Iron deficiency anaemia

Question 1

What are the causes of iron deficiency?

Answer 1

1. Insufficient dietary iron
2. Reduced iron absorption (coeliac disease)
3. Increased iron requirements (pregnancy)
4. Loss of iron through bleeding (cancer)

Question 2

What is the most common cause of iron deficiency in female adults?

Answer 2

Menorrhagia

Question 3

What is the most common source of blood loss in males?

Answer 3

GI tract, which could be from:
1. Cancer
2. Oesophagitis or gastritis
3. Peptic ulcers
4. IBD
5. Angiodysplasia

Question 4

How can PPIs cause iron deficiency anaemia?

Answer 4

Iron is mainly absorbed in the duodenum & jejunum and requires stomach acid to keep iron soluble (ferrous- Fe2+). When stomach contents are less acidic, it changes into its insoluble form (ferric- Fe3+).

Question 5

How do you test for iron deficiency anaemia?

Answer 5

Iron travels around blood bound to a carrier protein called transferrin. Total iron binding capacity is the space where iron attaches to on the transferrin molecule, so transferrin saturation = proportion of molecules bound to iron.

Question 6

What is the formula for transferrin saturation?

Answer 6

Transferrin saturation = serum iron/total iron binding capacity

Question 7

What is ferritin?

Answer 7

A protein that stores iron inside cells. It is an acute phase protein released with inflammation.

Question 8

What does low ferritin mean?

Answer 8

Suggestive of iron deficiency, but normal ferritin does not exclude iron deficiency.

Question 9

What does high ferritin mean?

Answer 9

1. Inflammation
2. Liver disease
3. Iron supplements
4. Haemochromatosis

Question 10

What is the normal range of transferrin saturation?

Answer 10

15-50%

Question 11

What causes iron overload?

Answer 11

1. Haemochromatosis
2. Iron supplements
3. Acute liver damage

Question 12

What is the management for iron deficiency?

Answer 12

1. Oral iron (ferrous sulphate or ferrous fumarate)
2. Iron infusion (IV CosmoFer)
3. Blood transfusion (severe)