Iron deficiency anaemia (IDA) is the most common form of anaemia. Causes include decreased iron intake, increased iron loss, and increased iron requirements.
Clinical history, presentation, and findings include fatigue, pallor, dyspnoea on exertion, and pica.
Blood tests reveal microcytic, hypochromic anaemia; low reticulocyte count.
Other laboratory findings include low serum iron, increased total iron-binding capacity (TIBC), less than 16% transferrin saturation, and low serum ferritin.
Diagnosis of IDA requires investigation of the underlying cause.
Treatment includes oral or intravenous iron replacement.
The WHO defines anaemia as haemoglobin <130 g/L (13 g/dL) in men aged ≥15 years, <120 g/L (12 g/dL) in non-pregnant women aged ≥15 years, and <110 g/L (11 g/dL) in pregnant women. Iron deficiency anaemia (IDA) is the most common type of anaemia. Causes include decreased iron intake, increased iron loss, and increased iron requirements. The cause is unknown in some cases.
History and exam
- haemoglobin and haematocrit
- platelet count
- red cell distribution width (RDW)
- peripheral blood smear
- reticulocyte count
- serum iron
- total iron-binding capacity (TIBC)
- transferrin saturation
- serum ferritin
- coeliac serology
- Helicobacter pylori testing
- urease breath test
- autoimmune gastritis testing
- upper gastrointestinal (GI) endoscopy (gastroscopy)
- small-bowel biopsy
- lower gastrointestinal (GI) endoscopy (colonoscopy)
- double contrast barium enema and sigmoidoscopy
- transferrin receptor-ferritin index
- bone marrow biopsy
- monitored trial of iron
- faecal occult blood tests
Atul Mehta, MD
Lysosomal Storage Disorders Unit
Department of Haematology
Royal Free Hospital
AM declares that he has no competing interests.
Dr Atul Mehta would like to gratefully acknowledge Dr Martina Murphy, Dr Marc Zumberg, and Dr Rebecca Fischer Connor, previous contributors to this topic.
MZ declares that he is medical director for NCF Diagnostics and DNA Technologies, and a consultant for Alexion Pharmaceuticals. MM and RFC declare that they have no competing interests.
Carlos Aravena, MD
Internal Medicine Instructor
Member of Evidence Based Medicine Unit
Catholic University of Chile
CA declares that he has no competing interests.
Jim Murray, MBBS
University Hospital Birmingham NHS Trust
JM declares that he has no competing interests.
Ajay Kumar, MD, FACP
AK has received a fee for speaking about perioperative blood management from Ortho-Biotech, and has also received reimbursement from medscape.com for the education webcast of the same presentation.
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