Iron Deficiency Anaemia

  • Hypochromic microcytic anaemia

Clinical Features

  • anaemia /pallor
  • pica (abnormal appetite)
  • koilonychia / ridged, brittle nails
  • glossitis
  • angular cheilosis / cheilitis (sore corners of mouth)

  • secondary loss of appetite

  • lethargy

  • slowing of development

  • hair thinning
  • pharyngeal web formation (Paterson Kelly syndrome)

Differential

  • thalassaemia minor

  • malabsorption

Investigations

  • Full blood count
    • Hypochromic microcytic anaemia
    • Platelets raised
  • Blood film
    • microcytic, hypochromic cells
    • anisocytosis (cells of different sizes)
    • poikilocytosis
    • target cells (darker middle of pale concavity)
    • 'pencil' cells
  • Haematinics
    • ferritin reduced
    • iron low
    • raised transferrin
    • unsaturated TIBC
  • Soluble transferrin receptors increased

Causes

  • Poor diet

    • Often when attempting to wean child onto solids and children refuse, taking a lot of milk on board

    • Especially common in UK Indian population

  • Chronic blood loss
    • Uterine
    • GI
      • malignancy
      • NSAIDs
      • oesophageal varices
      • gastrectomy
      • hookworm
      • angiodysplasia
      • colitis
      • diverticulosis
      • piles
    • haematuria
    • haemoglobinuria
    • pulmonary haemosiderosis
    • self-inflicted blood loss
  • Increased demands
    • Prematurity
    • Growth
    • Pregnancy
  • Malabsorption
    • Gastrectomy
    • gluten-induced enteropathy (coeliac disease)

Treatment

  • Input from paediatric dietician

  • Iron supplementation for 1-2 months

    • oral ferrous sulphate (200mg TDS)
      • side effects
        • abdominal pain
        • diarrhoea
        • constipation
    • Intramusclar iron if:
      • malabsorption
      • can't take oral
    • Intravenous
      • may cause anaphylaxis
 

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