Iron Deficiency Anemia, Post MVR

Vijayalakshmi G*, Indumathi,

1Non Critical Ward Incharge, Kauvery Heartcity, Trichy, India

*Correspondence:nursing.heartcity@kauveryhospital.com

Abstract

A 50-year-old female, euglycemic and normotensive, known case of RHD – S/P MVR (2012), came with a history of giddiness, palpitation & menorrhagia – 5 days for which gynaecologist evaluation was done. She was shifted from Kauvery Speciality to Kauvery Heartcity for further evaluation and post-MVR management.

Definition

  1. Iron deficiency anemia develops when body stores of iron drop too low to support normal red blood cell (RBC) production.
  2. Iron equilibrium in the body normally is regulated carefully to ensure that sufficient iron is absorbed in order to compensate for body losses of iron.
  3. Iron deficiency is defined as a decrease in total iron content in the body.
  4. Iron deficiency anemia occurs when iron deficiency is severe enough to diminish erythropoiesis and cause the development of anemia.

Etiology

The cause of iron-deficiency anemia varies based on age, gender, and socioeconomic status. Iron deficiency may result from insufficient iron intake, decreased absorption, or blood loss. Iron-deficiency anemia is most often from blood loss,

Signs and Symptoms

  1. Extreme fatigue.
  2. Weakness.
  3. Pale skin.
  4. Chest pain, fast heartbeat or shortness of breath.
  5. Headache, dizziness or lightheadedness.
  6. Cold hands and feet.
  7. Inflammation or soreness of your tongue.
  8. Brittle nails.

Abnormal Investigations

Peripheral Smear (PS):

RBCs – Normocytic normochromic

WBCs – Normal in number and morphology with neutrophilic preponderance and distribution.

Platelets: Decreased on smear

Parasites: No Parasites

Impression: Normocytic normochromic anemia with thrombocytopenia.

PT (Prothrombin Time):

Test (PT) – 15.2 sec

Control (PT) – 11.3 sec

INR – 1.35

Blood Group:

O+ve

1st HB Level – 5.0

1U packed RBC transfusion (26.08.22)

2nd HB Level – 9.4

2U Packed RBC transfusion (27.08.22)

3rd HB Level – 9.4 (28.08.22)

Packed Cell Volume: 30.0%

Total WBC Count: 6300 Cells/cumm

Red Blood Cell (RBC) Count: 3.94 million cells / cumm

Platelet Count: 46000 cells / cumm

ECHO:

Packed-Cell-Volume-1

X – Ray Report:

Packed-Cell-Volume-2

Liver function test:

Bilirubin total – 0.242 mg/dl

Bilirubin Direct – 0.121mg/dl

Bilirubin Indirect – 0.121mg /dl

SGOT – 15 U/L

SGPT – 10 U/L

Alkaline phosphate – 83.2 U/L

Total Protein – 5.78 g/dl

Albumin Serum – 3.66 g/dl

Globulin serum – 2.12 g/dl

AIG ratio – 1.73

Gamma – Glutamyl Transferase – 10 U/L (GGT)

Abdomen Scan Report:

  1. Impression
  2. Cholelithiasis
  3. Right ovarian hemorrhagic cyst
  4. Bulky cervix

Diagnosis

  1. Rheumatic Heart Disease
  2. S/P MVR (2012)
  3. Good LV function
  4. Normal sinus rhythm
  5. Menorrhagia – Prolonged INR
  6. Severe iron deficiency anemia – Transfused with 3 units of packed cells.
  7. Idiopathic Thrombocytopenic Purpura.

Nursing Care of Iron Deficiency Anemia (Post MVR):

    1. Blood Transfusions – especially RBC had to be transfused.
    2. Iron supplement – Oral ferrous sulphate, parentral iron therapy
    3. Nutritional Therapy – vitamin B12 rich diet, folic acid rich diet.
    4. Correction of chronic blood loss like menorrhagia.
    5. Patient should be restricted from taking Vitamin K rich diet like green leafy vegetables, cauliflower etc.,
    6. Advise to avoid alcoholic beverages.
    7. Maintained Interpersonal relationship with patient & family members.
    8. Activities has to be restricted, patient has to prioritize the recommended activities.
    9. Diversional therapies like newspaper reading, listening to music was induced.
    10. AIDET communication technique was followed for effective communication.
    11. Strict compliance on HICC standard precautions was ensured.
    12. INR had to be checked pm regular basis.
    13. The nurses assessed the skin integrity of the patient on a daily basis to prevent dehydration, skin tear.
    14. Necessary investigations were done on a daily basis to monitor her health improvement.
    15. The assigned nurses communicated with the patient reassuring her about her health status and gave her orientation to time, place and person.

Nurses coordinated with other health care professionals for care while doing X-ray, arranging diet at appropriate time and for other timely investigations.

  1. Advised and observed for not straining on defecation to prevent dyspnea.
  2. Opinions were obtained from Hematologist and Gynaecologist and their orders were carried out respectively.

Recovery

After 3 days of stay in the hospital, patient became stable with adequate blood transfusion and parental drug advice. She was discharged with active management and effective care of nurses and went home happily with good prognosis.

Vijayalakshmi

Ms. Vijayalakshmi

Non Critical Ward Incharge

Indumathi

Ms. Indumathi

Non Critical Ward Incharge

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