Iron Deficiency Anaemia

Question 1

Anaemia is

Answer 1

decrease in total number of RBC or haemoglobin content

Question 2

Normal haemoglobin range in males

Answer 2

13.5-17.5g/dL

Question 3

Normal haemoglobin range in females

Answer 3

11.5-15.5g/dL

Question 4

Anaemia threshold for men > 15 years

Answer 4

Hb below 13g/dL

Question 5

Anaemia threshold for non-pregnant women aged > 15 years

Answer 5

Hb below 12g/dL

Question 6

Anaemia threshold for children aged 12-14

Answer 6

Hb below 12g/dL

Question 7

Anaemia threshold for pregnant women

Answer 7

Hb below 11g/dL
Hb level of 110g/dL + appears adequate in first trimester and 105g/dL + seems adeqiate in the second and third trimesters

Question 8

Anaemia threshold postpartum

Answer 8

Below 10g/dL

Question 9

Name three symptoms of iron deficiency anaemia

Answer 9

Tiredness/lack of energy
Shortness of breath
Heart palpitations
Pale skin

Others include headaches, tinnitus, altered taste, itchy skin, sore tongue, hair loss, pica, dysphagia, mouth ulcers, spoon nails, restless leg syndrome.

Question 10

Causes of iron deficiency anaemia

Answer 10

• Dietary Deficiency: Insufficient iron intake.
• Malabsorption: Conditions like celiac disease affecting iron absorption.
• Increased blood loss: e.g., menstruation, gastrointestinal bleeding).
• Increased Requirements: Pregnancy, growth spurts in children.

Question 11

Diagnostic test for IDA

Answer 11

Serum ferritin level

Question 12

Levels required for a diagnosis on serum ferritin and limitations

Answer 12

Level <30mcg/L confirms iron deficiency
Limitations:
▪ Infections/inflammation can cause falsely high ferritin levels.
▪ Ferritin levels may be less reliable in pregnancy.

Question 13

Referral criteria for IDA

Answer 13

Referral should be arranged urgently using a suspected cancer pathway for an appointment within two weeks for:
* People aged over 60 years with iron deficiency anaemia.
* Women aged over 55 years with postmenopausal bleeding.

Urgent referral considered for people <50 years with rectal bleeding

Question 14

When should a diagnostic trial of iron treatment be used and not be used?

Answer 14

Used: in premenopausal women with menorrhagia or pregnant women (if no suspicion of coeliac disease).
Not used: for men or postmenopausal women without excluding gastrointestinal bleeding.

Question 15

Why is it vital to establish a clear IDA diagnosis before treatment?

Answer 15

Iron salts can be toxic if not needed.
Folate supplements can mask vitamin B12 deficiency anaemia symptoms resulting in neuropathy progression

Question 16

First line treatment of IDA

Answer 16

Oral iron (ferrous sulphate)
In pts where dietary deficiency is a cause, give appropriate dietary advice alongside.
100-200mg daily in divided doses.
If ferrous sulphate is not tolerated: ferrous fumarate or ferrous gluconate.

Question 17

Second line treatment for IDA

Answer 17

Parenteral iron dextron (CosmoFer), iron sucrose (Venofer), ferric carboxymaltose (Ferinject), or iron isomaltoside 1000 (Monofer).
Reserved for:
▪ Unsuccessful oral therapy.
▪ Inability to take oral iron reliably.
▪ Continued blood loss or malabsorption.

Question 18

Treatment response

Answer 18

• Continue treatment for 3 months after haemoglobin
• Check haemoglobin after 2-4 weeks of treatment.
• If haemoglobin does not increase by >2 g/dL, consider specialist assessment.

Question 19

Side effects with first line treatment

Answer 19

GI issues (nausea, epigastric pain, constipation/diarrhoea).

Question 20

Classification of anaemia

Answer 20

Microlytic