Blood - Level 1 Flashcards
Definition of iron deficiency anaemia?
- IDA is due to ineffective erythropoiesis which causes reduced red cell production
o Causes small, pale RBCs
Numerical definitions of iron deficiency anaemia in men, women, children?
o In men aged over 15 years — Hb<130 g/L.
o In non-pregnant women aged over 15 years — Hb<120 g/L.
o In children aged 12–14 years — Hb<120 g/L
o In pregnant women - Hb <110g/L
o Postpartum - Hb <100g/L
Serum ferritin level <15 micrograms/L confirms iron deficiency
Numerical definition of iron deficiency anaemia in pregnant women and postpartum?
o In pregnant women — Hb below 110 g/L throughout pregnancy.
o Postpartum — below 100 g/L.
Serum ferritin level of less than 15 micrograms/L confirms iron deficiency
Epidemiology of iron deficiency anaemia?
- Commonest nutritional deficiency
- Most common microcytic hypochromic anaemia
- 25% of infants with peak at 18 months
Causes of iron deficiency anaemia?
- Dietary (commonest) - Low level of dietary iron e.g. high milk intake (low iron), vegan, poverty
- Malabsorption (Coeliac disease, IBD, gastrectomy, H.pylori, Hookworm, schistosomiasis)
- Blood loss (Meckel’s diverticulum, oesophagitis, GI cancer. colon cancer, or secondary to drugs e.g. NSAIDs, menstruation)
- Increased requirement (Iron requirement 3x higher in pregnancy)
- Other (Blood donation, self-harm, medication)
Symptoms of iron deficiency anaemia?
Mostly asymptomatic
Symptoms o SOB o Fatigue o Headache o Cognitive dysfunction o Restless leg syndrome o Vertigo o Syncope o Dizziness, weakness o Palpitations o PICA (abnormal dietary cravings (soil, pencils, ice)
Signs of iron deficiency anaemia?
o Nails – koilonychia o Dry and rough skin o Pallor o Atrophic glossitis o Angular stomatitis o Alopecia o Tachycardia, heart failure
Investigations of iron deficiency anaemia?
Bloods
o FBC (low Hb, low MCV, MCH)
o Ferritin – low <15mcg/L
o B12 and folate – if normocytic
Blood film
o Small, pale red cells (central pallor)
o Anisocytosis (variation in size)
o Poikilocytosis (irregular shape red blood cells)
Diagnostic trial of iron in premenopausal women with history of menorrhagia or pregnant
Investigations in all confirmed iron deficiency anaemia?
o Coeliac serology
o Urinalysis – blood
When is no further testing needed in after diagnosis of iron deficiency anaemia?
o Healthy young people if history suggests cause
o Menstruating young women with no GI symptoms or FHx of colorectal cancer
o Pregnant women
o Terminally ill and unable to undergo invasive testing
General management of iron deficiency anaemia?
Address underlying cause if apparent (menorrhagia, NSAIDs blood donations)
Dietary Advice
- Increase level of iron in food
- e.g. iron fortified formulas and breakfast cereals, meat, liver, oily fish (sardines, pilchards), green veg, beans, egg, yolk, foods rich in vit C (inc iron absorption)
Iron supplementation management of iron deficiency anaemia?
- Oral ferrous sulfate 200mg BDS/TDS (ferrous sulphate contains 65mg of ferrous iron - recommended 100-200mg ferrous iron)
- Continued until Hb is normal and for a further 3 months
o Alternative: ferrous fumerate, ferrous gluconate
o Level starts to rise within a week so failure to do so indicates non-compliance
o Stools turn black and iron is dangerous in overdose
Monitoring in iron supplements of iron deficiency anaemia?
o 2-4 weeks – FBC (should rise 2g/100ml over 3-4 weeks)
If no response – refer to specialist
o Once normal – Continue for 3 months then stop
o FBC every 3 months for 1 year and then check after further year
When to give ongoing prophylactic dose of iron in iron deficiency anaemia?
Ongoing prophylactic dose of 200mg ferrous sulfate daily if:
o Recurring anaemia and further investigation not indicated
o Iron-poor diet
o Malabsorption
o Menorrhagia
o Gastrectomy
o Pregnancy
When to give parenteral iron in iron deficiency anaemia?
- Transfusion reserved for those at risk of CV instability (SOB, chest pain, presyncope)
- Parenteral Iron (iron dextran)
o If oral iron not tolerated, or rapid iron loss
When to urgently refer iron deficiency anaemia?
- Urgent if IDA and >60, IDA <50 and rectal bleeding
When to refer to gastroenterology of iron deficiency anaemia?
o All men and postmenopausal women with IDA unless overt non-GI bleeding
o All people >50 with anaemia or FHx of colorectal cancer
o Premenopausal women <50 with colonic symptoms, FHx (2 1st degree relative or 1 before 50) or persistent IDA
o Coeliac positive serology
When to refer to gynaecology of iron deficiency anaemia?
o Menorrhagia unresponsive to treatment
o Postmenopausal bleeding
Pregnant if significant symptoms and/or severe anaemia (<70) or >34 weeks or failure to respond
Complications of iron deficiency anaemia?
- Cognitive and behavioural impairment in children
- Impaired muscular performance
- Heart failure
- In pregnancy:
o Lower birthweight, high morbidity/mortality, preterm delivery