Internal Diseases and Therapy · MU Sofia

59. Iron deficiency anemia

Covers iron deficiency anaemia as the most common microcytic anaemia, placed within a general approach to anaemia based on mean cell volume. It lists symptoms and signs such as koilonychia and angular cheilitis, explains iron metabolism and absorption, and sets out investigations (ferritin, iron studies, endoscopy, coeliac testing) and oral or IV iron management. It ends by contrasting it with anaemia of chronic disease, including a comparison of ferritin and TIBC.

Inside: 1 section · 4 labelled pictures · 1 table · 14 flashcards · 5 min

Topic 59 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 1 section, about 808 words (5 min of reading), with 14 flashcards.

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  1. Iron deficiency anemia

Iron deficiency anemia

Right, to begin with lets talk about anaemia generally to set us up for the next four questions. Anaemia is defined as a low haemoglobin (Hb) concentration (<135g/L for men, <115g/L for women). There are many different causes of anaemia that we wild discuss here.

Almost irrespective of the cause of anemia the symptoms are similar:

  • Faintness
  • Dyspnoea
  • Palpitations
  • Headache
  • Tinnitus
  • Anorexia
  • Fatigue

Some of the general signs of anemia are:

  • Pallor (e.g. conjunctivae)
  • Hyperdynamic circulation (tachycardia, flow murmurs or rarely retinal hemorrhages)

When we hit a low Hb concentration we then need to think about differential diagnosis. The first thing to do is look at the mean cell volume (MCV). A normal cell volume is 76-96, smaller is microcytic, larger is macrocytic and in reference range is normocytic. So let's break down the types of anemia based on RBC size:

  • Low MCV (microcytic) anemia
  • Iron deficiency anemia (most common cause)
  • Thalassaemia (suspect if MCV is ‘too low’) - definitive diagnosis needs DNA
  • Sideroblastic anaemia (v rare)
  • Normocytic anaemia
  • Acute blood loss
  • Anaemia of chronic disease
  • Bone marrow failure
  • Renal failure
  • Hypothyroidism
  • Haemolysis
  • Pregnancy
  • Macrocytic anaemia
  • B12/folate deficiency
  • Alcohol excess/liver disease
  • Reticulocytosis
  • Cytotoxics
  • Myelodysplastic syndromes
  • Marrow infiltration
  • Hypothyroidism
  • Antifolate drugs

Now we’ve addressed that, lets talk about iron deficiency anemia. This is the most common of the microcytic anaemias (it is also hypochromic). If you see microcytic anaemia, you should be thinking it could be iron deficiency. Its found in up to 14% of menstruating women and is commonly caused by blood loss of any kind. Poor diet may cause IDA in the young (although rarely in adults), but also consider malabsorption (e.g. coeliac disease).

Image: “AnemiaFrote” by Roberto J. Galindo, CC BY-SA 3.0, via Wikimedia Commons.

Many patients will be asymptomatic. Those with symptoms have the standard anemia symptoms, but does have some interesting signs. Important clinical signs include:

  • Koilonychia (spoon shaped nails)
  • Angular cheilitis (ulceration at the side of the mouth)
  • Atrophic glossitis
  • And rarely, post-cricoid webs

Image: “Koilonychia iron deficiency anemia” by CHeitz, CC BY 2.0, via Wikimedia Commons.

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