IRON DEFICIENCY ANAEMIA

Question 1

How would you describe the blood film of someone with iron deficiency anaemia?

Answer 1

Microcytic

Hypochromic

Question 2

Where is iron absorbed in the intestine?

Answer 2

Duodenum
Upper jejunum
Acidic conditions help absorption of iron (ferrous form)

Question 3

What carries iron in the blood?

Answer 3

Transferrin

Question 4

In what forms is iron stored in?

Answer 4

Ferritin

Haemosiderin (found mainly in macrophages)

Question 5

What are the initial clinical features of iron deficiency anaemia?

Answer 5

Tiredness/lethargy

Often no symptoms

Question 6

What are the more serious clinical features of iron deficiency anaemia?

Answer 6

Dyspnoea
Headaches
Tinitus
Taste disturbance

Question 7

What are the risk factors for development of iron deficiency?

Answer 7

Age - infants (with history of prematurity), adolescents, postmenopausal women, elderly

Bleeding

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

Question 8

On examination, what might you notice in someone with iron deficiency anaemia?

Answer 8

Koilonychia
Angular stomatitis
Glossitis
Atrophy of the skin
Low blood pressure - especially from sitting to standing
Tachycardia

Question 9

What are the investigations that you would order for someone with suspected iron deficiency anaemia?

Answer 9

Full blood count
Blood film
Serum iron/ferritin
Total iron binding capacity

Question 10

When might the blood film of someone with iron deficiency anaemia be normocytic?

Answer 10

When in conjunction with folate deficiency or other malabsorption.

Question 11

When might serum ferritin be raised despite the patient having an iron deficiency anaemia?

Answer 11

It is an acute phase protein so can be raised in conjunction with other active disease such as:
Rheumatoid disease
Liver disease - ferritin stored in hepatocytes so damage will cause release
Malignancy

Question 12

In cases of iron deficiency where the ferritin level is likely to be misleading, what might be used to help diagnosis?

Answer 12

Soluble transferrin receptor - receptors on the surface of red blood cells that are increased in iron deficiency

Question 13

How would you manage someone with iron deficiency anaemia?

Answer 13

Look for cause

Iron replacement therapy

Question 14

In a male or postmenopausal women with iron deficiency anaemia with no obviously apparent cause what test must you order to rule something out?

Answer 14

Endoscopy to rule out gastrointestinal bleed

Question 15

What form is iron given in orally?

Answer 15

Ferrous salts - ferrous sulphate, ferrous gluconate or ferrous fumarate

Question 16

What are the side effects of ferrous salts, used as iron replacement therapy?

Answer 16

Nausea
Constipation
Diarrhoea

Question 17

Once haemoglobin concentration is back to normal in someone treated for iron defiency anaemia, should they stop their iron supplements?

Answer 17

Not immediately, they should continue for 3 months before stopping. This is to replenish iron stores.

Question 18

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?

Answer 18

IV iron preparations including iron hydroxide sucrose.

Question 19

Under what conditions must IV iron replacement therapy be given and why?

Answer 19

Under strict medical supervision

Risk of anaphylaxis

Question 20

When is blood transfusion indicated as a treatment option for iron deficiency anaemia?

Answer 20

Only if the patient is decompensated.