Anaemia - Iron-Deficiency Anaemia

Question 1

Causes of Iron Deficiency (4).

Answer 1

1. Insufficient Dietary Intake (commonest in kids).
2. Requirement Increase e.g. Pregnancy.
3. Increase Loss e.g. Slow Bleeding in Cancer, Menorrhagia (commonest in adults).
4. Inadequate Absorption.

Question 2

Absorption of Iron (3).

Answer 2

1. At duodenum and jejunum.
2. Requires acid from stomach to keep iron in the soluble ferrous (Fe2+) form.
3. If acid drops, it becomes insoluble ferric (Fe3+) form.

Question 3

Give 2 causes of reduced absorption of Iron.

Answer 3

1. Diseases that affect the Small Intestine.
2. Medications that affect Stomach Acid levels.

Question 4

Clinical Features of Iron-Deficiency Anaemia (4).

Answer 4

1. Brittle Hair (Loss) and Nails.
2. Koilonychia (Spoon-Shaped Nails).
3. Angular Chelitis.
4. Atrophic Glossitis (Smooth Tongue - Atrophy of Papillae).

Question 5

Investigations in Iron-Deficiency Anaemia (5).

Answer 5

1. TIBC.
2. Transferrin Saturation.
3. Serum Iron.
4. Serum Ferritin.
5. Transferrin.

Question 6

What is Transferrin?

Answer 6

The carrier protein that transports Iron as Ferric (Fe3+) ions.

Question 7

What is TIBC?

Answer 7

Total Iron Binding Capacity - the total space on the Transferrin molecules for the Iron to bind (related to amount of Transferrin).

Question 8

What is Transferrin Saturation?

Answer 8

Serum Iron ÷ TIBC (indicating total iron in the body).

Question 9

Why are fasting samples required in terms of Transferrin Saturations?

Answer 9

They can increase temporarily after eating a meal rich in Iron or taking Iron supplements.

Question 10

What is Ferritin?

Answer 10

The form of Iron when it has been deposited and stored in cells.

Question 11

Ferritin and Results (2).

Answer 11

1. Inflammation - Extra ferritin is released e.g. infection, cancer.
2. Iron-Deficiency : Low (can be normal if inflammation).

Question 12

Results of Iron Studies in Iron-Deficiency Anaemia (2).

Answer 12

1. Increase : TIBC, Transferrin.
2. Decrease : Ferritin, Iron, Transferrin Saturation.

Question 13

What can increase the value of all these results?

Answer 13

Iron Overload e.g. Supplementation with Iron, Acute Liver Damage (storage break).

Question 14

Blood Film in Iron-Deficiency Anaemia (3).

Answer 14

1. Anisopoikilocytosis - RBCs of different sizes and shapes.
2. Target Cells.
3. Pencil Poikilocytes.

Question 15

Management of Iron-Deficiency Anaemia (2).

Answer 15

1. New Iron-Deficiency Anaemia without Clear Underlying Cause - OGD and Colonoscopy.
2. Treat Underlying Cause and Correct Anaemia.

Question 16

What are the 3 options to treat Iron-Deficiency Anaemia?

Answer 16

1. Blood Transfusion (fastest + most invasive).
2. Iron Infusion (medium + medium) e.g. Cosmofer.
3. Oral Iron (slowest + least invasive) e.g. Ferrous Sulphate TDS.

Question 17

Considerations of Iron Infusion (2).

Answer 17

1. Small Risk of Anaphylaxis.
2. Avoid during Sepsis - Iron feeds bacteria.

Question 18

Considerations of Oral Iron (3).

Answer 18

1. Constipation and Black-Coloured Stools.
2. Unsuitable if Malabsorption is the Cause.
3. Continue for 3 months after correction to replenish iron stores.

Question 19

Progress with Iron Treatment of Iron Deficiency Anaemia.

Answer 19

Haemoglobin is expected to rise by around 10g/L per week.

Question 20

Iron-Rich Diet (3).

Answer 20

1. Dark Green Leafy Vegetables.
2. Meat.
3. Iron-Fortified Bread.

Question 21

How is Iron in the body regulated?

Answer 21

Hepcidin (Iron Regulatory Hormone) causes Ferroportin (Iron Channel) Internalisation and Degradation to reduce iron transfer from the duodenum into the plasma, based on iron concentrations.