Clinical update

Iron deficiency anaemia in adults: what to look for and the questions to ask

RCN guidance sets out the information nurses need to identify and manage patients with IDA

RCN guidance sets out the information nurses need to identify and manage patients with IDA

Picture: Alamy

Essential information

Iron deficiency is the most common form of anaemia and affects an estimated 2 billion people worldwide.

With causes including gastrointestinal conditions, iron deficiency anaemia (IDA) happens when a lack of iron in the body leads to a reduced number of red blood cells.

Typical symptoms include fatigue, weakness and impaired physical function.

Left untreated, IDA can affect the immune system, making patients more vulnerable to illness and infection.

It can also elevate risk of developing problems associated with the heart or lungs, and in pregnancy IDA increases the possibility of complications before and following birth.

What’s new

In July, the RCN published guidance on iron deficiency and anaemia in adults. The guidance was developed by expert nurses from several different specialties, including gastroenterology, gynaecology and chronic kidney disease. They aimed it at nurses, healthcare support workers, midwives and health visitors working in a variety of settings.

It gives information on identifying IDA and escalating its management; examines when, why and how IDA occurs; provides dietary advice, including use of oral iron supplements; and gives tips on delivering intravenous iron.

1 in 6 nurses

may have iron deficiency anaemia – could you be one of them?

Source: RCN

The document also features specialist guidance and case studies for nursing staff working in patient blood management, or with patients who have chronic kidney disease, inflammatory bowel disease, heavy menstrual bleeding, are pregnant or postpartum, have perioperative anaemia or experience heart failure.

Implications for nurses

Nursing staff in all clinical settings will encounter people affected by IDA but effective identification and management is often overlooked, says the RCN guidance.

Common signs and symptoms of anaemia include weakness, shortness of breath, dizziness, fatigue, fast or irregular heartbeat, pounding or whooshing in the ears, headache, cold hands or feet, pale skin, chest pain, lack of concentration, mouth ulcers or cracks at the corners of the mouth, slow or poor wound healing, and tinnitus.

Important issues to ask patients about include: diet and whether intolerances or preferences may lead to inadequate iron intake; medicines, including any that may cause gastrointestinal bleeding; menstrual pattern; pregnancy and lactation; unexplained and heavy bruising; family history; blood donation; any recent travel or contact with others who have been abroad; and other medical conditions.

Nursing staff can offer broad dietary advice, including advocating the avoidance of tea or coffee immediately before or after meals, and eating calcium-rich dairy products as snacks rather than as part of meals, because both habits can act to inhibit iron absorption. Nurses can also encourage patients to eat iron-rich foods, including leafy green vegetables, pulses, lean red meat, and dried fruit and nuts, and to consume vitamin C, which can enhance iron uptake. 

Expert comment

Isobel Mason, nurse consultant in gastroenterology, Royal Free London NHS Foundation Trust

'The guidance is aimed at all nursing staff because iron deficiency is common in all areas of practice, including primary and secondary care, long-term conditions and acute care. We don’t always realise how common it is – 15% of menstruating women live with iron deficiency.

'Nurses can play a key role in identifying it and making sure it’s treated. We want to raise their awareness, making them more alert to the symptoms, so they understand more about IDA, can identify it, and are able to manage it better. It’s often not picked up well enough, which has a big impact on patients’ quality of life, as well as the NHS, leading to complications and increased hospital stays.

‘If we can identify a deficiency and treat it before a patient has surgery, we know they will have much better outcomes.'


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