Fe (iron) Deficiency

Question 1

What type of anemia is this?

Answer 1

Microcytic

Question 2

Definition

Answer 2

Non inherited iron deficiency, impairing Hb synthesis

Mc anemia world wide
500 million cases

Question 3

Causes in:
Infants
Children
Adults
Elderly (60+)

Answer 3

Infants:
Malnutrition, prolonged breast feeding (poor Fe source)

Children:
Malnutrition, malabsorption (coeliac, IBD)

Adults:
Malnutrition, malabsorption (coeliac, IBD), menorrhagia (heavy period - female)
hookworm (mc worldwide cause : results in GI blood loss)

Elderly
Rare; red flag for colon cancer bleeding

Question 4

What does nice recommend for 60+ with Fe anemia?

Answer 4

Urgent endoscopy for any 60+ with Fe anemia

Question 5

Pathology

Answer 5

Fe absorbed in duodenum, circulates bound to transferin and stored as ferritin or used in Hb

Fe deficiency (loss, Malab, malnutrition) = low Hb synthesis therefore microcytic anemia (smaller RBC)

Question 6

Symptoms

Answer 6

General &
Koilonychia (spoon shaped nails)
angular stomatitis (ulcers at mouth corners)
Atrophic glossitis (tongue enlarged)

Question 7

Diagnosis

Answer 7

FBC = low Hb, low MCV <95 (microcytic anemia)

Blood film = Hypochromic RBC (pale due to less Hb), target cell (non specific, bulls eye pattern), Howell Jolly bodies (non specific, nucleated RBCs)

Fe Studies = low serum Fe, Leo ferritin, high TIBC (total iron binding capacity - unbound transferrin in blood), low transferrin saturation

endoscopy if 60+

Question 8

Treatment

Answer 8

Treat underlying cause
Oral Fe - ferrous sulfate (have with oj acidic to help absorption)

If poorly tolerated, consider ferrous gluconate

Question 9

Side effects of Ferrous sulphate

Answer 9

GI Upset, diarrhoea/constipation, black stool