Iron Deficiency Anaemia

Iron deficiency Anaemia occurs when iron losses or physiological requirements exceed absorption.

Aetiology

1. Increased physiologic demand, e.g. in infancy, puberty and pregnancy.
2. Decreased supply – dietary deficiencies.

• Cow’s milk (infants), ‘tea and toast’ diet(elderly)
• Post-gastrectomy
• Malabsorption (IBD of the duodenum, celiac disease, autoimmune atrophic gastritis)

1. Increased losses

• Haemorrhage
• Obvious causes: Menorrhagia, AUB, Frank GI bleeding
• Occult: PUD, Gastric or colorectal malignancy, hookworm infestation.
• Hemolysis

Clinical Presentation

• Fatigue may present before clinical anaemia.
• S/s of anaemia: Decreased exercise tolerance, headache, dizziness, palpitations, oedema.
• Brittle hair, nail changes (koilonychia, brittle nails)
• Pica
• Restless leg syndrome

Investigations

Confirmation of iron deficiency

• Iron indices. Low serum ferritin, low serum iron, high TIBC, low Transferrin saturation, and high soluble transferrin receptor.
• FHG, PBF – low Hb, microcytic hypochromic picture, anisocytosis, target cells.
• BMA

Investigating for the cause: OGD and Colonoscopy; stool for O/C

Treatment

• Treat underlying cause
• Transfusion if Hb <6g/dl and patient symptomatic.
• Iron supplementation
• Oral.

Ferrous sulphate 200mg TDS (195mg elemental iron/day), Ferrous gluconate 300mg BD (70mg elemental iron/day)

Duration: 3-6 months and taken with vitamin C to enhance absorption.

• IV is used if the patient cannot tolerate or absorb oral iron, continuing blood loss, or CRF on dialysis.

Iron sucrose, iron dextran, iron isomaltose, iron carboxymaltose.

• Monitor response.