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Iron deficiency anaemia

Iron deficiency anaemia


Blood loss


Most common cause is gastrointestinal blood loss result from occult gastric or colorectal malignancy, diverticulitis, polyps, gastritis, peptic ulceration, inflammatory bowel disease and angiodysplastic lesions.
Other causes : schistostomiasis, hookworm, aspirin, NSAIDS.
Very rarely chronic haemoptysis or haematuria.

Malabsorption

Achlorhydria (that is lack of gastric acid secretion) in the elderly or due to drugs such as proton pump inhibitors may contribute to the lack of iron availability from the diet.

Physiological demands

At the time of rapid growth, such as in infancy and puberty
In pregnancy, iron is diverted to the fetus.

Investigations 

Confirmation of iron deficiency 

Single best test to detect iron deficiency is measure of plasma ferritin level in blood.
Others are plasma iron and total iron binding capacity (TIBC)

 Investigation of the cause

It depends upon age, sex, underlying disease such as GI bleeding.
Endoscopy, radiological studies.
Check Serum anti-endomysial or anti-transglutaminase antibodies.
Stool and urine analysis for any parasites.

Management

Oral

Ferrous sulphate 200 mg 3 times daily.
Ferrous gluconate 300 mg twice daily.

Intravenous 

Iron dextran.
Iron sucrose.
Iron isomaltose.
Iron carboxymaltose.



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