Iron deficiency anaemia

Question 1

Symptoms

Answer 1

• Tiredness
• Pallor
• SoB
• Palpitations

Question 2

Who may require iron supplementation as prophylaxis?

Answer 2

• Malabsorption e.g. Crohn’s disease
• Gastrectomy
• Menorrhagia
• Chronic renal failure; haemodialysis
• Pregnancy
• Low birth weight infants

Question 3

Iron - counselling

Answer 3

Take with or after food
- Reduce GI effects (constipation, diarrhoea)
Take with a glass of orange juice
- Vit C aids iron absorption
Continue for 3 months after blood levels return to normal

Question 4

Compound preparations

Answer 4

Folic acid + iron can be used in pregnant women at high risk of iron AND folic acid deficiency.

Question 5

MR iron

Answer 5

• No real benefit
• Should not be used
• Reduces side effects but also reduces the amount of iron available for absorption.

Question 6

Parenteral iron

Answer 6

• Iron dextran
• Iron sucrose
• Ferric carboxymaltose
• Ferric derisomaltose.

Question 7

When should paretneral iron be used?

Answer 7

• Chronic renal failure with haemodialysis
• Malabsorption syndromes
• Chemotherapy-induced anaemia
• Oral therapy is unsuccessful because the patient cannot tolerate oral iron, or does not take it reliably
  -Continuing blood loss

Question 8

Parenteral iron - MHRA advice

Answer 8

Serious hypersensitivity reactions with IV iron
- Can occur even if previous doses have been tolerated.
- Caution
- Monitor for 30 mins after injection
- Trained staff + resuscitation available
- High risk in allergies, immune + inflammatory conditions and severe atopic allergies (asthma, eczema). Give if benefit outweighs risk.
- Avoid in pregnancy ESP first trimester.

Question 9

Iron overload

Answer 9

Caution to avoid iron overload (esp in children) - FATAL
Treatment = Desferrioxamine

Question 10

Neutropoenia + stem cell mobilisation

Answer 10

Low neutrophil count
Treatment = Filgrastrim

Question 11

Filgrastrim

Answer 11

Recombinant human granulocyte colony-stimulating factor.
Can reduce duration of chemotherapy-induced neutropenia

Question 12

Megaloblastic anaemia

Answer 12

Vitamin B12 or folic acid deficiency
Must establish which deficiency is the underlying cause.

Question 13

Symptoms of megaloblastic anaemia

Answer 13

Numbnes
Tingling hands and feet
Muscle weakness
Depression

Question 14

Megaloblastic anaemia - emergency

Answer 14

Give folic acid + vitamin B12

Question 15

Treatment (vitamin B12 deficiency)

Answer 15

Dietary deficiency = oral hydroxocobalamin
Malabsorption = IM hydroxocobalamin

Question 16

Causes - malabsorption of vitamin B12

Answer 16

• Gastrectomy
• Crohns disease
• Pernicious anaemia (lack of GI intrinsic factor)

Question 17

Folate deficiency - causes

Answer 17

Poor diet
Coeliac disease (malabsorption)
Pregnancy
Anti-epileptics
Methotrexate