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Management of Iron Deficiency Anemia in Nonpregnant Reproductive-Age Women

Protocol

Delaney Schick

Department of Nursing, Carson-Newman University

NURS 531: Advanced Primary Nursing Care for Women

Dr. Ashlie Pullen

February 26, 2025

Management of Iron Deficiency Anemia in Nonpregnant Reproductive-Age Women

Protocol

1. Topic

Iron deficiency anemia (IDA) is a prevalent blood disorder that occurs when low iron

levels prevent the body from producing enough healthy red blood cells, resulting in anemia.

Anemia can be classified as “mild (hemoglobin 10 g/dL to the lower limit of normal), moderate

(hemoglobin 8 to 10 g/dL), severe (hemoglobin 6.5 to 7.9 g/dL), or life-threatening (hemoglobin

less than 6.5 g/dL” (Badireddy & Baradhi, 2023). As the most prevalent nutritional deficiency

worldwide, IDA is caused by a variety of factors, including inadequate dietary intake, impaired

absorption, increased physiological demands, and chronic blood loss (Auerbach & DeLoughery,

2025). Women are particularly vulnerable at different stages of life due to menstrual blood loss,

heightened iron needs during pregnancy, and postpartum hemorrhage (Pai et al., 2023).

IDA is not only a widespread condition but also a major global health burden, affecting

approximately one-third of the population and contributing to nearly half of all anemia cases. It

is often linked to chronic conditions like cancer, chronic kidney disease, and inflammatory bowel

disease, making its management more complex. Despite medical advancements, it continues to

be a widespread issue, particularly among low-income populations who have limited access to

fresh or iron-fortified foods and healthcare. The global prevalence in women is estimated to be

around 15–18%, with significantly higher rates in developing countries, underscoring the urgent

need for improved screening, prevention, and treatment strategies (Mahar et al., 2024).

2. Goal of Therapy
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The goal of therapy is to restore iron levels and resolve anemia, identify and address

underlying causes, and prevent recurrence and long-term complications.

3. Data Base

A. Subjective

1. Patient report: The patient may report mild to severe feelings of fatigue or

exercise intolerance.

2. Typical symptoms: Common symptoms associated with IDA are fatigue,

exercise intolerance, pica, especially pagophagia, restless legs syndrome, hair

loss, brittle nails, headache, cold intolerance (Auerbach & DeLoughery,

2025a).

3. Less common symptoms requiring referral: Chest pain, palpitations, severe

fatigue impacting daily function, shortness of breath, dizziness or

lightheadedness (Auerbach & DeLoughery, 2025a).

B. Objective

1. Physical Exam Findings:

 Vital Signs: Tachycardia, hypotension

 Skin: Pallor, dry skin, brittle nails or koilonychia

 HEENT: Pale conjunctiva, atrophic glossitis, dry mouth, angular

cheilitis, hair loss, esophageal web with dysphagia (Plummer-Vinson

syndrome)
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 Cardiovascular: Tachycardia, systolic murmur, hemodynamic

instability

 Respiratory: Dyspnea on exertion (Auerbach & DeLoughery, 2025a).

2. Rationale: Reduced oxygen-carrying capacity due to low hemoglobin triggers

compensatory mechanisms, including tachycardia and hypotension, to

maintain tissue oxygenation and perfusion (Mozos, 2015). Reduced

hemoglobin results in decreased oxygen supply to tissues, leading to pallor.

Nail and skin changes occur due to impaired epithelial cell function (Lopez et

al., 2016).

C. Analysis

1. Nursing Diagnosis:

 Fatigue related to decreased oxygenation secondary to iron deficiency

anemia.

 Imbalanced Nutrition: Less Than Body Requirements related to blood

loss or inability to absorb adequate iron.

2. Medical Diagnosis:

 Iron deficiency anemia

3. Common Differential Diagnoses:

 Vitamin B12 or folate deficiency (pernicious anemia)

 Thalassemia

 Hypothyroidism or hyperthyroidism

 Anemia of chronic disease

 Restless leg syndrome

 Sideroblastic anemia

 Lead poisoning

D. Plan

Managing IDA involves identifying the condition through screening and lab evaluation,

determining the underlying cause, and providing individualized treatment, as needs vary based

on severity, absorption, and patient-specific factors.

1. Preventive & Screening Strategies:

The 2024 European Hematology Association (EHA) guidelines and 2023

International Federation of Gynecology and Obstetrics (FIGO) statement recommend

screening for IDA in these populations:

 Those who menstruate

 Athletes with high physical demands

 Vegetarians and those with limited dietary iron intake

 Frequent blood donors

 People with bleeding disorders or those on anticoagulant therapy

 Individuals with a history of gastric surgery

 Patients with chronic infections

 Those preparing for or recovering from major surgery

 Socioeconomically disadvantaged individuals with limited healthcare access

Recommendations include screening (through CBC and iron studies) adolescent and

adult females of reproductive age every five years, or annually for those with heavy

menstrual bleeding, low iron intake, or a history of deficiency, with further evaluation if

anemia persists (Auerbach & DeLoughery, 2025a).

2. Diagnostic Testing:

 CBC: Can identify anemia, but not iron deficiency or the cause

o Low hemoglobin (females: <11.9 g/dL)

o Low hematocrit (females <35%)

o Low MCV and MCHC

o High RDW

o Microcytosis and hypochromia on the blood smear

 Serum ferritin (<30 ng/mL): Has the highest specificity for diagnosing IDA

 Serum iron, TIBC (low iron, high TIBC confirms IDA)

 Transferrin saturation <20%

 Reticulocyte count (low in IDA)

 Bone marrow iron stain: Gold standard for IDA diagnosis, but rarely required

 Stool occult blood test if GI bleeding suspected (Refer to gastroenterologist if

positive)

3. Treatment Plan:

If IDA is not severe or life threatening, use the following approach. If IDA is severe or

life threatening, send to emergency room immediately for blood transfusion.

 First-Line Treatment (Oral Iron):

o Oral iron is most effective when taken every other day due to reduced

hepcidin-mediated absorption inhibition. Doses of 40–80 mg elemental iron

on alternate days optimize absorption while minimizing GI side effects

(Moretti et al., 2015).

o Example: Ferrous sulfate 325mg (65mg elemental iron) tablet PO once every

other day

o Side effects include constipation, nausea, dark stools, metallic taste, diarrhea.

Consider stool softeners if needed.

o Oral iron may be ineffective for individuals with ongoing blood loss,

malabsorption conditions, chronic kidney disease, or patients who cannot

tolerate the side effects (Auerbach & DeLoughery, 2025b).

 IV Iron Therapy:

o IV iron is recommended for individuals who cannot tolerate oral iron due to

gastrointestinal side effects, ongoing blood loss, severe anemia (Hb <7 g/dL),

or conditions that impair absorption, such as gastric surgery, IBD, or

malabsorption syndromes. IV iron allows for rapid repletion in one or two

infusions, unlike oral iron, which has limited daily absorption (Auerbach &

DeLoughery, 2025b).

o Iron sucrose requires multiple infusions, whereas ferric carboxymaltose

allows for rapid correction in 1–2 doses. Ferric derisomaltose has the
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advantage of a single high-dose infusion (1000 mg) with a lower risk of

hypophosphatemia.

o Refer to hematologist is IV iron is being considered.

 Non-Medication Treatments:

o Dietary counseling for increased iron intake (increasing iron-rich foods: organ

meat, nuts, seeds, beans and peas, green leafy vegetables)

o Address underlying causes

 Refer to gastroenterologist for GI causes

 Work up heavy menstrual bleeding

Treatment plan derived from Auerbach & DeLoughery (2025b).

4. Patient Education:

 Importance of Adherence to Treatment

o Taking iron supplements as prescribed is essential for replenishing iron stores

and preventing complications.

o Skipping doses or stopping treatment too soon can delay recovery and

increase the risk of persistent anemia.

o Even if symptoms improve, continue the full course of treatment to restore

iron levels completely.

 Minimizing Gastrointestinal Side Effects

o Taking iron with food may reduce stomach discomfort, though absorption is

best on an empty stomach.

o Avoid consuming dairy, calcium supplements, coffee, or tea close to iron

intake, as these can interfere with absorption.

o Consider using a lower dose formulation if GI symptoms are severe.

 Signs of Improvement

o Most patients notice increased energy and reduced fatigue within 2–4 weeks

of starting treatment.

o Hemoglobin levels typically rise within a month, but full iron store

replenishment may take 3–6 months.

o If symptoms persist beyond a few weeks, follow up with a healthcare provider

to reassess treatment effectiveness.

 Dietary and Lifestyle Considerations

o Include iron-rich foods (from plant and animal sources) like meats, beans, and

leafy greens.

o Pair iron intake with vitamin C-rich foods to enhance absorption.

o Stay hydrated and consider fiber intake adjustments to prevent constipation

from iron supplements.

 When to Seek Medical Attention

o Report any severe side effects, such as black stools (a normal effect of iron

but should be monitored), severe stomach pain, allergic reactions, or chest

pain.

o If symptoms of anemia persist despite adherence, further evaluation may be

needed to check for underlying causes.

Patient education information derived from Auerbach (2025).

5. Follow-Up:

 Check a CBC two weeks after starting oral iron therapy. Hemoglobin levels should

increase by at least 1 g/dL and continue to rise by approximately 2 g/dL over the

following three weeks. Within a month, the deficiency should be reduced by half,

with full normalization expected within six to eight weeks (Auerbach & DeLoughery,

2025b).

 Ferritin can be checked 8-12 weeks after initiating oral iron therapy. Levels should be

>50 ng/mL).

 Continue treatment for 3–6 months after correction to replenish iron stores.

 Monitor for recurrence annually, especially if heavy periods persist.

 For IV iron, hemoglobin is rechecked at least 4 weeks after IV (Auerbach &

DeLoughery, 2025b).

E. Clinical Applicability

 This protocol provides a structured, evidence-based approach to diagnosing and

managing IDA in reproductive-age women.

 Can be applied in primary care, OB/GYN, and internal medicine settings.

References:

Auerbach, M. (2025) Patient education: Anemia caused by low iron in adults (Beyond the

Basics). UpToDate. Retrieved February 24, 2025, from

https://www.uptodate.com/contents/anemia-caused-by-low-iron-in-adults-beyond-the-

basics#H13

Auerbach, M., & DeLoughery, T.G. (2025a). Causes and diagnosis of iron deficiency and iron

deficiency anemia in adults. UpToDate. Retrieved February 23, 2025, from

https://www.uptodate.com/contents/causes-and-diagnosis-of-iron-deficiency-and-iron-

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Auerbach, M., & DeLoughery, T.G. (2025b). Treatment of iron deficiency anemia in adults.

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Badireddy, M., & Baradhi, K. M. (2023). Chronic anemia. StatPearls. Retrieved February 23,

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Lopez, A., Cacoub, P., Macdougall, I. C., & Peyrin-Biroulet, L. (2016). Iron deficiency

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Mahar, B., Shah, T., Shaikh, K., Shaikh, S. N., Uqaili, A. A., Memon, K. N., Warsi, J., Mangi,

R., Aliyu, S., Abbas, Q., & Shaikh, F. (2024). Uncovering the hidden health burden: a

systematic review and meta-analysis of iron deficiency anemia among adolescents, and

pregnant women in Pakistan. Journal of Health, Population & Nutrition, 43(1), 1–11.

https://doi.org/10.1186/s41043-024-00643-y

Moretti, D., Goede, J. S., Zeder, C., Jiskra, M., Chatzinakou, V., Tjalsma, H., Melse-Boonstra,

A., Brittenham, G., Swinkels, D. W., & Zimmermann, M. B. (2015). Oral iron

supplements increase hepcidin and decrease iron absorption from daily or twice-daily

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Mozos I. (2015). Mechanisms linking red blood cell disorders and cardiovascular

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Deficiency/Iron-Deficiency Anemia in Women: An Asian Expert

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