Iron deficiency anaemia (zero to finals)

Question 1

What type of anaemia does iron deficiency lead to?

Answer 1

Microcytic hypochromic anaemia.

Microcytic refers to small red blood cells with a low mean cell volume (MCV).

Hypochromic refers to pale cells due to a reduced haemoglobin concentration.

Question 2

What can lead to iron deficiency?

Answer 2

Several scenarios can lead to iron deficiency:

• Insufficient dietary iron (e.g., restrictive diets)
• Reduced iron absorption (e.g., coeliac disease)
• Increased iron requirements (e.g., pregnancy)
• Loss of iron through bleeding (e.g., from a peptic ulcer or bowel cancer)

Question 3

Most common cause of iron deficiency anaemia in adults and where may this be from?

Answer 3

Blood loss.

There is a clear source of blood loss in menstruating women, particularly in women with heavy periods (menorrhagia).

In women not menstruating and men, the most common source of blood loss is the gastrointestinal tract.

Question 4

If the bleeding is gastrointestinal in origin, where are the places that could cause the bleeding?

Answer 4

Cancer (e.g., stomach or bowel cancer)

Oesophagitis and gastritis

Peptic ulcers

Inflammatory bowel disease

Angiodysplasia (abnormal vessels in the wall)

Question 5

What is the most common cause of iron deficiency anaemia in children?

Answer 5

Dietary insufficiency

During growth, iron requirements often exceed the dietary intake. Pica (e.g., eating dirt or soil) is a common exam presentation for iron deficiency anaemia in children.

Question 6

Where in the GI tract is iron mostly absorbed?

Answer 6

duodenum and jejunum

Question 7

Why does iron require acid from the stomach?

Answer 7

To keep the iron in the soluble ferrous (Fe2+) form. When the stomach contents are less acidic, it changes to the insoluble ferric (Fe3+) form.

Question 8

What can interfere with iron absorption?

Answer 8

Medications that reduce stomach acid, such as proton pump inhibitors (e.g., omeprazole), can interfere with iron absorption.

Inflammation of the duodenum or jejunum (e.g., from coeliac disease or Crohn’s disease) can also reduce iron absorption.

Question 9

How does iron travel in the blood?

Answer 9

Bound to a carrier protein called transferrin.

Question 10

What is Total iron-binding capacity (TIBC)?

Answer 10

The space for iron to attach to on all the transferrin molecules combined. Total iron-binding capacity is directly related to the amount of transferrin in the blood.

Question 11

What is transferrin saturation?

Answer 11

Transferrin saturation refers to the proportion of the transferrin molecules bound to iron, expressed as a percentage.

Question 12

Normal ferritin means that there is NO iron deficiency. True/false?

Answer 12

False

Normal ferritin does not exclude iron deficiency. Raised ferritin is difficult to interpret and may be caused by:

Inflammation (e.g., infection or cancer)
Liver disease
Iron supplements
Haemochromatosis

Question 13

What to do if there is new iron deficiency in an adult without any particular cause?

Answer 13

New iron deficiency in an adult without a clear underlying cause (e.g., heavy menstruation or pregnancy) should be investigated further, including a colonoscopy and oesophagogastroduodenoscopy (OGD) for malignancy.

Exclusion of cancer is important

Question 14

3 options for treating iron deficiency anaemia?

Answer 14

• Oral iron (e.g., ferrous sulphate or ferrous fumarate)
• Iron infusion (e.g., IV CosmoFer)
• Blood transfusion (in severe anaemia)

Oral iron is considered to be first line management for iron deficiency anaemia.

Question 15

Features of oral iron supplementation

Answer 15

Oral iron works slowly. A rise in haemoglobin of 20 grams/litre is expected in the first month.

Common side effects are constipation and black stools.

Prophylactic supplementation may be required in recurrent cases.

Question 16

Features of iron infusions?

Answer 16

Iron infusions provide a rapid boost in iron.

There is a small risk of allergic reactions and anaphylaxis. It should be avoided during infections, as there is potential for it to “feed” the bacteria.

Question 17

Differences in side-effects between ferrous fumarate and ferrous sulphate?

Answer 17

Ferrous Fumarate: Some people may experience fewer gastrointestinal side effects with ferrous fumarate.

Ferrous Sulphate: It may be associated with a higher incidence of gastrointestinal side effects, such as constipation and stomach upset.

Question 18

Differences in absorption between ferrous fumarate and ferrous sulphate?

Answer 18

Ferrous Fumarate: It is often considered to have better absorption and is less affected by food, which means it can be taken with or without meals.

Ferrous Sulphate: Absorption may be influenced by the presence of certain foods and is often recommended to be taken on an empty stomach for optimal absorption.