Iron deficiency anaemia

Question 1

34 F presented with fatigue, new onset heavy menstrual bleed for 6/7 days (normal cycle 30 days), story about husband, story about child, vegetarian for 2 years, identifies as Aboriginal.

Impression/DDx/Goals

Answer 1

Impression:
PDx - iron deficiency anaemia given menstrual history, female gender, dietary choices.
DDx
Consider other causes of anaemia
- microcytic: TAILS
- normocytic: haemolytic condition (intra and extra corpuscular
- macrocytic: B12/folate def, chronic liver disease
- Bleeding disorder (VWD, F5Leiden deficiency, etc)

RED FLAGS
- Malignancy (haematological, gastro, other)

Goals

• Identify underlying cause of iron deficiency
• Treat underlying aetiology
• Correct Hb deficiency

Question 2

Iron deficiency anaemia - History

Answer 2

History:

• Sx: fatigue, breathlessness, chest-pain (severe anaemia), pica, pallor, restless legs, GI symptoms
• RED FLAG: sx of malignancy
• bleeding history - screen for bleeding disorders
• Menstrual/obstetric history
• PMHx, Medications
• SNAP

Question 3

Iron deficiency anaemia - Examination

Answer 3

Exam:

• Signs of anaemia: cap refill, palmar crease, conjunctival pallor
• Cardiovascular examination
• Speculum examination +/- CST

Question 4

Iron deficiency anaemia - Investigations

Answer 4

Investigations:
Key diagnostic for iron deficiency
- FBC
- Iron studies

Otherwise:

• Bedside: Vitals, urinalysis (urinary blood loss, pregnancy)
• Bloods: FBC, Iron studies, consider reticulocyte count, B12/Folate level, blood film analysis, coats (bleeding disorder, then further VWD testing: ristoceting, VWF antigen assay)
• Imaging: Nil relevant,
• Other: endoscopy (upper/lower), pill cam

Question 5

Iron deficiency anaemia - Management

Answer 5

Management:
Non-pharm
- dietary modification

Pharm

• Oral Iron supplementation
• IV Iron infusion
• if acutely unwell and meet criteria, consider whole blood transfusion
• COCP/ other hormone therapy options for menstrual bleeding control

Review/Referral/Safety-netting

• To present to ED if serious sx (chest pain, breathlessness)
• Return to GP if non-improving
• Consider Gastro referral if no underlying cause identified to screen for bowel pathology