IRON DEFICIENCY ANAEMIA

Question 1

How would you describe the blood film of someone with iron deficiency anaemia?

Answer 1

Microcytic

Hypochromic

Question 2

Where is iron absorbed in the intestine?

Answer 2

Duodenum
Upper jejunum
Acidic conditions help absorption of iron (ferrous form)

Question 3

What is the daily requirement of iron for a male adult?

Answer 3

1 mg

Question 4

What is the daily requirement of iron for a female adult of reproductive age?

Answer 4

2-3 mg

Question 5

What is the daily requirement of iron for a pregnant lady?

Answer 5

3-4 mg

Question 6

What carries iron in the blood?

Answer 6

Transferrin

Question 7

In what forms is iron stored in?

Answer 7

Ferritin

Haemosiderin (found mainly in macrophages)

Question 8

What are the initial clinical features of iron deficiency anaemia?

Answer 8

Tiredness/lethargy

Often no symptoms

Question 9

What are the more serious clinical features of iron deficiency anaemia?

Answer 9

Dyspnoea
Headaches
Tinitus
Taste disturbance

Question 10

What are the risk factors for development of iron deficiency?

Answer 10

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

Question 11

On examination, what might you notice in someone with iron deficiency anaemia?

Answer 11

Koilonychia
Angular stomatitis
Glossitis
Atrophy of the skin
Low blood pressure - especially from sitting to standing
Tachycardia

Question 12

What are the investigations that you would order for someone with suspected iron deficiency anaemia?

Answer 12

Full blood count
Blood film
Serum iron/ferritin
Total iron binding capacity

Question 13

When might the blood film of someone with iron deficiency anaemia be normocytic?

Answer 13

When in conjunction with folate deficiency or other malabsorption.

Question 14

When might serum ferritin be raised despite the patient having an iron deficiency anaemia?

Answer 14

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

Question 15

In cases of iron deficiency where the ferritin level is likely to be misleading, what might be used to help diagnosis?

Answer 15

Soluble transferrin receptor - receptors on the surface of red blood cells that are increased in iron deficiency

Question 16

How would you manage someone with iron deficiency anaemia?

Answer 16

Look for cause

Iron replacement therapy

Question 17

In a male or postmenopausal women with iron deficiency anaemia with no obviously apparent cause what test must you order to rule something out?

Answer 17

Endoscopy to rule out gastrointestinal bleed

Question 18

What form is iron given in orally?

Answer 18

Ferrous salts - ferrous sulphate, ferrous gluconate or ferrous fumarate

Question 19

What are the side effects of ferrous salts, used as iron replacement therapy?

Answer 19

Nausea
Constipation
Diarrhoea

Question 20

Once haemoglobin concentration is back to normal in someone treated for iron defiency anaemia, should they stop their iron supplements?

Answer 20

Not immediately, they should continue for 3 months before stopping. This is to replenish iron stores.

Question 21

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?

Answer 21

IV iron preparations including iron hydroxide sucrose.

Question 22

Under what conditions must IV iron replacement therapy be given and why?

Answer 22

Under strict medical supervision

Risk of anaphylaxis

Question 23

When is blood transfusion indicated as a treatment option for iron deficiency anaemia?

Answer 23

Only if the patient is decompensated.