1 / 18

Approach To Patient With Iron Deficiency Anaemia

Approach To Patient With Iron Deficiency Anaemia. By Sin Kaan Chan 11/7/02. Scenario. A 40 years old lady, presented with pallor, lethargy, palpitations and SOB on exertion. FBC: Hb 7.5g/dl MCV 64fl MCH 18.5pg WBC and differential normal Platelet normal range

quinto
Download Presentation

Approach To Patient With Iron Deficiency Anaemia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Approach To Patient With Iron Deficiency Anaemia By Sin Kaan Chan 11/7/02

  2. Scenario A 40 years old lady, presented with pallor, lethargy, palpitations and SOB on exertion. FBC: Hb 7.5g/dl MCV 64fl MCH 18.5pg WBC and differential normal Platelet normal range What is next?

  3. Differential Diagnosis of Hypochromic Microcytic Anaemia • Fe deficiency • Anaemia of chronic disease • Thalassaemia • Sideroblastic anaemia (rare)

  4. Causes of Iron Deficiency Bleeding: • Menorrhagia • GI bleed  Peptic ulcer  Oesophageal varices  Aspirin ingestion  Hookworm  Neoplasm  IBD  Haemorrhoids

  5. Factors contributing to Iron Deficiency Increased demands: • Pregnancy (commonest factor - and increases with parity) • Growth (infancy and adolescent) • Erythropoietin therapy

  6. Causes of Iron Deficiency Malabsorption: • Gluten-induced enteropathy • Gastrectomy Poor diet

  7. History • Any ongoing bleeding? • Menstrual history • Passing bloody stool / black stool • Any abdominal symptoms? • Easy bruising or bleed? (clotting or platelet abN) • Medications • Diet • How long has the patient been anaemic?

  8. History • Past medical history: Any chronic diseases? (renal, liver, connective tissue…etc) • Family history: Thalassaemia, cancer, other illness • Social History: Racial origin (thalassaemia more common in Mediterranean/Southern Asian) Smoking, alcohol Vegetarian

  9. Haematological Examination Basically a thorough examination from head to toe. In Fe deficiency: • General: pallor • Hands: Pale ridged or spoon-shaped nails (koilonychia) • Pulse rate increase • Pale conjunctiva • Painless glossitis/angular stomatitis

  10. Investigations • Repeat FBC including ESR (to better evaluate ferritin result) • FE study

  11. Investigations • The above studies will sort out single-cause cases. Where multiple causes confuse the picture enough to prevent diagnosis, may rarely have to undertake: • Bone marrow iron • Sensitive and reliable test for Fe deficiency • Prussian blue stain for stored iron in macrophages and erythroblasts • In iron deficiency, decrease or absence of haemosiderin in marrow

  12. Investigation For Cause of Iron Deficiency • GI bleed • History, physical and rectal examination • Occult blood tests • Upper GI endoscopy, sigmoidoscopy, or colonoscopy. • Abdominal X-ray, Barium study • Microscope stool for hookworm ova

  13. Investigation For Cause of Iron Deficiency • Malabsorption If history highly suspected, - Test for endomysial and gluten antibodies. - Duodenal biopsy

  14. Management Principle: • Determine and treat underlying cause. • Correct anemia and replenish iron stores by oral iron.

  15. Oral Iron • Ferrous sulphate • Ferrous gluconate • Should be given long enough to correct anaemia and replenish iron stores. Therefore given for at least 6 months.

  16. Failure to Response to Oral Iron • Possible cause considered b4 parenteral iron used. • Possible causes: • Continuing bleeding • Failure to take tablets • Wrong dx – thalassaemia trait / sideroblastic anaemia • Other causes – malignancy, inflammation • Malabsorption

  17. Parenteral Iron • Iron-sorbitol-citrate Repeated deep IM injections • Ferric hydroxide-sucrose Slow IV injection or infusion • May have hypersensitivity or anaphylactic reaction

  18. Summary…… • Approach to iron deficiency: • Determine and treat the underlying cause!

More Related