Iron Deficiency Anaemia

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A lack of iron in the body (mainly due to nutritional deficiency, chronic blood loss, malabsorption and  hookworm infestations and increased demand such as during pregnancy). 

Clinical  presentation:  fatigue,  palpitation,  dizziness,  glossitis,  koilonychias  (spoon  shaped  nails)  and pica 

Investigations  

  • Full blood picture (FBP) 
  • Peripheral smear 
  • Iron studies- serum iron levels, total iron binding capacity, serum ferritin   
  • Stool analysis for hookworm ova and occult blood. If stool for occult blood is positive, do Oesophagoduodenoscopy (OGD) to confirm upper gastrointestinal bleeding 

Non-Pharmacological Treatment            

To prevent iron deficiency; 

  • Eat a variety of iron rich foods like meat, eggs, legumes (dried beans, lentils, peas),  spinach and dark green leafy vegetables, iron fortified breads and cereals, nuts and  seeds. 

To help in iron absorption from diet; 

  • Avoid drinking tea/coffee with meals 
  • Increase intake of vitamin C rich foods (e.g. citrus fruit, broccoli, cauliflower, guavas,  tomatoes, bell peppers and strawberries) with meals to maintain iron in its reduced  state 

Pharmacological Treatment  

Treat the underlying cause of iron deficiency anaemia. 
Adults  

A: ferrous sulfate (PO) 200mg 8hourly for 3months.  

Children: 

A: ferrous sulphate (PO) 5mg/kg 8hourly. Continue for 3months after the normal hemoglobin  has been achieved.  

OR 

B: Blood transfusion (is only indicated if anaemia is life threatening; e.g anaemia in failure,  hypoxia.) 

OR 

D: Iron sucrose (IV) 200mg in 100ml0.9% sodium chloride running for 15 minutes once a day  three times a week for 2 weeks.  

Parenteral iron is indicated in patients who can not tolerate or are refractory to oral iron. 

  • Total cumulative dose = number of 100mg ampoules for Hb increase
  • Divide the total cumulative dose in 200mg doses, given 24hourly 

Table 3.1: Number of 100mg/ampoules of iron sucrose needed for Hb increase based on the  body weight. 

Increase in Hb required (g/dL) ie Target Hb minus Actual Hb     
  1g 2g 3g 4g 5g 6g 7g
Body Weight (kg) 40 6 7 8 9 10 11 12
45 6 7 8 9 10 11 12
50 6 7 9 10 11 12 13
55 6 8 9 10 12 13 14
60 6 8 9 11 13 14 16
65 7 8 10 11 13 14 16
70 7 8 10 12 13 15 17
75 7 9 10 12 14 16 18
80 7 9 11 13 15 17 18
85 7 9 11 13 15 17 19
90 7 9 11 14 16 18 20
95 7 10 12 14 16 19 21
100 7 10 12 15 17 19 22
  • Duration of treatment may extend to 4 weeks based on the total cumulative dose required.    Monitor blood counts and clinical assessment monthly. 

Note: Formulations of iron combined with other nutritional supplements (vitamins, 0.4mg-5mg folic acid, zinc  and  amino  acids)  are  recommended  to  enhance  absorption  of  iron  and  correct  combined  nutritional  deficiencies.