Iron Deficiency Anaemia

Question 1

Is iron deficiency anaemia microcytic or macrocytic?

Answer 1

Microcytic

Question 2

What are the symptoms of iron deficiency anaemia?

Answer 2

• fatigue
• headache
• faintness
• SOB
• Angina
• intermittent claudication
• palpitations

Question 3

What are the signs of iron def anaemia?

Answer 3

• pallor
• Tachycardia
• systolic flow murmur
• cardiac failure

HANDs:

• koilonychia (spoon shaped nails)
• brittle nails

Face

• glossitis
• Cheilitis (angular stomatitis)
• conjuctival pallor

Question 4

What are the screening questions for iron def anaemia/

Answer 4

1) ask about dietry intake (red meat)
2) NSAIDs (GI bleed)
3) Blood in faeces, malaena ? —> cancer / haemorrhoids.
4) Menstruation (duration + number of pads/ tampons used)

Question 5

What are the risk factors for iron deficienct anaemia?

Answer 5

1) Blood loss
2) Increased demand (pregnancy, growth)
3) Reduced intake (diet / malabsorption)

Question 6

What are the most likely reasons behind iron deficiency anaemia in children?

Answer 6

• diet
• growth
• malabsorption

Question 7

What are the most likely reasons behind iron deficiency anaemia in young women?

Answer 7

• menstrual loss
• pregnancy
• diet

Question 8

What are the most likely reasons behind iron deficiency anaemia in old people?

Answer 8

• bleeding

- GI problems eg. ulcer, malignancy, diverticulitis

Question 9

What are the invx for iron def anaemia?

Answer 9

1) FBC (low HB, low MCV / microcytic)
2) Blood film shows microcytic, pale cells (hypochromic) with variation in shape and size)
3) Serum ferritin (reflects amount of stored iron)
4) Serium iron / TIBC (total iron binding capacity) - serum iron low and TIBC high in iron deficiency anaemia
5) Serum soluble transferrin receptor (increased in iron deficiency anaemia, helps to distinguish between iron def and anaemia of chronic disease)
6) Bone marrow - (useful to distinguish between iron def and anaemia of chronic diseases)

Question 10

What is the blood film picture of iron def anaemia?

Answer 10

microcytic, hypochromic RBC with poikilocytosis (variation in shape) and anisocytosis (variation in size)

Question 11

What is poikilocytosis?

Answer 11

variation in shape of RBC

Question 12

What is anisocytosis?

Answer 12

variation in size of RBC

Question 13

Why may a serum ferritin show a falsely high iron level?

Answer 13

Serum ferritin relfects the amount of stored iron. It is also an acute phase inflammatory marker, so in the prescence of inflammation the serum ferritin levels increase.
So use serum ferritin together with serum iron, TIBC and soluble transferrin to determine if iron deficiency.

Question 14

What is the test that shows stored iron levels?

Answer 14

Serum Ferritin

Question 15

What would the serum iron and TIBC levels be in iron deficiency anaemia?

Answer 15

Serum iron = low
TIBC (total binding capacity)= high

in iron def anaemia

Question 16

What tests help to distinguish between iron deficiency anaemia and anaemia of chronic diseases?

Answer 16

1) Serum soluble transferrin receptors (will be raised in iron deficiency.)
2) Bone marrow staining

Question 17

What is the treatment for iron deficiency anaemia?

Answer 17

Treat iron and the cause of low iron.
- Oral iron (ferrous sulphate 200mg 3X daily)
(IM iron (painful), IV iron (malabsorption), Blood transfusion)
-Diet

Question 18

What are the differentials of iron deficiency anaemia?

Answer 18

1) Anaemia of chronic disease (TBm IBD, SLE ect.)

2) Sideroblastic Anaemia ( ringsiderblasts in bone marrow is diagnostic)