Anaemia, iron deficiency

D50.9

DESCRIPTION

Iron deficiency is the most common cause of anaemia. The commonest causes of iron deficiency anaemia are poor nutritional intake, excessive milk ingestion and blood loss due to parasites (whipworm and hookworm).

Lower limits of normal haemoglobin:

Age Hb (g/dL)
Birth 13.5
6 weeks 9.5
3 months 10.0
6 - 12 months 10.5
12 - 18 months 10.5
18 months - 4 years 11.0
4 - 7 years 11.0
7 - 12 years 11.5
12 years and older 12 (F) : 13 (M)

DIAGNOSTIC CRITERIA

Clinical

Symptoms and signs vary with the severity of the deficiency:

  • pallor,
  • delayed motor development,
  • fatigue,
  • pica,
  • irritability,
  • soft ejection systolic murmur,
  • behavioural and cognitive effects.

Investigations

  • Haemoglobin below normal for age.
  • Hypochromic microcytic anaemia.
  • Low MCV (mean corpuscular volume) and MCH (mean corpuscular haemoglobin), increased red cell distribution width.
  • Decreased serum iron, ferritin and transferrin saturation.
  • Elevated total iron binding capacity.
  • Stool examination to identify intestinal parasites or to confirm occult blood loss.
  • Iron studies are not necessary if nutritional iron deficiency is strongly suspected. Document a response to a trial of iron therapy to confirm the diagnosis.

Note:
Chronic infections may also cause microcytic hypochromic anaemia.
See Anaemia of chronic disorders (infection or disease) .

GENERAL AND SUPPORTIVE MEASURES

  • Dietary adjustment.
  • Counselling.

MEDICINE TREATMENT

Treatment

NB sepsis must be excluded prior to iron treatment

  • Iron (elemental), oral, 3 mg/kg/dose 12 hourly with meals.

Elemental iron per preparation

Ferrous gluconate elixir 350 mg/5 mL 40 mg elemental
iron per 5 mL 		8 mg
elemental iron
per mL
Ferrous gluconate syrup 250 mg/5 mL 30 mg elemental
iron per 5 ml 		6 mg
elemental iron
per mL
Ferrous lactate drops 25 mg/mL 25 mg elemental
iron per mL 		1 mg
elemental iron
per 0.04 mL
Ferrous sulphate
compound tablets 		170 mg ± 65 mg elemental
iron per tablet 		± 65 mg
elemental iron
per tablet
  • Follow up at monthly intervals.

The expected response is an increase in Hb of 2 g/dL or more in 3 weeks.
Continue for 3–4 weeks after Hb is normal to replenish body iron stores.
The reticulocyte count will increase if there is a positive response and may be useful where the diagnosis is in doubt, if done within 1–2 weeks after iron therapy is started.

Treat for intestinal helminths.
Children 1–2 years of age:

  • Mebendazole, oral, 100 mg 12 hourly for three days.

Children > 2 years:

  • Mebendazole, oral, 500 mg as a single dose immediately.

CAUTION
Iron is extremely toxic in overdose, particularly in children
All medication should be stored out of reach of children

Prophylaxis

All preterm babies, day 15 to 1 year:

  • Iron (elemental), oral, 2 mg/kg daily.
  • Multivitamin, drops, oral, 0.3 mL daily for formula fed babies.
  • Multivitamin, drops, oral, 0.6 mL daily for breast fed babies.

REFERRAL

  • Patients not responding to adequate therapy.
  • Patients in whom easily treatable causes for non-response have been excluded, e.g.:
  • non-adherence to therapy,
  • on-going GIT/other blood loss,
  • on-going infection.