Haematological Flashcards
Epi of IDA?
Cause of IDA
Most commonly occurs in pre-school children
Low dietary iron: most common cause (due to prolonged/ exclusive consumption of cow’s/ breast milk/ late intro of iron containing solids)
Increased demands due to rapid growth
Malabsorption
GI blood loss (rare: meckel’s divert, oesophagitis, drugs/NSAIDs, cysts, tumours)
Intestinal parasites e.g. hookworm
RFs for IDA?
Preterm, low birthweight (LBW) infants, multiple births
After exclusive breastfeeding >6 months, delayed introduction of iron-containing solids, excessive cow’s milk (protein enteropathy)
Adolescent females – due to growth spurt + menstruation
Low iron-containing diet due to poverty, fad diets, or strict vegan diets
Presentation of IDA?
Pallor
Lethargy
Poor feeding
Breathlessness (severe anaemia)
Signs of iron deficiency
Neurological effects of listlessness and irritability (infants)
Mood changes
↓cognitive and psychomotor performance (mild/moderate deficiency before anaemia develops)
Pica (eating abnormal items e.g. soil/pencils)
Investigations for IDA
Important differentials
FBC: ↓Hb, ↓MCV/MCH/MCHC, platelets often raised. Will demonstrate hypochromic microcytic anaemia
Blood film: microcytic, hypochromic anaemia. anisopoikilocytosis (red blood cells of different sizes and shapes) , target cells, ‘pencil’ poikilocytes
Serum ferritin↓ (indicative of iron stores) – may be low before anaemia
Check CRP as ferritin may be falsely raised due to acute phase reaction: ↓serum iron and ↑total iron binding capacity (TIBC) confirms iron deficiency: high TIBC reflects low IRON stores
IDA Management
5mg/kg elemental iron per day (as oral ferrous salt) given in 2-3 divided doses (max dose 200mg/day)
Response in reticulocyte count usually within 5-10 days
Continue for 3 months after Hb normalises to replenish body stores
If indices don’t improve once Hb normalises – screen for thalassaemia trait
Important differentials of IDA?
Other causes of microcytic anaemia
Thalassaemias
Sideroblastic anaemias
Anaemia of chronic disease
