Iron deficiency anaemia

Question 1

What are the causes?

Answer 1

• Reduced intake (coeliac, dietary)
• Excess use (pregnancy) or blood loss (GI bleed, menstration)
• Some parasitic worms (e.g. schistosomiasis)

Question 2

Symptoms (3)

Answer 2

Fatigue
Dyspnoea
Palpitations

Question 3

Signs (5)

Answer 3

Pallor
Atrophic glossitis
Angular stomatitis
Nail signs (longitudinal ridges, koilonychia)
Cardiac signs- tachycardia, murmurs, cardiomegaly, cardiac failure if severe)

Question 4

What is the investigation?

Answer 4

Serum ferritin level

Question 5

When might the investigation show false results?

Answer 5

Infection, inflammation, last 2 trimesters of pregnancy (

Question 6

When would you refer for 2 week endoscopy?

Answer 6

Unexplained iron deficiency anaemia in any man with a Hb =11mg/100ml or a woman who isn’t menstruating with a Hb =10mg/100ml.
For upper and lower GI investigation

Question 7

Do people who don’t qualify for the 2 week referral still need investigation? what?

Answer 7

Yes, any unexplained iron deficiency anaemia will still need upper and lower GI investigation. Urgency depends on clinical judgement.

Question 8

What is the treatment?

Answer 8

Oral iron and diet advice. Check Hb after 2-4 weeks to assess response

Question 9

What if there is no response?

Answer 9

Refer

Question 10

What is the long term management?

Answer 10

Once Hb and red cell indices are normal, iron treatment should continue for 3 months to replenish stores then stop.
FBC monitoring every 3 months for 1 year