Iron Deficiency Anaemia

Question 1

Iron physiology:

Where is iron absorbed?

How does the stomach aid absorption?

Why does iron deficiency cause microcytosis specifically?

Answer 1

Duodenum and jejunum

Gastric acid and vit C convert iron to a more absorbable chemical

As the newly produced RBCs contain less amount of haemoglobin, they are relatively of small size when compared to normal RBCs, thus the name, microcytic.

Question 2

Causes:

Blood loss - what may cause this?

Why does blood loss cause iron deficiency anaemia specifically?

What may cause malabsorption on iron?

What is another obvious cause?

What may they have done recently that would cause a drop in iron?

YOU CAN ALSO HAVE INCREASED IRON DEPENDENCY DURING PREGNANCY

Answer 2

GI - ulcer, tumour
Uterine - menses, fibroid

Chronic blood loss causes the bone marrow to increase the production of haemoglobin, thereby depleting iron in body stores.

Coeliac Disease, gastroectomy, gastritis

Low intake - more common in babies and children

Donating blood

Question 3

Chronic IDA signs:

Patients develop a spoon-shaped nail. What is this called?

What else may you notice about the nails?

They get the following. Define them:

• angular cheilitis
• atrophic glossitis

Pica is a food disorder associated with anaemia. What is it?

Answer 3

Koilonychia

They are brittle

Also called stomatitis
Ulceration at the side of the mouth
Also found in Vit B12 deficiency

A condition characterised by absence of filiform or fungiform papillae on the dorsal surface of the tongue. Consequently, the ordinary texture and appearance of the dorsal tongue, determined by the papillary protrusion, turns into a soft and smooth aspect.

To describe craving and chewing substances that have no nutritional value — such as ice, clay, soil or paper.

Question 4

Investigations:

Ferritin is used to measure iron levels. What can cause a false elevation? - 2

What is TIBC?

What is TSAT?

Blood film shows poikilocytes (PENCIL CELLS)

You look for a source of bleeding. What investigations would you do?

Answer 4

Inflammation or liver disease

Iron moves through the blood attached to a protein called transferrin.
Total iron-binding capacity - This test helps your health care provider know how well that protein can carry iron in your blood.

Transferrin saturation ( TSAT ) measures how much of your stored iron can be used to make new red blood cells.

If TSAT low and TIBC is high, it shows a functional iron deficiency i.e. impaired use of iron stores, usually due to inflammation (i.e. anaemia of chronic disease)

Colonoscopy
Urinalysis

Question 5

Management:

Ferous sulphate/fumarate PO:

• With or without food
• What Vit can be added to it to help aid absorption?
• How long do they need to be on tablets?
• Side effects?
• How do you know the black stool isn’t melena?

What can food is high in iron?

Answer 5

Without food

Vit C

3-6 months for levels to go back to normal

N&V
Constipation
Black poo

Not as foul-smelling as melena

Meat and fish

Question 6

Management:

When is IV iron indicated?

Why is IV iron better than tablets?

Answer 6

If oral intake is impossible or ineffective

(e.g. functional iron deficiency in chronic renal failure)

Also an alternative to RBC transfusion - Jehovah witness

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Quicker and more reliable