Iron deficiency anaemia

Question 1

What is the definition of iron deficiency anaemia?

Answer 1

↓ red blood cell count due to ↓ iron

Question 2

How common is iron deficiency anaemia?

Answer 2

Common

Question 3

What is the pathophysiology of iron deficiency anaemia?

Answer 3

• Fe is required for the formation of the haem in haemoglobin, myoglobin, haem enzymes and cytochromes
• Normal to lose a small amount each day in faeces, skin cells and mucosa
• Iron is absorbed in the jejunum and stored in the form of ferritin
• If more iron lost than absorbed, iron stores used up = deficiency

Question 4

What are the risk factors/aetiology of iron deficiency anaemia?

Answer 4

• Blood loss e.g. menorrhagia/GI bleed
• Poor diet – mainly in children
• Special diet
• Poverty
• Malabsorption e.g. coeliac disease
• Tetracyclines/quinolones – neither iron of antibiotic is absorbed
• Antacids/PPI – impairs absorption as raises Ph
• Phytate (wholegrain cereals, nuts etc), polyphenols (tea/coffee), calcium – impair iron absorption
• Partial/total gastrectomy
• H.pylori – impairs iron uptake
• Hookworm – in the tropics
• GI carcinoma
• Times of rapid growth in children - ↑ requirements
• Pregnancy - ↑ requirements
• Exfoliative skin disease - ↑ requirements

Question 5

What are the signs/symptoms of iron deficiency anaemia?

Answer 5

• Koilonychia – spoon shaped nails
• Atrophic glossitis
• Angular cheilosis – ulcerations in the corner of the mouth
• Pale conjunctiva
• Pale skin
• Pale palmar creases?
• Tiredness
• SOB
• Palpitations
• Headache
• Changes in hair/hair loss

Question 6

What investigations are carried out for suspected iron deficiency anaemia?

Answer 6

• FBC – microcytic hypochromic anaemia, ↓ MCV, MCH and MCHC
• ↓ Serum Ferritin
• ↑ Red cell protoporphyrin
• Gastroscopy – GI bleed
• Signmoidoscopy – GI bleed
• Colonoscopy – GI bleed
• Stool microscopy - hookworm

Question 7

What are the pharmacological treatments for iron deficiency anaemia?

Answer 7

• Blood transfusion

* Ferrous sulfate

Question 8

What are the non pharmacological treatments for iron deficiency anaemia?

Answer 8

• Iron rich diet e.g. green vegetables, meat, raisins, prunes etc