Iron Deficiency Anaemia

Clinical Description

Anaemia due to iron deficiency. Common causes of iron deficiency are chronic blood loss or poor nutritional intake. Other causes are parasitic infestation (worms, schistosomiasis). This is usually hypochromic microcytic anaemia.

Signs and Symptoms

• Anaemia symptoms and signs
• Nail spooning

Investigations

• Full blood count: microcytic anaemia.
• Iron studies (Iron level, ferritin level).
• Stool microscopy: worms ova, Schistosoma ova.
• Urine microscopy: Schistosoma ova.
• Gastroscopy/colonoscopy if GIT blood loss.
• Assess for a haematological response to Iron therapy.

Treatment

Treatment objectives

• Identify and treat the cause
• Dietary adjustment

Pharmacological

1st Line Treatment:

• Ferrous sulphate (dried or anhydrous), oral

Adults

• 200 mg (65 mg elemental iron) q8h for 3-6 months

Children

> 10 years; 200 mg q12h for 3-6 months 8-10 years; 200 mg q24h for 3-6 months 5-7 years; 80-120 mg q8-12h for 3-6 months 1-4 years; 45-90 mg q8-12h for 3-6 months < 1 year; 30-60 mg q8-12h for 3-6 months

Alternatively

• Ferrous sulphate 6mg/kg orally, q24h (can be given in 2 divided doses)
• Continue for a minimum of 3 months after anaemia has been corrected to replenish iron stores.
• Repeat Hb in 1 month.
• If there is no response; then consider the following causes: no compliance, wrong dose prescribed, continued blood loss, wrong diagnosis; malabsorption, thalassemia, and concurrent folate or vitamin B12 deficiency or ferrous fumarate, oral,
• Adults: 200 mg (65 mg elemental iron) q8h
• Children: 3-6 mg elemental iron/kg per day for 3-6 months 2nd Line Treatment

Parenteral Iron

• Parenteral iron has no advantage over oral iron preparations
• Parenteral iron indications include:
• Malabsorption
• Patients on hemodialysis and erythropoietin.
• Patients requiring repeated iron therapy
• Patients who are not tolerating oral iron therapy
• Where a once-off dose is required, give intramuscularly (if iron dextran). Minimum required dose is 250 mg of iron per gram of Hb below normal.
• Use in consultation with a hematologist/specialist.

Adults

• Iron sucrose (venofer), IV (as a slow bolus injection over 2-5 minutes)
• 200 mg every 3 days for 5 doses

Children

• Total dose = weight (kg) x [11 g/dl - actual Hb (g/dl)] x 2.4 + 200 mg.
• Maximum daily dose: 200 mg.
• Administer over 30 minutes in 200 ml

Alternatively

Iron dextran, IV (as a slow bolus or IM by deep intramuscular) injection

Adults

• 25-100 mg q24h as needed

Children: Not recommended

• Repeat every second day until the total dose is given.
• Ensure that the correct formulation is given as some preparations can be given IM, or IV only, or both.
• Resuscitation equipment should be ready to manage anaphylaxis.
• Blood transfusion (see above section 1.2)

Deworming:

• Albendazole STAT dose 200mg if <10kg, 400mg if >10kg

Non-pharmacological

Dietary advice:

• Increase intake of vitamin C containing foods
• Increase intake of iron rich foods, beans, liver, eggs, lentils, meat

Complications

• Iron overload

Complications and Referral Criteria

• No response to iron therapy after ensuring compliance and correct dose.