Iron Deficiency Anemia Flashcards
What is Anaemia?
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.
What is the epidemiology of Iron deficiency anaemia?
- Women in reproductive age
- young children
Explain how Anaemia is classified.
Aetiological:
- decreased RBC production
- increased RBC destruction
- Blood loss
Morphological:
- Microcytic (small RBCs)
- Normocytic (normal sized RBCs)
- Macrocytic (Large RBCs)
What are some signs and symptoms of Anaemia?
Signs:
- bounding pulse
- postural hypotension
- tachycardia
- conjunctival pallor
- shock
Symptoms:
- syncope
- fatigue
- headaches
- dizziness
- dyspnoea
- confusion
- palpitations
- angina
What are some less common symptoms of iron deficiency anaemia?
- restless leg syndrome
- tinnitus
- pruritis
- hair loss
- mouth ulcers
- vertigo/dizziness
What are some causes of decreased production of RBCs?
- iron deficiency
- reduced hormonal influence (low EPO, hypothyroid)
- bone marrow suppression or infiltration
What are the causes of ineffective erythropoesis?
- megaloblastic anemia (eg. folate and B12 deficiency)
- thalassaemias
- myelodysplastic syndromes
- sideroblastic anaemia
What can hemolysis be further divided into?
- inherited and acquired
What are some causes of inherited hemolytic anaemias?
- membrane abnormalities (heriditary spherocytosis)
- metabolic deficiencies (G6PD deficiency)
- Haemoglobin abnormalities (alpha-thalassaemia, beta-thalassaemia, sickle cell disease)
What can acquired hemolytic anaemia be further divided into?
- Immune and non-immune
Give examples of conditions that cause acquired immune and non-immune hemolytic anaemias.
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
What are the possible causes of blood loss?
- 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
What are the three major causes of iron deficiency?
1) reduced absorption of iron
2) increased utilisation of iron
3) Blood loss
What are the causes of reduced absorption of iron?
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.
What are some causes of increased utilisation of iron?
- pregnancy
- Growth spurts in children
What are some causes of blood loss that can lead to iron deficiency?
- 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
What are some risk factors for iron deficiency anaemia?
- pregnancy
- menorrhagia
- vegetarian/vegan diet
- hookworm infection
- haemodyalysis
- coeliac disease
- Gastrectomy- absence of gastric acid production
- NSAID use
What are some clinical findings of iron deficiency anaemia?
- conjunctival pallor
- angular chelitis (ulcers in the corner of the mouth)
- atrophic glossitis (painful tongue with loss of papillae)
- koilonychia
- dry skin and hair
What is the morphology of RBCs in iron deficiency anaemia?
- microcytic hypochromic anaemia- small and pale RBCs
What are some other causes of microcytic hypochormic anaemia?
- thalassemia- common in the mediterranean coast
- sideroblastic anemia
- lead poisoning
- anaemia of chronic disease (predominantly causes normocytic anaemia)
What are some examples of Anaemia of chronic disease?
- inflammatory arthritis
- cancer
- kidney disease
- infections (TB/HIV)
What are some other causes of micocytic anaemia?
- lead toxicity
- copper deficiency
What are some causes of normocytic anaemia?
- anaemia of chronic disease
- blood loss
- renal disease
- malignancy
- pregnancy
What are some causes of macrocytic anaemia?
- most commonly- folate and B12 deficiency
- Drugs (methotrexate)
- Alcohol abuse
- liver disease
- hypothyroidism
- hematological malignancies
- reticulocytosis
What are the investigations you would do for IDA and what would you find?
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
What is the management of IDA?
- 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
What are some side effects of oral ferrous sulphate tablets?
- nausea
- GI irritation
- constipation or diarrhoea
Note: These effects may subside gradually and when taken with food.
What are the complications of iron deficiency anaemia?
- 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.
What can IDA in older males mean, until proven otherwise?
GI malignancy
