Anaemia, iron deficiency

D50.0-1/D50.8-9

DESCRIPTION

Anaemia due to iron deficiency. Common causes of iron deficiency are chronic blood loss, poor iron absorption or poor nutritional intake.

Investigations

  • Low MCV and MCH (mean cell Hb – hypochromia) – note that this often normal in early stages.
  • Full blood count (FBC) Smear: Hypochromic microcytic anaemia and pencil cells often reported.
  • Confirm with low ferritin.
  • Investigate for cause of iron deficiency.
  • Consider upper and lower endoscopies in high risk patients (all males and postmenopausal female patients) and patients not responding to treatment.

GENERAL MEASURES

Identify and treat the underlying cause.
Dietary adjustment if this is the underlying cause.

MEDICINE TREATMENT

Oral iron supplementation

Treatment

Treat underlying cause.

  • Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) 12 hourly.

OR

Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) 12 hourly.

LoEIII [1]

LoEIII [2]

Follow the patient after one month of treatment and Hb should rise by at least 2 g/dl in the adherent patient without ongoing blood loss.

Prophylaxis O99.0/D50.0-1/D50.8-9/Z29.2

For example during pregnancy:

  • Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) daily.

LoEIII [3]

OR

Ferrous fumarate, oral, 200 mg once daily (± 65 mg elemental iron).

If daily iron is poorly tolerated (e.g. epigastric pain, nausea, vomiting and constipation), intermittent iron supplementation may be administered:

  • Ferrous sulphate compound BPC (dried), oral, 340 mg per week, (± 110 mg elemental iron), with meals.

LoEIII [4]

OR

Ferrous fumarate, oral, 400 mg per week (± 130 mg elemental iron).

Consider the following if there is failure to respond to iron therapy:

  • non-adherence,
  • continued blood loss,
  • wrong diagnosis,
  • malabsorption, or
  • mixed deficiency; concurrent folate or vitamin B12 deficiency.

Parenteral iron

Parenteral iron is seldom required and may very rarely be associated with anaphylaxis.

Parenteral iron is only indicated when oral iron is:

  • ineffective, defined as lack of response after three months of oral iron therapy, or
  • iron deficiency anaemia from 36 weeks of pregnancy, or
  • expected to be ineffective, e.g. malabsorption, patients on haemodialysis and erythropoietin therapy, or
  • not tolerated.

In people who require repeated therapy, the intravenous route is preferred.

Minimum required dose is 250 mg of iron per gram of Hb below normal.

Note: Use in consultation with a specialist.

  • Iron, IV, e.g.:
  • Iron sucrose, IV, 200 mg in 200 mL sodium chloride 0.9%, over 30 minutes, given on alternate days until the total dose has been given.
    • Note: Test dose is not required.
    • An initial total dose of 600 mg is usually adequate to raise the Hb to acceptable levels.

OR

  • Low molecular weight iron dextran, administered as a single dose.
    • Determine total dose of iron required (total dose up to 20 mg/kg body weight).
    • Note: Start with test dose - 25 mg in 100 ml sodium chloride 0.9%, infused over 15 minutes and observe the patient for 1 hour.
    • If there is no adverse drug reaction, administer the remaining dose in 500 mL of sodium chloride 0.9%, 0.9% over 4-6 hours. Observe the patient for 1 hour after the infusion.

LoEIII [5]

Resuscitation equipment should be ready to manage anaphylaxis.

Red cell concentrate transfusion

Indicated in patients with:

  • anaemia leading to cardiac failure or severe dyspnoea;
  • active, ongoing bleeding; or
  • where correction of anaemia is required prior to performing an urgent invasive procedure or surgery.