![]() ![]() What is the treatment for iron deficiency? If bowel investigation is negative, bone marrow examination may be considered in undifferentiated cases. Older patients sometimes have unexplained iron deficiency anaemia. Retest iron status after three months of iron supplementation. It is unchanged in anaemia of chronic disease. It is useful at discriminating iron deficiency in difficult cases, for instance, in patients with chronic renal failure or chronic inflammation like rheumatoid arthritis. Soluble transferrin receptor (sTfR) is reduced – this reflects total body stores, except if there is a disease of the bone marrow.Iron binding capacity is increased - a measure of the capacity of iron to bind with transferrin (an iron transporter).Serum iron is reduced - be aware that serum iron can be very variable, fluctuating through the day, and serum iron is not useful in assessing iron stores.Ferritin is also more elevated in patients with chronic kidney disease and heart failure. In the context of inflammation, significantly higher cut-off values for ferritin are used (eg, 100 μg/ml) and are more predictive of iron deficiency. Levels are higher in the presence of chronic inflammation (eg, rheumatoid arthritis) when erythrocyte sedimentation rate ( ESR) or C-reactive protein ( CRP) are elevated. Normal or high levels of ferritin do not exclude iron deficiency, because ferritin acts as an acute phase reactant. Levels higher than 40 μg/ml in a healthy person are considered optimal. Low levels of ferritin less than 15 μg/ml are diagnostic of iron deficiency. Ferritinįerritin is a measure of iron stores and is the most sensitive and specific test for iron deficiency. Red cell distribution width (RDW) can reveal mixed iron and vitamin B12 deficiency as this results in red cells of variable size. Reticulocyte haemoglobin content (Ret-Hb), which tends to be low in iron deficiency anaemia, can be used to monitor response to iron replacement. If anaemia is due to iron deficiency, the cells are smaller and contain less haemoglobin resulting in lowered red blood cell count or haematocrit, mean corpuscular volume (MCV) and mean cell haemoglobin concentration (MCH). What tests should be done? Full blood countĪ full, or complete, blood count (FBC, CBC) is essential to detect anaemia. Iron deficiency can be present when blood count indices are normal. Increased hair shedding ( telogen effluvium) resulting in diffuse alopecia.Atrophic glossitis, loss of tongue papillae (smooth, shiny tongue).Angular cheilitis, painful cracks at the corners of the mouth.Paleness of skin, palm creases and conjunctiva.Skin signs of anaemia are often subtle and may include: The first symptoms to appear are due to low delivery of oxygen to tissues, and may include: In cases where anaemia develops slowly, the patient can often tolerate extremely low concentrations of red blood cells (< 100 g/L) for some weeks before developing any symptoms. The signs and symptoms of an iron deficiency depend on whether the patient is anaemic, and if so, how fast the anaemia develops. What are the clinical features of iron deficiency? Intravascular haemolysis (rare) as in paroxysmal nocturnal haemoglobinuria.Myelodysplasia - bone marrow disease which can present with anaemia.Congestive cardiac failure - possibly due to subclinical inflammation and impaired iron absorption.End-stage renal failure - a combination of blood loss from dialysis and low erythropoietin levels (a hormone that stimulates red blood cell production).Bleeding disorders, such as von Willebrand disease.Proton pump inhibitors – may impair iron absorption.Aspirin and n on-steroidal anti- inflammatory drugs - cause gastritis.Intestinal parasitic infections, such as hookworm or tapeworm.Helicobacter infection or atrophic gastritis, which may also lead to B12 deficiency.Gastrointestinal bleeding - from peptic ulcer, polyps or cancer, may occur over a long period.Cereal-based diets - decreases iron bioavailability, as phytates in grains reduce iron absorption.Malnutrition - poverty, premature babies (milk is a poor source of iron), young children who are picky eaters.In people living in developing countries, iron deficiency tends to be due to insufficient dietary iron intake or to blood loss from intestinal worm colonisation. In high-income countries, iron deficiency may result from a vegetarian diet, chronic blood loss, or malabsorption. ![]()
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