iron deficiency anaemia

Question 1

what are the different reasons someone may have low iron?

Answer 1

Insufficient dietary iron

Iron requirements increase (for example in pregnancy)
Iron is being lost (for example slow bleeding from a colon cancer)

Inadequate iron absorption

Question 2

where is iron absorbed and what things can affect iron absorption?

Answer 2

absorbed in the duodenum and jejunum, requires stomach acid for absorption

• ppi can interfere with absoprtion
• conditions affecting duodenum and jejunum can affect absorption e.g. coeliac and crohns

Question 3

what happens to the Total iron binding capacity if there is iron deficiency?

Answer 3

it will go up because there is more space for iron to attach

Question 4

what does total iron binding capacity measure?

Answer 4

how much space there is on transferrin for iron to bind

Question 5

what is the risk of an iron infusion -cosmofer?

Answer 5

anaphylaxis- small risk

Question 6

when should iron infusion not be given?

Answer 6

should avoid in sepsis as bacteria feeds on iron

Question 7

what investigation should you do for a new iron deficiency anaemia in an adult without a clear cause such as mensuration?

Answer 7

should be investigated with suspicion. This involves doing a oesophago-gastroduodenoscopy (OGD) and a colonoscopy to look for cancer of the gastrointestinal tract.

Question 8

what are the management options for an iron deficiency anaemia?

Answer 8

1. Blood transfusion. This will immediately correct the anaemia but not the underlying iron deficiency and also carries risks.
2. Iron infusion e.g. “cosmofer”
3. Oral iron e.g. ferrous sulfate 200mg three times daily. This slowly corrects the iron deficiency. Oral iron causes constipation and black coloured stools. It is unsuitable where malabsorption is the cause of the anaemia.

Question 9

when is iron supplements an unsuitable treatment for iron deficiency anaemia?

Answer 9

where malabsorption is the cause of the anaemia.