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Gastroenterology > Iron Deficiency Anemia > Flashcards

Iron Deficiency Anemia Flashcards

1
Q

What is Anaemia?

A

It is defined as a reduction in circulating blood mass, particularly RBC count, Hemoglobin concentration, Haematocrit.

The standard levels below which a person is considered anaemic, according to the WHO is below 130 g/L in males, and below 120 g/L in non-pregnant females.

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2
Q

What is the epidemiology of Iron deficiency anaemia?

A
  • Women in reproductive age
  • young children
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3
Q

Explain how Anaemia is classified.

A

Aetiological:
- decreased RBC production
- increased RBC destruction
- Blood loss

Morphological:
- Microcytic (small RBCs)
- Normocytic (normal sized RBCs)
- Macrocytic (Large RBCs)

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4
Q

What are some signs and symptoms of Anaemia?

A

Signs:
- bounding pulse
- postural hypotension
- tachycardia
- conjunctival pallor
- shock

Symptoms:
- syncope
- fatigue
- headaches
- dizziness
- dyspnoea
- confusion
- palpitations
- angina

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5
Q

What are some less common symptoms of iron deficiency anaemia?

A
  • restless leg syndrome
  • tinnitus
  • pruritis
  • hair loss
  • mouth ulcers
  • vertigo/dizziness
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6
Q

What are some causes of decreased production of RBCs?

A
  • iron deficiency
  • reduced hormonal influence (low EPO, hypothyroid)
  • bone marrow suppression or infiltration
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7
Q

What are the causes of ineffective erythropoesis?

A
  • megaloblastic anemia (eg. folate and B12 deficiency)
  • thalassaemias
  • myelodysplastic syndromes
  • sideroblastic anaemia
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8
Q

What can hemolysis be further divided into?

A
  • inherited and acquired
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9
Q

What are some causes of inherited hemolytic anaemias?

A
  • membrane abnormalities (heriditary spherocytosis)
  • metabolic deficiencies (G6PD deficiency)
  • Haemoglobin abnormalities (alpha-thalassaemia, beta-thalassaemia, sickle cell disease)
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10
Q

What can acquired hemolytic anaemia be further divided into?

A
  • Immune and non-immune
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11
Q

Give examples of conditions that cause acquired immune and non-immune hemolytic anaemias.

A

Immune:
1) Warm autoimmune hemolytic anaemia- idiopathic, chronic lymphocytic leukemia, lymphoma, SLE, drugs
2) Cold AIHA- idiopathic, mycoplasma pneumoniae, infectious mononucleosis, lymphomas

Non-immune:
1) menchanical trauma- metalic heart valves, microangiopathic hemolytic anaemia, thrombotic thrombocytopenic purpura
2) Infections- malaria, clostridium perfringens
3) Hypersplenism- liver cirrhosis

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12
Q

What are the possible causes of blood loss?

A
  • trauma
  • hematemesis
  • gastrointestinal malignancy or bleeding

Note: blood loss through menstruation in young females and GI bleeding in older populations are common causes of blood loss

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13
Q

What are the three major causes of iron deficiency?

A

1) reduced absorption of iron
2) increased utilisation of iron
3) Blood loss

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14
Q

What are the causes of reduced absorption of iron?

A

1) Diet- meat, leafy green vegetables and fortified foods such as cereals and bread.
2) malabsorption- Coeliac disease, IBS, intestinal resection, jejuno-ileal bypass
3) Drugs- tetracyclines and PPIs (decrease gastric acid necessary for iron absorption.

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15
Q

What are some causes of increased utilisation of iron?

A
  • pregnancy
  • Growth spurts in children
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16
Q

What are some causes of blood loss that can lead to iron deficiency?

A
  • mennorrhagia in women
  • GORD
  • gastric ulcers
  • IBD
  • gastric malignancy
  • hookworm
  • drugs such as NSAIDs
  • trauma
  • heamaturia
  • recurrent nose bleeds
  • blood donation
  • hemolysis
  • rectal bleeding- anal fissure, haemorrhoids
17
Q

What are some risk factors for iron deficiency anaemia?

A
  • pregnancy
  • menorrhagia
  • vegetarian/vegan diet
  • hookworm infection
  • haemodyalysis
  • coeliac disease
  • Gastrectomy- absence of gastric acid production
  • NSAID use
18
Q

What are some clinical findings of iron deficiency anaemia?

A
  • conjunctival pallor
  • angular chelitis (ulcers in the corner of the mouth)
  • atrophic glossitis (painful tongue with loss of papillae)
  • koilonychia
  • dry skin and hair
19
Q

What is the morphology of RBCs in iron deficiency anaemia?

A
  • microcytic hypochromic anaemia- small and pale RBCs
20
Q

What are some other causes of microcytic hypochormic anaemia?

A
  • thalassemia- common in the mediterranean coast
  • sideroblastic anemia
  • lead poisoning
  • anaemia of chronic disease (predominantly causes normocytic anaemia)
21
Q

What are some examples of Anaemia of chronic disease?

A
  • inflammatory arthritis
  • cancer
  • kidney disease
  • infections (TB/HIV)
22
Q

What are some other causes of micocytic anaemia?

A
  • lead toxicity
  • copper deficiency
23
Q

What are some causes of normocytic anaemia?

A
  • anaemia of chronic disease
  • blood loss
  • renal disease
  • malignancy
  • pregnancy
24
Q

What are some causes of macrocytic anaemia?

A
  • most commonly- folate and B12 deficiency
  • Drugs (methotrexate)
  • Alcohol abuse
  • liver disease
  • hypothyroidism
  • hematological malignancies
  • reticulocytosis
25
Q

What are the investigations you would do for IDA and what would you find?

A

1) FBC:
- Low Hb
- Low MCV
- Low MCH (hypochromia)
- Low MCHC
- Increased red cell distribution width (RDW)- indicates variation in the size of RBCs

2) Ferritin:
- low serum ferritin
Note: However, ferritin can be normal or raised in acute inflammation states such as infection and autoimmune disease.

3) Transferrin saturation & total iron-binding capacity (TIBC):
- low transferrin saturation
- raised TIBC- there is increased capacity to bind to iron due to reduced levels of iron

4) Blood film:
- hypochromic cells which differ in size and shape.

5) B12 and Folate levels:

6) Coeliac serology
7) Urine dipstick
8) Stool examination- to detect parasites
9) Faecal immunochemical test- to rule out suspected colorectal cancer

26
Q

What is the management of IDA?

A
  • Dietary advice
  • Oral ferrous suphate- 200 mg once daily- treatment to be continued for three months
  • IV iron supplementation (there is a risk of anaphylaxis)
  • prophylactic dose of iron
27
Q

What are some side effects of oral ferrous sulphate tablets?

A
  • nausea
  • GI irritation
  • constipation or diarrhoea

Note: These effects may subside gradually and when taken with food.

28
Q

What are the complications of iron deficiency anaemia?

A
  • Cognitive or behavioral impairment in children
  • reduced exercise capacity and endurance
  • high output HF
  • immunodeficiency
  • In pregnancy, can lead to increased morbidity for mother and infant, and increased risk of preterm delivery and perinatal mortality.
29
Q

What can IDA in older males mean, until proven otherwise?

A

GI malignancy

Gastroenterology (21 decks)

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