Iron Deficiency Anaemia Flashcards
what is the definition of iron deficiency anaemia?
Microcytic anaemia, inadequate iron for haemoglobin synthesis
what is the epidemiology of iron deficiency anaemia?
Most common cause of anaemia
14% of menstruating women
what is the aetiology of iron deficiency anaemia?
Blood loss:
- Menorrhagia (severe menstruation with heavy blood loss)
- GI bleeding
- Hookworm - the leading cause of iron deficiency worldwide resulting in GI blood loss
Poor diet:
- Especially in children and babies (but rarely in adults) where there is poverty
• Increased demands such as during growth and pregnancy
Malabsorption:
- Poor intake - rare in developed countries
- Coeliac disease
Pregnancy
what are the risk factors for iron deficiency anaemia?
- Undeveloped countries
- High vegetable diet
- Premature infants
- Introduction of mixed feeding delayed - since breast milk contains low iron
what is the pathophysiology of iron deficiency anaemia?
less iron is available for haem synthesis - crucial for haemoglobin production thus reduction in iron will result in a decrease in haemoglobin and thus smaller RBC’s resulting in microcytic anaemia
what are the key presentations for iron deficiency anaemia?
Non-Specific Anaemia presentation: Fatigue, headaches and faintness Dyspnoea and breathlessness Angina if there is pre-existing coronary disease Anorexia Intermittent claudication Palpitations
what are the signs of iron deficiency anaemia?
May be absent even in severe anaemia • Pallor • Tachycardia • Systolic flow murmur • Cardiac failure Brittle nails and hair Spoon-shaped nails - koilonychia Atrophy of the papillae of the tongue - atrophic glossitis Angular stomatitis/cheilosis
what are the symptoms of iron deficiency anaemia?
Brittle nails and hair Spoon-shaped nails - koilonychia ulceration of the corners of the mouth Fatigue, headaches and faintness Dyspnoea and breathlessness Angina if there is pre-existing coronary disease Anorexia Intermittent claudication Palpitations
what are the first line investigations for iron deficiency anaemia?
Are they bleeding?, menstrual blood less, GI blood loss (could be malignancy)
Blood count & film:
• RBC’s are MICROCYTIC and HYPOCHROMIC (pale)
• There is poikilocytosis (variation in RBC shape) and anisocytosis (variation in RBC size)
what are the gold standard investigations for iron deficiency anaemia?
microcytic, hypochromic red cells
Low transferrin saturation
high total iron binding capacity.
Serum Ferritin – (low is diagnostic) measure of iron stores. Male 30-400 ug/L. Female age >60 30-400ug/L. Female age 17-60 15 – 150 ug/L. (also increased in inflammation ,tissue destruction, liver disease, malignancy, iron replacement).
Serum Iron - (low) Female 6.6 – 26 umole/l, Male 11 – 28 umole/litre. (notable day to day and circadian variation)(TIBC = total iron binding capacity, measures all of the proteins in the serum that bind iron; transferrin is principle amongst these.)
Serum soluble transferrin receptors - (Transferrin synthesis is increased in iron deficiency) Female 15 – 45%, Male 15 – 50%.
what are the differential diagnoses for iron deficiency anaemia?
Thalassaemia
Sideroblastic anaemia
Anaemia of chronic disease
how is iron deficiency anaemia managed?
Investigate/treat the source of blood loss.
Replace iron; oral iron preferred (e.g.ferrous sulphate 200mg one to three times daily), Hb should rise approx. 20g every 3-4 weeks. Intravenous iron is no faster than oral.
how is iron deficiency anaemia monitored?
Afer Hb and MCV return to normal, continue supplementation for a further 3 months to replenish stores.
what are the complications of iron deficiency anaemia?
Side effects of oral iron: Nausea, abdominal discomfort, diarrhoea/constipation and black stools
Depression
Heart problems
Increased risk of infections
Motor or cognitive development delays in children
Pregnancy complications, such as preterm delivery or giving birth to a baby with low birth weight
what is the prognosis of iron deficiency anaemia?
Short term - excellent. Underlying cause may be fatal in chronic anaemia
