Iron Deficiency Anaemia

Question 1

Iron Deficiency Anaemia Definition

Answer 1

• Insufficient iron to support red blood cell production
• Hb<130 in men
• Hb<120 in non-pregnant women

Question 2

Iron Deficiency Anaemia Aetiology

Answer 2

Excessive blood loss
-Blood loss from GI tract most common cause of adult male and postmenopausal IDA
-Menorrhagia
-Causes of blood loss
-NSAIDS, gastric/colonic carcinoma, gastric or duodenal ulceration, angiodysplasia
-Others include other malignancy, varies, IBD, haemorrhoids…
Dietary Inadequacy
-Fairly uncommon
-Vegetarians at greater risk
Failure of absorption
-Some drugs can bind e.g. tetracyclines bind with iron so that neither are absorbed
-Antacids raise pH
-Vitamin C enhances iron absorption
-Malabsoroption diseases
Excessive requirement for Iron
-Rapid growth, pregnancy, exfoliative skin disease

Question 3

Iron Deficiency Anaemia Presentation

Answer 3

• Often incidental finding

- Fatigue, SOB, palpitations, sore tongue, changed in hair, pruritus, headache, tinnitus, angina

Question 4

Iron Deficiency Anaemia History

Answer 4

• Current/recent diet
• Drug history
• Any bleeding
• History of blood donation
• Menstrual history in women
• Recent illnesses
• Surgery
• Travel
• FHx

Question 5

Iron Deficiency Anaemia Examination

Answer 5

• Pallor, koilonychia, angular cheilitis, atrophic glossitis

- Stigmata of liver disease

Question 6

Iron Deficiency Anaemia Confirming Diagnosis

Answer 6

• FBC and serum ferritin
• FBC: hypochromic microcytic anaemia (similar to haemoglobinopathy picture)
• Ferritin will be low (however if concurrent infection or inflammation; ferritin may be raised (body wants to take all iron for itself cc decreased TIBC in ACD)

Question 7

Iron Deficiency Anaemia Differentials

Answer 7

Thalassaemia, sideroblastic anaemia, anaemia of chronic disease, lead poisoning

Question 8

Iron Deficiency Anaemia Ix

Answer 8

• Test urine in all cases (haematuria)
• All male and postmenopausal women should be considered for upper/lower GI Ix
• All patients should be screened for coeliac
• H. pylori screening (and eradication) if still unexplained
• If iron deficient and no anaemia, only postmenopausal women and men over 50 should have GI investigations

Question 9

Iron Deficiency Anaemia Referral to Secondary Care

Answer 9

-If over 60
-If under 50 with rectal bleeding
Refer:
-All men and PM women with IDA unless overt non GI bleeding , urgently if Hb very low
-All people over 50 with marked anaemia or FHx of ca even if coeliac disease is found
-Premenopausal women if under 50 with colonic symptoms, strong FHx or ca, or persistent IDA
Refer to gynaecologist if
-Menorrhagia unresponsive
-Postmenopausal bleeding

Question 10

Iron Deficiency Anaemia Management

Answer 10

-Treat before results of investigations
-Iron salts by mouth (constipation, black stools, diarrhoea, heartburn, nausea, abdo pain)
-Manage food
-Check FBC 2-4 weeks after treatment
-If normal check again in 2-4 months
-Continue treatment for 3 months once Hb level is normal
-Re-check every three months for one year
-Re-check after another year
If inadequate response
-Assess compliance
-If compliance problems, consider laxative, advise patient to take iron with or after meals, reassure, reduce frequency