IRON DEFICIENCY ANAEMIA Flashcards
How would you describe the blood film of someone with iron deficiency anaemia?
Microcytic
Hypochromic
Where is iron absorbed in the intestine?
Duodenum
Upper jejunum
Acidic conditions help absorption of iron (ferrous form)
What is the daily requirement of iron for a male adult?
1 mg
What is the daily requirement of iron for a female adult of reproductive age?
2-3 mg
What is the daily requirement of iron for a pregnant lady?
3-4 mg
What carries iron in the blood?
Transferrin
In what forms is iron stored in?
Ferritin
Haemosiderin (found mainly in macrophages)
What are the initial clinical features of iron deficiency anaemia?
Tiredness/lethargy
Often no symptoms
What are the more serious clinical features of iron deficiency anaemia?
Dyspnoea
Headaches
Tinitus
Taste disturbance
What are the risk factors for development of iron deficiency?
Age - infants (with history of prematurity), adolescents, postmenopausal women, elderly
Bleeding
Malabsorption - coeliac, atrophic gastritis
Sex - female
Reproduction - menorrhagia
Drug history - especially aspirin and other NSAIDs
Diet - vegetarians
Pregnancy and breast feeding
Infection - worldwide biggest cause of iron deficiency is hookworm
On examination, what might you notice in someone with iron deficiency anaemia?
Koilonychia Angular stomatitis Glossitis Atrophy of the skin Low blood pressure - especially from sitting to standing Tachycardia
What are the investigations that you would order for someone with suspected iron deficiency anaemia?
Full blood count
Blood film
Serum iron/ferritin
Total iron binding capacity
When might the blood film of someone with iron deficiency anaemia be normocytic?
When in conjunction with folate deficiency or other malabsorption.
When might serum ferritin be raised despite the patient having an iron deficiency anaemia?
It is an acute phase protein so can be raised in conjunction with other active disease such as:
Rheumatoid disease
Liver disease - ferritin stored in hepatocytes so damage will cause release
Malignancy
In cases of iron deficiency where the ferritin level is likely to be misleading, what might be used to help diagnosis?
Soluble transferrin receptor - receptors on the surface of red blood cells that are increased in iron deficiency
How would you manage someone with iron deficiency anaemia?
Look for cause
Iron replacement therapy
In a male or postmenopausal women with iron deficiency anaemia with no obviously apparent cause what test must you order to rule something out?
Endoscopy to rule out gastrointestinal bleed
What form is iron given in orally?
Ferrous salts - ferrous sulphate, ferrous gluconate or ferrous fumarate
What are the side effects of ferrous salts, used as iron replacement therapy?
Nausea
Constipation
Diarrhoea
Once haemoglobin concentration is back to normal in someone treated for iron defiency anaemia, should they stop their iron supplements?
Not immediately, they should continue for 3 months before stopping. This is to replenish iron stores.
If a patient is not tolerating oral iron replacement therapy or their daily losses outweigh the total absorption capacity, what therapies might be used to treat someones iron deficiency anaemia?
IV iron preparations including iron hydroxide sucrose.
Under what conditions must IV iron replacement therapy be given and why?
Under strict medical supervision
Risk of anaphylaxis
When is blood transfusion indicated as a treatment option for iron deficiency anaemia?
Only if the patient is decompensated.
