Anemia Care Plan: A Detailed Guide

A complete diagnostic workup for anemia includes: (1) CBC (Complete Blood Count): Hemoglobin <12g/dL (women) or <13g/dL (men) = anemia. MCV (mean corpuscular volume): low MCV (<80fL) indicates microcytic anemia (likely iron deficiency); high MCV (>100fL) indicates macrocytic anemia (B12 or folate deficiency); normal MCV = normocytic (chronic disease or haemolytic); (2) Iron studies: Serum ferritin <30ng/mL confirms iron deficiency; serum iron, TIBC (total iron-binding capacity), and transferrin saturation (<20% indicates iron deficiency). Ferritin is the most sensitive single test for iron deficiency — order this first before other iron studies; (3) Vitamin B12 and folate: B12 <200 pg/mL = deficiency; folate <2ng/mL = deficiency; (4) Reticulocyte count: elevated = active blood loss or haemolysis; low = bone marrow suppression. In clinical practice, always treat the underlying cause, not just the anaemia number. A 60-year-old with new iron deficiency anaemia without obvious cause needs colonoscopy to rule out colorectal cancer.

Oral iron (ferrous sulphate 200mg 3×/day = 180mg elemental iron/day) is first-line for mild-to-moderate iron deficiency anaemia in patients without GI issues. Expected response: 1g/dL Hb rise per 2–3 weeks; treat for 3 months after Hb normalises to replenish stores. Give with Vitamin C (enhances absorption 2–3×); avoid with tea, coffee, calcium, or antacids (reduce absorption by 30–60%). Intravenous iron (ferric carboxymaltose, iron sucrose) is indicated when: oral iron is not tolerated (GI side effects in 30–40% of patients); malabsorption (coeliac disease, IBD, post-bariatric surgery); pre-operative optimisation with surgery in <2 weeks; heavy menstrual blood loss exceeding oral supplementation rate; chronic kidney disease (often used with ESAs); non-compliance or unreliable oral intake. IV iron restores stores much faster (weeks vs. months) and bypasses GI absorption. India-specific note: IV iron is available as Dextran-free ferric carboxymaltose (Monofer) at major hospitals; ferric gluconate/iron sucrose at most district hospitals.

India's vegetarian diet can provide adequate iron but non-haem iron (plant sources) has only 3–8% bioavailability vs. 25–30% for haem iron (meat). High-iron Indian foods: Rajma (kidney beans): 8mg per cup cooked; Palak (spinach): 6mg per 100g cooked; Methi (fenugreek): 13mg per 100g; Bajra (pearl millet): 8mg per 100g; Til (sesame seeds): 14mg per 100g; Chana dal: 5mg per cup; Jaggery (gur): 11mg per 100g. Absorption enhancers — always combine with Vitamin C sources: amla (Indian gooseberry — highest VitC food, 600mg/100g), lemon juice on dal, tomato in sabzi. Absorption blockers to avoid at iron-rich meals: tea and coffee (reduce absorption by 60% — wait 2 hours after iron-rich meal); calcium-rich foods; antacids. Pressure cooking improves iron bioavailability by reducing phytates (anti-nutrients) in legumes. Cooking in iron kadhai has been shown to increase food iron content by 2–3× — still relevant for rural India where anemia is high.

Timeline for iron deficiency anaemia correction: Symptom relief (fatigue, breathlessness): begins within 2–4 weeks of starting oral iron — RBC production increases before Hb reaches target. Haemoglobin normalisation: typically 6–8 weeks for mild anaemia (Hb 10–11.9g/dL); 10–12 weeks for moderate anaemia (Hb 8–9.9g/dL). Iron store replenishment: 3–6 months of treatment after Hb normalises — the most common mistake is stopping iron when Hb reaches normal (stores remain empty → relapse within months). Reassessment schedule: CBC at 4 weeks (confirm Hb is rising — if not, check compliance, absorption, or consider IV iron); CBC at 8 weeks (confirm target Hb reached); serum ferritin at 3 months (confirm stores are replenished — target ferritin >50ng/mL); address underlying cause (investigate GI bleeding, menstrual loss, dietary inadequacy). Red flags requiring urgent specialist referral: Hb <7g/dL (severe anaemia); no response after 4 weeks of compliant oral iron (consider IV iron or further investigation); suspected haematological malignancy.