Iron deficiency anaemia

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Diagnosis

A summary of the changes in iron tests seen in various diseases of iron status is shown in the table below.

Disease Iron TIBC/Transferrin UIBC  % Transferrin saturation Ferritin
Iron Deficiency Low High High Low Low
Haemochromatosis High Low Low High High
Chronic Illness Low Low Low/Normal Low Normal/High
Iron Poisoning High Normal Low High Normal

Iron deficiency can range in severity. The mildest stage is iron depletion, which means the amount of functioning iron in the body is adequate, but the body does not have any extra iron stores. Serum iron concentration may be normal in this stage, but ferritin levels will be low. As iron deficiency worsens, all of the stored iron is used and the body begins to produce more transferrin to increase iron transport. Serum iron becomes low, and transferrin and TIBC are high. As this stage progresses, fewer red cells are produced. In iron-deficiency anaemia, the number of red cells is decreased and many of the cells appear smaller and paler than normal.

Monitoring

Haemoglobin (Hb)

  • Lower than normal hemoglobin levels indicate anemia
  • Treat when <13.2 g/dL for men and <11.6 g/dL for women

Ferritin

  • This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron
  • treat when <15ug unless CRP significantly raised in which case <40ug

C-Reactive Protein (CRP)

  • usually raised in an infection or inflammation 
  • also means that we cannot rely on the ferritin test result so recommended to redo
  • Diet and lifestyle can significantly affect CRP levels 

Treatment

  • Adults: Ferrous fumarate 305 bd for 3 months then BT then continue for 3 months to replenish supplies then BT 6-8 weeks after completed course
  • Children: Sodium federate liquid (Sytron) 
    •  Neonates
      • Up to 2.5 mL twice daily, smaller doses to be used initially
    • For Child 1–11 months
      • Up to 2.5 mL twice daily, smaller doses to be used initially
    • For Child 1–4 years
      • 2.5 mL 3 times a day.
    • For Child 5–11 years
      • 5 mL 3 times a day.
    • For Child 12–17 years
      • 5 mL 3 times a day, increased to 10 mL 3 times a day, dose to be increased gradually.
  • No dosage alterations for pregnant/breastfeeding/renal/liver

Overcoming side effects

  • Take with food
  • Take with vitamin C (or orange juice)
  • Lower the dose 
  • Ferrous gluconate 300 mg tablets may be better tolerated than ferrous sulfate as there is less elemental iron content per tablet than ferrous sulfate
  • Ferrous fumarate tablets contain more elemental iron per tablet than ferrous sulfate and is therefore likely to be no better tolerated.

Ongoing prophylaxis beneficial for

  • Recurring anaemia
    • for example in an elderly person and further investigations are not indicated or appropriate
  • An iron-poor diet
    • for example, vegans
  • Malabsorption
    • for example, coeliac disease
  • Menorrhagia
    • Refer if the woman has iron deficiency anaemia which has failed to respond to treatment
  • Had a gastrectomy
  • Women who are pregnant
  • People undergoing haemodialysis

NB all new anaemia and ferritin must be investigated for a cause 

 

 

Ferrous gluconate Ferrous fumarate Sodium federate

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