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Capstone Case Study of a Patient with Anemia

Alina Rivero

Florida National University

Advanced Primary Care of Family

Professor: Dr Luis Serrano

November 22, 2022

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Capstone Case Study of a Patient with Anemia

Anemia is a severe worldwide health condition that affects persons of all ages but

principally females of reproductive age. Iron deficiency anemia is one of the utmost prevalent

roots of anemia witnessed in women, with menstruation being one of the primary reasons.

Extreme, prolonged, and uneven uterine bleeding, also recognized as menometrorrhagia, can

bring about severe anemia. In this case report, the paper will present a case of a premenopausal

woman leading to profound iron deficiency anemia with the utmost low hemoglobin.

Scrutiny of the worldwide anemia problem exposed that the occurrence of iron deficiency

anemia, though lessening each year, stayed considerably high, impacting virtually one in every

five women. Menstruation is mainly deemed liable for the exhaustion of body iron stores within

premenopausal females. It has been projected that the percentage of menstruating females in the

USA who hold minimal-to-lacking iron reserves varies from 20% to 65% (Chai et al., 2021).

Research has determined that a premenopausal female's iron storage volumes could be nearly

two to three times below those in a female ten years post-menopause. Extreme and extended

uterine bleeding that transpires at irregular and recurrent intervals may be witnessed in virtually a

quarter of females who are 40–50 years old (Chai et al., 2021). Typically, women with

menometrorrhagia bleed over 80 mL, or 3 ounces, throughout a menstrual cycle and are

consequently at greater risk of experiencing iron deficiency and anemia.

The selected problem for this Capstone Case Study is a patient suffering from the effects

of anemia. Anemia is a disorder wherein one lacks sufficient vigorous red blood cells to convey

sufficient oxygen to the body's organs. Having anemia may make one feel exhausted and feeble.

There are numerous kinds of anemia, each with its source. Iron deficiency anemia is prevalent

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amongst non‐pregnant females of the reproductive stage or menstruating women globally, even

though the commonness is most significant in low‐income backgrounds. Iron insufficiency

anemia has been linked with an array of adverse health results that the compensation of iron

stores by iron supplements has been deemed possible to solve. Worldwide, around 29 % of non-

pregnant females aged 15–49 are anemic, which translates to approximately 500 million females

(Stevens et al., 2022). Iron deficiency anemia is prevalent in the United States, with 12 % and 4

% occurrence among women (Stevens et al., 2022). These statistics are even more significant in

African-American women and are often a consequence of heavy menstrual bleeding. The

primary objective of the capstone case study is to determine the efficiency of the iron supplement

on a patient with anemia.

PICOT

The PICOT question is: How can patients with anemia use an iron supplement to

improve anemia compare to patients with anemia using no iron supplement in 15 weeks? The

target population is non-pregnant women with anemia aged 15–49 years old. The intervention is

the use of an iron supplement. Iron supplements can help reverse an iron deficiency when dietary

changes alone are unsuccessful. Childbearing women of reproductive age who are menstruating

are more disposed to low iron levels and ought to get their iron levels tested often. Women who

menstruate are excessively affected by anemia because of the fact that they lose blood through

their periods. Actually, 29% of childbearing females and 38% of pregnant women globally are

impacted by anemia (Stevens et al., 2022). The intervention compares childbearing women with

anemia using an iron supplement to non-pregnant women without an iron supplement. The

outcome is to improve anemia by using iron supplements for 15 weeks.

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The Vulnerable Population

Anemia is a public health issue in developing nations, particularly for women. Females of

childbearing age are experiencing a distinct epoch of menstruation and serve a vital role in the

economy, family, and society. Consequently, their health status warrants exceptional attention.

Anemia in childbearing females not only threatens the mother's health but as well has a bad

influence on the subsequent generation when they become pregnant, like the augmented threat of

preterm delivery and low birth mass. Worldwide, the anemia prevalence in women aged 15–49

improved slightly from 31% to 30% between 2000 and 2019 (Dündar, 2019). Internationally,

regionally, and in virtually all nations, advancement on anemia in childbearing women aged 15–

49 years is inadequate to suit the WHA worldwide nutrition goal to halve anemia occurrence by

2030.

Since anemia is considerably linked with mortality and morbidity amongst women of the

procreative stage, recognizing the risk aspects of anemia stays a vital matter of public health.

Because of the substantial menstruation losses and more critical physiologic requirements for

iron, females of procreative age experience iron insufficiency anemia (Dündar, 2019). At a

worldwide level, dominance and risk aspects of anemia stay impending pointers to inquire the

efficient interventions and to evaluate the advancement made to decrease the anemia rate. The

contraception method was a substantial risk factor for reducing the anemia rate. Education was

also discovered to be a noteworthy aspect of anemia condition. Furthermore, the education level

is confusing with socioeconomic status at large but may also be mirrored in the comparatively

poor knowledge of nutritional practices.

Literature Review

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A study by Fernández-Gaxiola & De-Regil (2019) was completed to evaluate the impacts

of intermittent oral iron supplementation and its related damages amongst menstruating females,

compared without intervention or regular supplements (Fernández-Gaxiola & De-Regil, 2019).

Periodic iron supplementation decreased anemia and enhanced iron stores amongst menstruating

females in populations with diverse anemia backgrounds. In contrast with an everyday

supplement, intermittently, the supply of iron supplements is possibly as efficient in averting or

managing anemia.

A study by Idemili-Aronu et al. (2020) shows that using iron for at slightest 90 days of

pregnancy is a cost-efficient method of reducing iron insufficiency anemia, which is the

prevalent type of anemia amongst females of childbearing age (Idemili-Aronu et al., 2020). The

study shows that numerous socio-demographic aspects, like the type of residence, maternal age,

wealth, and education, are connected with the occurrence of maternal anemia. The study showed

that compliance with the proposed use of micronutrients effectively protects against anemia.

Moreover, the study outcomes show that the wealthier, urban inhabitants and more learned

women adapted to using iron supplements to improve their anemia condition.

According to a study by Mwangi et al. (2017), the commonness of iron deficiency in

pregnant women regularly surpasses 50% in low-income nations. On top of the effects of

swelling in blocking iron consumption, iron deficiency transpires since the diets of poor persons

are monotonous. The study's meta-analyses discovered that pregnancy iron supplements profit

maternal well-being. The study recommends a general iron supplement of 30–60 mg/day during

gestation though coverage is low in most nations. (Mwangi et al., 2017). The welfares of

universal iron supplements probably differ from the commonness of iron insufficiency. As a

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result, the balance between risks and benefit is possibly more promising in low-income nations

than in high-revenue nations, regardless of the greater exposure to contagious pathogens.

Low et al., (2017) established that iron deficiency anemia is widespread amongst non-

pregnant females of the procreative stage (menstruating females) globally, even though the

prevalence is uppermost in lower-income backgrounds. Even though several tests from the study

reported the impacts of iron in non-expectant females, they were never amalgamated in a

systematic evaluation. The current systematic evaluation established that everyday iron

supplement successfully decreases the commonness of anemia and iron insufficiency, increases

iron and hemoglobin stores, advances workout performance, and decreases symptomatic

exhaustion (Low et al., 2017). The welfares come at the cost of augmented gastrointestinal

symptomatic consequences.

Oral contraceptive usage has been linked with reduced blood losses in menstruation;

therefore, it may independently decrease the threat of iron insufficiency and anemia in women.

Producers have lately begun to comprise additional iron in placebo drugs of certain

contraceptives (Fischer et al., 2021). A study found that ICOC holds the prospective to be a cost-

efficient resolution to manage iron deficiency anemia and family planning needs. However, more

demanding trials assessing the efficacy of ICOC on refining indicators of iron insufficiency and

anemia and exploring the security of its intake amongst iron-replete populaces are reasonable.

Iron insufficiency anemia is a significant worldwide public health matter, particularly in

young females. An oral iron supplement may be an efficient approach to manage and avert IDA

though strategies differ. Certain specialists endorse 150–200 mg of essential iron daily, with the

dosages separated throughout the day. In brief, the study suggests altering from routine to

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alternate-day timetables and from separated to morning solitary dosages, raising iron immersion

and decreasing impacts (Stoffe, 2020). Therefore, offering morning dosages of 60–120 mg iron

provided with absorbable acid on different days might be an optimum oral dosage treatment for

females with iron insufficiency.

Strengths and Weaknesses of Selected Literature

The strength of the selected literature is that it is evidence-based, making it more reliable.

The literature is from previously completed studies that followed reliable procedures to produce

reliable results. Another strength of the selected literature it is not biased on the topic of

discussion. Moreover, the selected literature provides extensive view and knowledge on the

subject matter. The weakness of the literature is that it is not comprehensive since they fail to

cover various elements in their discussion. Another weakness of the selected literature is that it

does not provide new information on the topic.

Proposal

The proposed intervention to the issue of Iron deficiency anemia or patient with anemia is

iron supplements. The paper will present a case of a premenopausal woman leading to profound

iron deficiency anemia with the highest low hemoglobin. The patient will be provided with iron

supplements to improve iron sufficiency. Evidence shows that iron supplement improves

hemoglobin and decreases the incidence of anemia and iron insufficiency. A daily iron

supplement will be given since it lessens the commonness of anemia and iron insufficiency,

increasing iron and hemoglobin stores. An iron supplement of 30–60 mg/day is recommended.

To determine the efficiency of iron supplements in patients with iron deficiency anemia,

various resources are necessary to complete the research successfully. Some of the necessary

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resources include iron supplements and nursing care services. The feasibility of a nurse in an

advanced role is practical. Nurses will provide a nursing care plan for the patient with anemia.

There is a need for an iron supplement supply for the plan to be effective. Those involved in the

whole plan include patients with anemia, nurses who will help implement the plan, and other

staff who will offer critical support. The plan will take place within a hospital setting for 3 to 6

months.

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References

Dündar, B. (2019). The Prevalence And Analysis Of Risk Factors For Postpartum Anemia In

Women Without Prepartum Anemia. Haydarpasa Numune Training and Research

Hospital Medical Journal. https://doi.org/10.14744/hnhj.2019.75436

Fernández-Gaxiola, A. C., & De-Regil, L. M. (2019). Intermittent iron supplementation for

reducing anaemia and its associated impairments in adolescent and adult menstruating

women. Cochrane Database of Systematic Reviews.

https://doi.org/10.1002/14651858.cd009218.pub3

Fischer, J. A. J., Sasai, C. S., & Karakochuk, C. D. (2021). Iron-Containing Oral Contraceptives

and Their Effect on Hemoglobin and Biomarkers of Iron Status: A Narrative Review.

Nutrients, 13(7), 2340. https://doi.org/10.3390/nu13072340

Idemili-Aronu, N., Igweonu, O., & Onyeneho, N. (2020). Uptake of iron supplements and

anemia during pregnancy in Nigeria. Journal of Public Health.

https://doi.org/10.1093/pubmed/fdaa168

Low, M. S. Y., Speedy, J., Styles, C. E., De-Regil, L. M., & Pasricha, S.-R. (2017). Daily iron

supplementation for improving anaemia, iron status, and health in menstruating women.

Cochrane Database of Systematic Reviews, 4.

https://doi.org/10.1002/14651858.cd009747.pub2

Mwangi, M. N., Prentice, A. M., & Verhoef, H. (2017). Safety and benefits of antenatal oral iron

supplementation in low-income countries: a review. British Journal of Haematology,

177(6), 884–895. https://doi.org/10.1111/bjh.14584

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Stevens, G. A., Paciorek, C. J., Flores-Urrutia, M. C., Borghi, E., Namaste, S., Wirth, J. P.,

Suchdev, P. S., Ezzati, M., Rohner, F., Flaxman, S. R., & Rogers, L. M. (2022). National,

regional, and global estimates of anemia by severity in women and children for 2000–19:

a pooled analysis of population-representative data. The Lancet Global Health, 10(5),

e627–e639. https://doi.org/10.1016/S2214-109X(22)00084-5

Stoffe, N. (2020). Oral iron supplementation in iron-deficient women: How much and how

often? Molecular Aspects of Medicine, 75, 100865.

https://doi.org/10.1016/j.mam.2020.100865

Chai, A. L., Huang, O. Y., Rakočević, R., & Chung, P. (2021). Critical iron deficiency anemia

with record low hemoglobin: a case report. Journal of Medical Case Reports, 15(1).

https://doi.org/10.1186/s13256-021-03024-9