Friday, October 14, 2016

Iron Deficiency Anemia

The above picture is from a 28 year old woman who presented to her family physician with complains of fatigue and shortness of breath on walking. On further history she mentions having heavy menstrual bleeding that has existed over the past year. On general physical examination she had pale conjunctiva, palms and nail beds.
Her clinical history of prolonged chronic blood loss due to underlying menstrual disorder and examination points to the diagnosis of iron deficiency anemia.

Case Discussion :

Iron Deficiency Anemia: Is most commonly seen in menstruating women or undernourished populations. 

Causes: Include:
  • Blood loss e.g menorrhagia or GI bleeding.
  • Poor diet
  • Malabsorption
  • Hookworm infestation.
Clinical Signs And Symptoms: Patients may be asymptomatic if there is mild deficiency but they may start to feel fatigue, shortness of breath and decreased energy when Hb gets below 10 g/dl. On examination there is pale conjunctiva, palms and nail beds. With chronic iron deficiency patients may develop koilonychia (spoon shaped nails), atrophic glossitis, angular chelosis and rarely plummer Vinson syndrome  ( For detail discussion on Plummer vinson Syndrome read the article : ) 

Investigations: There is microcytic, hypochromic anemia with anisocytosis and poikilocytosis. 
Decreased MCV, MCH and MCHC. Ferritin in also decreasedas well as decreased total serum iron. . 
Workup should be done to find out the underlying cause (e.g endoscopy for GI bleeding, pelvic ultrasound for menorrhagia) 

Treatment: Treat the underlying cause.
Give oral iron e.g ferrous sulphate 200mg/8hrly . Hb should rise by 1g/dl/week with reticulocytosis. 
Continue iron supplements until Hb is normal and for at least 3 months to replenish body iron stores. 
Intravenous iron is usually not needed but can be used for patients who are unable to tolerate any oral iron preparation.
Iron absorption is increased if taken with vitamin C, so citrus fruits like oranges that contains vitamin C or vitamin C supplements can be given along with oral iron.
Calcium may impair iron absorption and so patients should be instructed not to take calcium supplements within 2 hrs of iron supplements. 


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