Flashcards in IRON DEFICIENCY ANAEMIA Deck (23):
How would you describe the blood film of someone with iron deficiency anaemia?
Where is iron absorbed in the intestine?
Acidic conditions help absorption of iron (ferrous form)
What is the daily requirement of iron for a male adult?
What is the daily requirement of iron for a female adult of reproductive age?
What is the daily requirement of iron for a pregnant lady?
What carries iron in the blood?
In what forms is iron stored in?
Haemosiderin (found mainly in macrophages)
What are the initial clinical features of iron deficiency anaemia?
Often no symptoms
What are the more serious clinical features of iron deficiency anaemia?
What are the risk factors for development of iron deficiency?
Age - infants (with history of prematurity), adolescents, postmenopausal women, elderly
Malabsorption - coeliac, atrophic gastritis
Sex - female
Reproduction - menorrhagia
Drug history - especially aspirin and other NSAIDs
Diet - vegetarians
Pregnancy and breast feeding
Infection - worldwide biggest cause of iron deficiency is hookworm
On examination, what might you notice in someone with iron deficiency anaemia?
Atrophy of the skin
Low blood pressure - especially from sitting to standing
What are the investigations that you would order for someone with suspected iron deficiency anaemia?
Full blood count
Total iron binding capacity
When might the blood film of someone with iron deficiency anaemia be normocytic?
When in conjunction with folate deficiency or other malabsorption.
When might serum ferritin be raised despite the patient having an iron deficiency anaemia?
It is an acute phase protein so can be raised in conjunction with other active disease such as:
Liver disease - ferritin stored in hepatocytes so damage will cause release
In cases of iron deficiency where the ferritin level is likely to be misleading, what might be used to help diagnosis?
Soluble transferrin receptor - receptors on the surface of red blood cells that are increased in iron deficiency
How would you manage someone with iron deficiency anaemia?
Look for cause
Iron replacement therapy
In a male or postmenopausal women with iron deficiency anaemia with no obviously apparent cause what test must you order to rule something out?
Endoscopy to rule out gastrointestinal bleed
What form is iron given in orally?
Ferrous salts - ferrous sulphate, ferrous gluconate or ferrous fumarate
What are the side effects of ferrous salts, used as iron replacement therapy?
Once haemoglobin concentration is back to normal in someone treated for iron defiency anaemia, should they stop their iron supplements?
Not immediately, they should continue for 3 months before stopping. This is to replenish iron stores.
If a patient is not tolerating oral iron replacement therapy or their daily losses outweigh the total absorption capacity, what therapies might be used to treat someones iron deficiency anaemia?
IV iron preparations including iron hydroxide sucrose.
Under what conditions must IV iron replacement therapy be given and why?
Under strict medical supervision
Risk of anaphylaxis