Anaemia due to iron deficiency
Cause
- 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
Investigations
- 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
Management
- 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
Note
- 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