Iron Deficiency Anaemia Flashcards
(24 cards)
What are the signs and symptoms of iron deficiency anaemia?
Pallor Palpitations SOB Easy fatiguability Koilonychia Hair loss Pica
What are the parameters for determining if someone has microcytic, normocytic or macrocytic anaemia?
Microcystic < 80 fL MCV
Normocytic 80-96 fL MCV
Macrocytic >96 fL MCV
Give some examples of things that present with microcytic anaemia?
Iron deficiency
Anaemia of chronic disease
Thalassaemia
Sideroblastic anaemia
Give some examples of things that present with normocytic anaemia?
Acute blood loss Anaemia of chronic disease Combined deficiency e.g. iron and folate Marrow infiltration/fibrosis Endocrine disease Haemolytic anaemias
Give some examples of things that present with macrocytic anaemia?
Megalobastic - Vitamin B12 deficiency, folate deficiency
Normoblastic - Alcohol, raised reticulocyte (e.g. haemorrhage, haemolysis), liver disease, hypothyroidism and drug therapy e.g. azathioprine
Where do we take in non-haem iron from?
From:
- Fortified cereals
- Vegetables
Where do we take in haem iron from?
Derived from Hb and myoglobin in red or organ meats. Haem iron is better absorbed than non-haem iron.
What are the risk factors of iron deficiency anamia?
Blood loss:
- women with heavy periods
- Peptic ulcer, hiatal hernia, colon polyp or colorectal cancer
What are the causes of iron deficiency?
- Blood loss
- Increased demands such as growth and pregnancy
- Decreased absorption, e.g. small bowel disease of post-gastrectomy
- Poor intake; this is rare in developed countries.
Hook worms can also cause iron deficiency as well as H.pylori
How is iron deficiency anaemia investigated?
- Blood count and film
2. Serum ferritin
What will a blood film and count show in iron deficiency anaemia?
Blood film and count - microcytic and hypochromic, anisocytosis (variation in size) and poikilocytosis (variation in shapes)
What will serum ferritin as part of the blood test show in iron deficiency anaemia?
will be low - which shows iron stores are low.
NB. It is an acute phase reactant, therefore the presence of inflammatory or malignant disease may alter results - ie may be normal even though anaemia exists.
What will the serum iron and the total iron binding capacity show in iron deficiency anaemia?
Serum iron - low
TIBC - high
Transferrin saturation <19% (serum iron divided by TIBC)
What happens to the number of serum soluble transferrin receptor numbers in iron deficiency?
Serum soluble transferrin receptor number increases in iron deficiency
What is the management of iron deficiency anaemia?
- Find and treat underlying cause
- oral iron - Ferrous sulphate or ferrous gluconate.
- Parental iron (deep intramuscular or intrveni
What is the response to iron treatment in iron deficiency anaemia?
A response to iron treatment is characterised by an increase in the reticulocyte count followed by an increase in Hb at a rate of about 10 g/L every week until the Hb concentration is normal.
What is sideroblastic anaemia?
A rare disorder of haem synthesis characterized by a refractory anaemia with hypochromic cells in the peripheral blood and ring sideroblasts in the bone marrow. The bone marrow produces ringed sideroblasts rather than healthy red cells.
What are ring sideroblasts?
Ring sideroblasts are erythroblasts with iron deposited in mitochondria and reflect impaired utilization of iron delivered to the developing erythroblast
What is the treatment of sideroblastic anaemia?
Treatment is to withdraw the causative agents and some cases respond to pyridoxine (vitamin B6).
What are the causes of sideroblastic anaemia?
It may be inherited or acquired (secondary to myelodysplasia, alcohol excess, lead toxicity, isoniazid)
What is anaemia of chronic disease?
This occurs in patients with chronic inflammatory disease (such as crohn’s disease and RA), chronic infections such as TB, malignancy and CKD.
What are the characteristic lab findings of anaemia of chronic disease?
- low serum iron levels
- low serum iron-binding capacity
- increased or normal serum ferritin
What is the pathophysiology of anaemia of chronic disease?
The mechanisms responsible for these effects include decreased release of iron from bone marrow to developing erythroblasts, inadequate erythropoietin response to the anaemia and high levels of hepcidin expression. Hepcidin binds to the export transport protein, ferroportin, in the iron-absorbing cells in the duodenum, thereby causing its degradation, with a consequent reduction in the transport of iron from duodenal cells into the plasma
What is the treatment of anaemia of chronic disease?
Treatment of anaemia of chronic disease is that of the underlying cause and sometimes recombinant erythropoietin.
