Iron deficiency anaemia Flashcards
How common is it?
Most common deficiency state in the world, affecting two billion people worldwide. It is especially present in less-developed countries. Has a prevalence of 2-5% among adult men and post-menopausal women in the western world
Who does it affect?
During childbearing years, there is a higher incidence of iron deficiency anaemia in women because they lose iron through menstruation and pregnancy.
What causes it?
GI causes: Blood loss from the GI tract is the most common cause of iron deficiency anaemia in adult me and post-menopausal women, and can be caused by NSAIDs, colonic carcinoma, gastric carcinoma, benign gastric ulceration, or angiodysplasia
Gynaecological causes: Menstruation – the most common cause of iron deficiency in premenopausal women (20-30% of cases). Pregnancy – physiological iron requirements are three times higher in pregnancy than they are in menstruating women.
Malabsorption, for example due to Coeliac disease, gastrectomy, and H. Pylori infection
Other causes, such as blood donation
Uncommon causes include:
GI causes: For example, oesophagitis, schistomiasis or hookworm, or IBD
Gynaecological causes: for example, haemorrhage in childbirth
Malabsorption: due to gut resection (rare) or bacterial overgrowth (rare)
Other causes: Such as haematuria (rare), nosebleeds (rare), and inadequate dietary intake (for example elderly people or vegans). Inadequate dietary intake is rare in UK women who are not pregnant.
How does it present?
Symptoms commonly include fatigue, dyspnoea and palpitations
Less common symptoms include: Headache, tinnitus, taste disturbance, pruritus, pica (abnormal dietary cravings, for example ice or clay), glossitis, dysphagia, impairment of body temperature regulation (in pregnant women)
Serious symptoms such as angina, marked ankle oedema, or dyspnoea at rest are unlikely at haemoglobin concentrations of more than 70g/L unless there is additional heart or lung pathology.
Symptoms of iron deficiency may occur without anaemia. These symptoms include fatigue, hair loss, lack of concentration and irritability
Signs on examination?
May be no signs, even in severe anaemia.
Pallor
Less commonly: Atrophic glossitis, angular cheilosis (or stomitis). Nail changes, such as longitudinal ridging and koilonychia. Tachycardia, murmurs, cardiac enlargement, and heart failure may occur if anaemia is severe (haemoglobin less than 70g/L
Investigations
FBC. You are looking for a microcytic anaemia (low haemoglobin and low mean cell volume (MVC). If you find this, then also measure ferritin (just be aware this test is less reliable in pregnant women
Treatment
Address underlying causes and treat. Ferrous sulphate 200mg tablets 2/3 times a day. Monitor response to treatment.
Conditions that would present similarly
The differential diagnosis of microcytic anaemia includes: Thalassaemia, sideroblastic anaemias, anaemia of chronic disease, lead poisoning, Thalassaemia and sideroblastic anaemia are both associated with an accumulation of iron, so tests will show and increase in serum iron and ferratin, and a low total iron binding capacity.
