Iron deficiency anaemia

Question 1

What is iron deficiency anaemia

Answer 1

• Insufficient iron to support red blood cell production

- Microcytosis (ass w/ def Hb production)

Question 2

How does the WHO define anaemia

Answer 2

Hb <13g/dL in men +15yrs

Hb <12 g/dL in non-preg women +15yrs

Question 3

How common is it

Answer 3

• most common form of anaemia
• 2-5% developed world
• 14% menstruating women

Question 4

What causes it

Answer 4

BLOOD LOSS

• Menorrhagia (premenopausal)
• GI bleed (Men, post menopausal) e.g. varices, haemorroids
• NSAID use
• GI Carcinoma
• Ulceration
• IBD/ reflux

DIETARY INADEQUACY
- Babies/children, pts on diets, poverty

MALABSORPTION

• Coeliac disease
• tetracylcine
• H pylori

TROPICAL
- Hookworm infestation

Question 5

What are the symtpoms

Answer 5

• Fatigue
• Headache
• SOB on exertion
• Palpitations (angina if pre-existing coronary disease)
• Sore tongue + taste disturbances
• Hair loss/ changes in hair
• Tinnitus

Question 6

What are some signs

Answer 6

• Koilonychia
• Atrophic glossitis
• Angular stomatitis (also B12)
• Pallor
• May be tachycardia, flow murmur, ankle oedema

Question 7

What are some DDx

Answer 7

• Thalassaemia
• Anaemia of chronic disease
• Lead poisoning

Question 8

What investigations do you perform

Answer 8

BLOOD FILM

• Microcytic
• Hypochromic
• Anisocytosis (unequal size)
• Poikilocytosis (presence of poikilocytes - abnormal shaped RBCs)
• Decrease MCV, MCH, MCHC
• Confirmed by FERRITIN (however also present in inflammation)
• If MCV down + Hx menorrhagia –> oral Fe (no further tests)
• Investigate blood loss - colonoscopy etc

Question 9

How do you treat IDA

Answer 9

• Treat cause
• Oral Iron –> ferrous sulfate PO (SE: nausea, diarrhoea/ constipation, abdo discomfort, black stools)
• Continue until Hb normal 3 months