Aneamia Flashcards
Iron deficiency anaemia
Iron deficiency occurs as result of long-term negative iron balance.
The iron deficiency spectrum ranges from iron depletion to iron deficiency anaemia.
Iron deficiency anaemia is diminished red blood cell production due to low iron stores in the body.
Anaemia is defined as a haemoglobin (Hb) level two standard deviations below the normal for age and sex:
Causes + Symptoms of iron deficient aneamia
Causes: dietary deficiency, malabsorption, increased loss, or increased requirements.
Symptoms: fatigue, dyspnoea, and headache.
Common signs of iron deficiency anaemia include pallor and atrophic glossitis.
Less common signs include: tachycardia, nail changes, and angular cheilosis.
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
TREATMENT
Iron deficiency anaemia should be treated with one tablet once daily of oral ferrous sulfate, ferrous fumarate or ferrous gluconate and continued for 3 months after iron deficiency is corrected.
Haemoglobin levels (full blood count) should be checked after 2–4 weeks to assess the person’s response to iron treatment.
People should undergo specialist assessment if there is a lack of response (increase of less than 20 g/L in the Hb level) after 2–4 weeks.
Megaloblastic anaemias
Megaloblastic anemias result from a lack of either vitamin B12 or folate,
It is essential to establish in every case which deficiency is present and the underlying cause. In emergencies, when delay might be dangerous, it is sometimes necessary to administer both substances after the bone marrow test while plasma assay results are awaited
Causes of megaloblastic aneamia
One cause of megaloblastic anaemia in the UK is pernicious anaemia in which lack of gastric intrinsic factor resulting from an autoimmune gastritis causes malabsorption of vitamin B12.
Vitamin B12 is also needed in the treatment of megaloblastosis caused by prolonged nitrous oxide anaesthesia, which inactivates the vitamin, and in the rare syndrome of congenital transcobalamin II deficiency.
Symptoms include:
Symptoms of vitamin B12 and folate deficiency include: Cognitive changes. Dyspnoea. Headache. Indigestion. Loss of appetite. Palpitations. Tachypnoea. Visual disturbance. Weakness, lethargy.
Tests to confirm
For people with suspected vitamin B12 or folate deficiency, arrange:
A full blood count to determine mean cell volume (MCV), haematocrit and haemoglobin levels, and a blood film — which help to identify megaloblastic anaemia.
Measurement of serum cobalamin and folate levels — to determine the cause of anaemia.
Additional investigations, such as liver function tests, gamma-glutamyl transpeptidase, and/or thyroid function tests — to identify the underlying cause.
How should I treat a person with vitamin B12 deficiency anaemia?
Initially administer hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks.
The maintenance dose - administer hydroxocobalamin 1 mg intramuscularly every 2–3 months for life.
Give dietary advice about foods that are a good source of vitamin B12 — good sources of vitamin B12 include:
Eggs.
Foods which have been fortified with vitamin B12 (for example some soy products, and some breakfast cereals and breads) are good alternative sources to meat, eggs, and dairy products.
Meat.
Milk and other dairy products.
Salmon and cod.
How should I treat a person with folate deficiency anaemia?
Prescribe oral folic acid 5 mg daily — in most people, treatment will be required for 4 months.
Check vitamin B12 levels in all people before starting folic acid — treatment can improve wellbeing, mask underlying B12 deficiency, and allow neurological disease to develop.
Give dietary advice about foods that are a good source of folic acid — good sources of folate include: Asparagus. Broccoli. Brown rice. Brussels sprouts. Chickpeas. Peas.
