Iron Deficiency Anaemia

Question 1

What are the 2 main causes of a low Hb concentration?

Answer 1

• Low red cell mass

- Increased plasma volume

Question 2

What are the 2 possibles causes of a low red cell mass?

Answer 2

• Reduced production of RBCs

- Increased loss of RBCs

Question 3

How is Anaemia categorised based on MCV?

Answer 3

=> Low MCV - Microcytic Anaemia
=> Normal MCV - Normocytic Anaemia
=> High MCV - Macrocytic Anaemia

Question 4

What are the causes of Microcytic Anaemia and Normocytic Anaemia?

Answer 4

=> Microcytic Anaemia:

• Iron Deficiency Anaemia
• Thallasaemia
• Sideroblastic Anaemia
• Anaemia of Chronic Disease
• Lead poisoning

=> Normocytic Anaemia:

• Anaemia of chronic disease
• Chronic kidney disease
• Aplastic anaemia
• Haemolytic anaemia
• Acute blood loss

Question 5

What is Iron Deficiency Anaemia?

Answer 5

• Iron is needed to make Hb in RBCs

- Deficiency in iron leads to reduction in RBCs

Question 6

What are the risk factors of Iron Deficiency Anaemia?

Answer 6

• Gender
• Ethnicity
• NSAID use
• Coeliac disease
• Menorrhagia
• Pregnancy

Question 7

What are the causes of Iron Deficiency Anaemia?

Answer 7

• Excessive blood loss
• Inadequate intake
• Poor absorption
• Increased iron requirements

Question 8

What are the clinical features of Iron Deficiency Anaemia?

Answer 8

• Fatigue
• Hair loss
• Dyspnoea upon exercise
• Atrophic glossitis
• Angular Stomatitis
• Post cricoid webs
• Pallor
• Palpitations
• Koilonychia

Question 9

How is iron handled in the body?

Answer 9

• Iron is absorbed in the duodenum, where it enters blood via enterocytes
• Binds to transferrin and in then transported to bone marrow to form RBCs
• Excessive absorption of iron is stored as ferettin

=> Factors that affect Iron absorption:

• Food types
• GI acidity
• State of iron storage
• Bone marrow activity

Question 10

What is Hepcidin?

Answer 10

• Iron regulatory protein
• Causes ferroportin internalisation and degredation
• Decreasing iron transfer into the blood plasma at duodenum

Question 11

What happens to the levels of Ferretin, Transferrin and Total iron binding capacity in Iron deficiency Anaemia?

Answer 11

• Ferretin levels low as ferretin stores iron and body needs to increase iron levels
• Transferrin levels increase to bind more iron in the blood BUT Transferrin saturation is low
• Total iron binding capacity increases

Question 12

What are the investigations in suspected iron Deficiency Anaemia?

Answer 12

=> History

• Changes in diet
• Medication history
• Menstrual cycle
• Weight loss
• Changes in bowel

=> FBC

• Serum Ferretin will be low as iron stores are depleted to bring up irons
• Transferrin and TIBC will be high as the body is trying to bind as much of the little iron available
• Tranferrin saturation however will be low because there is less iron available

=> Endoscopy

• Rule out malignancy
• In men with Hb ≤ 11 and post-menipausal women with Hb ≤ 10
• If age > 60 and iron deficiency anaemia do colonoscopy to rule out colorectal cancer

=> Screening for Coeliac Disease is usually first line

Question 13

What is the management of Iron Deficiency Anaemia?

Answer 13

• Identify and manage underlying cause
• Oral ferrous sulphate taken for 3 months after diagnosis
• Iron rich diet

Question 14

What are the common side effects of Ferrous Sulphate?

Answer 14

• Nausea
• Abdominal pains
• Constipation
• Diarrhoea