Anaemia due to iron deficiency


  • Poor nutritional intake
  • Chronic blood loss, e.g., infestation with Ancylostoma, prolonged/excessive menstrual bleeding, chronic
    gastrointestinal bleeding (e.g., chronic use of NSAIDS, large bowel tumors)

Clinical features

  • It usually develops slowly
  • As per general anaemia symptoms plus:
    • Sore tongue, atrophy of lingual papillae
    • Erosions of the corners of the mouth
    • Brittle, fragile fingernails

Differential diagnosis

  • Conditions that cause microcytic red cells


  • Blood: CBC, Hb, (haematocrit (Hct) rarely <28% unless iron deficiency is present)
  • Low MCV and Mean Corpuscular Hb (MCH)- hypochromia
  • Hypochromic microcytic (small size) red cells
  • Investigate the cause of iron deficiency


  • Identify, and treat cause of iron deficiency
  • Adjust diet if poor diet is one of underlying causes
  • Adult: Oral ferrous sulphate 200 mg (or ferrous sulphate/folic acid 200/0.4 mg) every 8 hours
    (equivalent to 180 mg elemental iron per day)
  • Child: Oral ferrous sulphate 5 mg/kg (max 200 mg) every 8 hours (equivalent to around 5 mg/kg
    elemental iron per day)

    • Hb rises in 2-3 weeks and returns to normal after 2 months
    • Treat for 6 months to 1 year to replenish stores
  • Give an antihelminthic
    • Albendazole 400 mg single dose

Refer to hospital in case of:

  • Severe symptoms – for blood transfusion
  • Gastrointestinal bleeding
  • Malabsorption
  • Intolerance to oral therapy
  • Unclear cause – not improving
  • Side effects of oral iron: diarrhoea, abdominal discomfort, constipation, black stools. Warn patient not
    to worry
  • Parenteral iron is rarely necessary, and can cause anaphylaxis. It should only be used by specialists