Iron-deficiency anaemia

Fe deficiency is the commonest cause of anaemia worldwide

Normal daily Fe balance:

Losses:

• Both sexes: 1mg
• Menstruating women: 1.5mg
• Pregnant women: 1.5mg

Requirements:

• Children/adult males/post menopausal women: 1mg
• Women of child-bearing age: 2-3mg
• Adolescents: 2-3mg

Causes of Fe deficiency:

• Blood loss (e.g. menstruation)
• Increased demands (e.g. growth, pregnancy)
• Decreased absorption (e.g. bowel resection)
• Inadequate intake

Clinical features specific to iron-deficiency anaemia:

• Brittle nails
• Koilonychia (spoon-shaped nails)
• Smooth tongue
• Angular stomatitis
• Glossitis

Investigations:

FBC and film:

• Decreased MCV (microcytosis)
• Decreased MCH (hypochromia)
• Anisocytosis (variation in RBC size)
• Poikilocytosis (variation in RBC shape)

Serum ferritin:

• This reflects the amount of stored Fe

Treatment:

Important to discover underlying cause and treat it

Oral Fe is all that is required in most cases:

• Ferrous sulphate 600mg daily
• Side-effects include nausea and diarrhoea/constipation

Failure of response to oral Fe may be due to:

• Poor compliance
• Continued haemorrhage
• Severe Malabsorption
• Another cause for the anaemia