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Iron-deficiency Anaemia

Iron in the Body

Iron is absorbed in the duodenum, and is transported bound to Transferrin. The excess iron is stored as Ferritin, and it's blood levels are regulated by Hepcidin. Hepcidin is in turn regulated by iron concentrations and erythropoietic demand.


The most common cause of iron-deficiency is chronic blood loss e.g. due to menstruation. Other causes include:

  • Reduced Intake - Poor diet, Malabsorption, Increased demand (pregnancy)

  • Increased Loss


Clinical features:

  • Symptoms - Fatigue, SOB, Dizziness, Headache

  • Signs - Koilonychia, Tachycardia, Tachypnoea, Angular stomatitis, Atrophic glossitis, Hair loss

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Main symptoms that may appear in anaemia - Mikael Häggström (https://commons.wikimedia.org/wiki/File:Symptoms_of_anemia.svg)

Iron Studies in Iron Deficiency

Serum iron is not a good diagnostic tool as its levels are hugely variable throughout the day.


Ferritin is the best diagnostic marker as its levels are low when there's iron-deficiency, but it isn't as good of a diagnostic tool during infection as its levels are raised with inflammation.


Total Iron Binding Capacity is the measurement of the Transferrin capacity to bind to iron - High with deficiency


Transferrin Saturation is the serum iron/total iron binding capacity, which gives the % of Transferrin binding sites occupied by iron - Low with deficiency


Management

PO Ferrous Sulfate 200mg TDS

  • Side-effects - Constipation and Black stools

  • Can't be used if malabsorption is the cause of their IDA (won't be effective)


FBC has to be monitored within the first 4 weeks of starting a patient on Ferrous sulphate to check for improvement.



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