Iron deficiency anaemia

Question 1

1) Where is iron absorbed in GI tract?
2) Why does iron absorption require an acidic environment?

Answer 1

1) Duodenum and jejunum
2) To keep the iron in the soluble ferrous (Fe2+) form - when acid drops it changes to the insoluble ferric (Fe3+) form which impacts absorption

Question 2

1) What is the commonest cause of iron deficiency anaemia in adults?
2) What is the commonest cause of iron deficiency anaemia in children?
3) Name another cause of iron deficiency anaemia

Answer 2

1) Blood loss
2) Dietary insufficiency
3) Poor absorption (i.e. IBD, PPIs due to decreased acidic environment of the stomach) and increased requirement in pregnancy

Question 3

1) In what form does iron travel in the blood, and bound to what protein?
2) What is the total iron binding capacity?
3) The total iron binding capacity is related to what in the blood?
4) If you measure iron in the blood and then measure the total iron binding capacity of that blood, what can you measure, and what is it called?
5) What is the form that iron takes when it is deposited and stored in cells?

Answer 3

1) 3+ - ferric. Transferrin
2) The total space on the transferrin molecules for the iron to bind
3) Transferrin
4) The proportion of the transferrin molecules that are bound to iron - transferrin saturation
5) Ferritin

Question 4

New iron deficiency in an adult without a clear underlying cause should be investigated with what investigations, and why?

Answer 4

Oesophago-gastroduodenoscopy (OGD) and a colonoscopy to look for a GI cancer

Question 5

Management involves treating the underlying cause and correcting the anaemia, name 2 ways of achieving this

Answer 5

• Blood transfusion
• Iron infusion i.e. cosmofer
• Oral iron

Question 6

Name a side effect of giving oral iron, and when it’s unsuitable as a treatment for iron deficiency anaemia

Answer 6

Constipation and black coloured stools, unsuitable when the cause of the anaemia is malabsorption

Question 7

In a patient with IDA, what would happen to their total iron binding capacity and ferritin level?

Answer 7

Total iron binding capacity would increase and serum ferritin decrease

Question 8

MCV < what is considered microcytic anaemia?

Answer 8

<80fl

Question 9

Raised ferritin

Answer 9

• Plenty of iron available - haemochromatosis, transfusions
• Sequester iron - infection, inflammation
• Ferritin containing tissues are damages - ferritin released

Question 10

When are transferrin sats high and low?

Answer 10

• High = low iron levels
• Low = iron levels high

Question 11

Transferrin sats of roughly what suggests iron def?

Answer 11

<20%