been removed due to aging (McCance & Huether, 2023)
A decrease in hepcidin related to the immune response to infection is possible, causing hypoferremia
(lack of iron in blood), which hinders the growth of pathogens that require iron for survival. However,
adequate iron is also required for the innate immune response to function appropriately (McCance &
Huether, 2023)
Consumption of cow's milk decreases bioavailability of iron in
infants & toddlers (McCance & Huether, 2023)
Restricted diets ingested by older adults (McCance & Huether, 2023)
Eating disorders (over- & underweight) (McCance &
Huether, 2023)
Gradual onset of symptoms (medical attention usually sought when hemoglobin
level is around 7-8g/dL) (McCance & Huether, 2023)
Koilonychia (spoon-shaped, brittle fingernails) due to impaired ciliary
circulation (McCance & Huether, 2023)
Cheilosis (fissures/scales of the mouth) (McCance & Huether, 2023)
Stomatis (inflammation of mouth) (McCance & Huether, 2023)
Glossitis (painful ulcers of buccal mucosa & burning tongue) (McCance &
Huether, 2023)
Dysphagia (difficulty swallowing) (McCance & Huether, 2023)
Worsened by hyposalivation (McCance & Huether, 2023)
Other symptoms include gastritis, headache,
neuromuscular changes, numbness, tingling, irritability,
& vasomotor disturbances (McCance & Huether, 2023)
Gait alterations are rare (McCance & Huether, 2023)
Complications
Lab tests (McCance & Huether, 2023)
Decreased hemoglobin & hematocrit (<7-8 start to see symptoms) (McCance & Huether, 2023)
Microcytic (low MCV) & hypochromic (low MCHC) erythrocytes found in blood (McCance & Huether, 2023)
Symptom evaluation (McCance & Huether, 2023)
Decreased serum iron, ferritin, & transferritin saturation levels
(McCance & Huether, 2023)
Sensitive indicator of heme synthesis: Amount of free erythrocyte
protoporphyrin (FEP) in erythrocytes (McCance & Huether, 2023)
Identify & eliminate source(s) of blood loss
(McCance & Huether, 2023)
Oral iron replacement therapy (McCance &
Huether, 2023)
Parenteral (IV) iron replacement therapy
(McCance & Huether, 2023)
Hematocrit levels should improve within 1-2 months with oral iron replacement therapy
(McCance & Huether, 2023)
More precise measurement of improvement: Serum ferritin (SF) levels
(McCance & Huether, 2023) A rapid decline in symptoms
(fatigue, weakness, etc) usually seen within first month of therapy
(McCance & Huether, 2023)
Menstruating women may need daily oral iron until menopause
(McCance & Huether, 2023)
Fat absorption disorders (McCance & Huether, 2023)
Celiac disease (McCance & Huether, 2023)
Bariatric surgery & surgeries that decrease stomach acidity (McCance & Huether, 2023)
Menstruation, especially in adolescent girls (Lee, 2020)
Estimated 30-50% of global population has
IDA (Lee, 2020)
IDA prevalence was 0.7% for men & 8.0% for women in a
2014 Korean domestic report survey (Lee, 2020)
Poor diets in teenagers (i.e. junk foods) (McCance & Huether, 2023)
Period of rapid growth - nutrition/adequate intake of iron is crucial (Lee, 2020)
Period of active growth - increased need for quality
nutrition (Lee, 2020)
Weight loss is influenced by social/peer pressures,
especially in adolescent girls who already have
increased iron loss from menstruation (Lee, 2020)
Low birth weight & prematurity (Lee, 2020)
Strict vegan & vegetarian diets (iron not absorbed as well as it is from meat, fish, & poultry) (Lee,
2020)
Regular blood donation (Lee, 2020)
Certain medications (Lee, 2020)
Genetics (Kumar et al., 2022)
Blood loss should be evaluated for an occult source if IDA is
otherwise unexplained (McCance & Huether, 2023)
Occult blood test (McCance & Huether, 2023)
PPIs interfere with absorption of iron & NSAIDs increase risk of blood loss
(Lee, 2020)
Replenish iron deficiency & iron stores (Lee, 2020)
Higher cost for IV iron than oral iron therapy, but decreased number of
hospital/outpatient visits (Lee, 2020)
Hepcidin is affected by inflammation &
iron metabolism (Lee, 2020)
Chronic inflammatory conditions (Lee, 2020)
Normal hemoglobin (Hb) concentrations
(Bathla & Arora, 2021)
Adult males: Hb > 13g/dL; Adult females: Hb > 12 g/dL (Bathla &
Arora, 2021)
Children 9-24 months: Hb 105-135g/ L; Children 2-16 years: Hb 115-150 g/
L (Mattiello et al., 2020)
More adolescents in India (10-20%) diagnosed with
IDA than in other countries as a result of insuffiecent
dietary intake of iron (Kumar et al., 2022)
Inherited hemoglobinopathies (Kumar et al., 2022); Family history of
iron-refractory IDA (Lee, 2020)
Maternal deaths are 3x higher in women with
IDA (Kumar et al., 2022)
Vegetarians have a greater lack of bioavailable heme iron
in their diets (Kumar et al., 2022)
33% of adults in South Asia compared to 2.4%
in the US population (Kumar et al., 2022)
The Centers for Disease Control & Prevention (CDC) recommends
screening nonpregnant females for anemia every 5-10 years by
measurement of hemoglobin level (Weyand et al., 2023)
Low iron is associated with an increased all-
cause rate of mortality (Weyand et al., 2023)
Screenings & iron supplements improve
risk of developing anemia (Weyand et al.,
2023)
Food insecurity (Weyand et al., 2023)
More non-white race & hispanic ethnicity affected (Weyand et al.,
2023)
In developing & developed countries, IDA is more prevalent in women &
children, but men are also susceptible (Bathla & Arora, 2021)
IDA affects 20-25% of pre-school aged
children (< 5 years) worldwide, with the
highest prevelance in Africa & South Asia (Gedfie et al., 2022)
6,021 deaths in the United States (1.8
deaths per 100,000 population) (CDC, 2024)
With low iron stores, iron is used for hemoglobin synthesis, leaving the brain & other organs/tissues
at risk for adverse effects (i.e. decreased perfusion/oxygenation)
(Jefferds et al., 2022)
Minority groups with low incomes/SES (Jefferds et al., 2022)
i.e. Obesity, CHF, CKD, & IBS (Kumar et al., 2022)
IDA is common & a "major cause of
morbidity worldwide" (Snook et
al., 2021)
Treatment goals: Restore hemoglobin level/iron stores,
improve functioning & quality of life (Snook et al., 2021)
Consider blood transfusion (Snook et al., 2021)
Treatment not effective? Investigate
further; change regimen for persistent or recurrent IDA with
unknown or irreversible cause (Snook et al.,
2021)
Take doses on an empty stomach to help absorption (Snook et al., 2021)
Additional testing may be warranted to identify
cause of IDA (ASH, n.d.)
Look for GI tract abnormalities (i.e. endoscopy, capsule enteroscopy,
etc) (ASH, n.d.)
Test urine for blood/hemoglobin (ASH, n.d.)
Gynecologic evaluation (i.e. pelvic ultrasound, uterine biopsy) (ASH,
n.d.)
Dietary counseling/Increase dietary intake of iron (ASH,
n.d.)
Iron-rich foods (i.e. meat, poultry, fish, leafy greens, legumes,& iron- enriched grains/pastas) (ASH, n.d.)
Help diagnose IDA severity & determine treatment plan (McCance & Huether, 2023)
Choice for poor adherence/ intolerance of oral iron
replacement, uncontrolled chronic blood loss, or intestinal
malabsorption (McCance & Huether, 2023)
Most asymptomatic (Lee, 2020)
Iron supplements (McCance & Huether, 2023)
See irregularly shaped erythrocytes (McCance & Huether, 2023)
IDA symptoms occur at stage III as a result of iron store depletion, reduced hemoglobin
production, & reduced oxygen carrying capacity to body tissues (McCance &
Huether, 2023)
Results in reduced hemoglobin synthesis (McCance & Huether,
2023)
Poor exercise tolerance & increased heart rate
(Warner & Kamran, 2023)
Overall US prevalence among females aged 12-21 years old: 6.3% (Weyand et al., 2023)
Due to blood loss with menstruation, the rate of IDA in
women of childbearing age is 10% in the US (Warner & Kamran,
2023)
IDA in children: cognitive impairments (might be long-lasting & irreversible)
(McCance & Huether, 2023)
Increased risk of infection (Warner & Kamran, 2023)
Pregnancy complications (Warner & Kamran, 2023)
Heart conditions (Warner & Kamran, 2023)
Depression (Warner & Kamran, 2023)
Low birth weight, premature delivery, &
maternal mortality (Warner & Kamran, 2023)
Can lead to death from underlying heart or
lunch disorders (Warner & Kamran, 2023)
US mortality rates with IDA as the cause of
death grew from ~0.04 in 1999 to ~0.08 in 2018 per 100,000 people (Sun
& Weaver, 2021)
Higher bioavilability fron breast milk than cow's milk (McCance & Huether, 2023)
SF levels < 12 mcg/L in children under 5 years old, & <15 mcg/L in individuals over 5 (Mattiello
et al., 2020)