Questions and Answers
What is the primary component contained in most parenteral iron preparations?
In which situation is parenteral iron typically avoided?
Which of the following conditions can lead to oral iron being ineffective?
What is the maximum dose of ferric hydroxide–sucrose that can be administered in a single dose?
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What type of reaction may occur in patients receiving parenteral iron?
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How is Ferumoxytol administered?
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Which of the following is NOT an indication for parenteral iron use?
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What effect does intravenous iron have on patients with congestive heart failure?
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Which type of iron preparation can be given as a total dose in one day by intravenous infusion?
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What is the common rationale for calculating the parenteral iron dose based on?
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What is a reason for giving parenteral iron rather than oral iron?
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Which preparation of parenteral iron is administered only by intravenous infusion?
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What common risk factor increases the likelihood of hypersensitivity reactions to parenteral iron?
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In which condition might intravenous iron improve functional capacity even without anemia?
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What is an indication for administering parenteral iron?
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What is typically true regarding the hematological response to parenteral iron compared to oral iron?
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How should ferric hydroxide–sucrose be administered in terms of dosage?
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What is a possible reason for the administration of parenteral iron during pregnancy?
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What is a potential adverse effect related to the administration of intravenous iron?
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Study Notes
Clinical Features of Iron Deficiency
- Reticuloendothelial stores, such as haemosiderin and ferritin, deplete before anemia manifests.
- Symptoms of developing iron deficiency include general anemia signs, painless glossitis, angular stomatitis, brittle nails (koilonychia), and cravings (pica).
- Cognitive and behavioral abnormalities in neonates are linked to iron deficiency.
- Children may experience irritability, poor cognitive function, and declines in psychomotor development.
- Oral or parenteral iron therapy may alleviate fatigue in non-anemic, iron-deficient women.
Causes of Iron Deficiency
- In developed nations, chronic blood loss, especially from uterine and gastrointestinal sources, is the primary cause.
- A 500ml blood volume contains approximately 250mg of iron; chronic blood loss typically results in negative iron balance despite increased absorption.
- Infants, adolescents, pregnant women, lactating women, and menstruating individuals are at higher risk due to increased iron demand.
- Newborns receive iron from cord blood; mixed feeding with iron-fortified foods from 6 months can prevent deficiency.
- In pregnancy, iron needs rise for increased maternal blood volume and fetal iron transfer; supplementation is often warranted if hemoglobin is low.
Laboratory Findings
- Falling red cell indices and a blood film showing hypochromic, microcytic cells occur early in iron deficiency, with low reticulocyte counts.
- Severe deficiency may reveal a dimorphic blood film with both macrocytic and microcytic red cell populations.
- Bone marrow examination typically indicates complete iron absence in macrophages and erythroblasts.
- Serum iron levels decrease while total iron-binding capacity (TIBC) increases, showing low saturation levels.
- Serum ferritin, reflecting body iron stores, is very low in anemia, while normal or high ferritin indicates either iron overload or inflammation.
Investigation of Iron Deficiency Cause
- In premenopausal women, menorrhagia is often responsible; further examination is required if absent.
- Gastrointestinal blood loss is the main cause in men and postmenopausal women, assessed via medical history, physical exams, and diagnostic tests.
- Testing may include upper/lower gastrointestinal imaging, looking for autoimmune gastritis or malabsorption causes.
- Hookworm and schistosomiasis are relevant in certain geographic areas; specific tests may confirm.
- Evaluations of iron loss via urine occurrence may be warranted if other causes are excluded.
Treatment of Iron Deficiency
- Treatment emphasizes addressing the underlying cause, along with iron supplementation to correct anemia and restore iron stores.
- Oral iron preparations, primarily ferrous sulfate, provide effective treatment and are typically given on an empty stomach.
- New dosing guidelines recommend once-daily administration due to hepcidin-induced absorption inhibitions.
- Common side effects may be mitigated through lower iron content formulations or dietary adjustments.
- Oral therapy duration should span at least six months, targeting a hemoglobin rise of approximately 20g/L every three weeks.
- Parenteral iron is reserved for high demand situations or when oral forms are ineffective or intolerable.
Parenteral Iron Administration
- Various parenteral preparations exist, typically containing ferric iron; dosing is often based on body weight and severity.
- Ferric hydroxide is administered via slow infusion or injection; rapid-release forms are available for quick treatment.
- Monitoring for hypersensitivity reactions is essential, especially in patients with prior allergies.
- Parenteral iron may be necessary in cases of severe menorrhagia, gastrointestinal bleeding, pregnancy, chronic renal failure, or significant iron malabsorption.
- The clinical response to parenteral iron is comparable in speed to effective oral supply, but stores replenish more quickly, showing added benefits in specific conditions like congestive heart failure.
Clinical Features of Iron Deficiency
- Reticuloendothelial stores, such as haemosiderin and ferritin, deplete before anemia manifests.
- Symptoms of developing iron deficiency include general anemia signs, painless glossitis, angular stomatitis, brittle nails (koilonychia), and cravings (pica).
- Cognitive and behavioral abnormalities in neonates are linked to iron deficiency.
- Children may experience irritability, poor cognitive function, and declines in psychomotor development.
- Oral or parenteral iron therapy may alleviate fatigue in non-anemic, iron-deficient women.
Causes of Iron Deficiency
- In developed nations, chronic blood loss, especially from uterine and gastrointestinal sources, is the primary cause.
- A 500ml blood volume contains approximately 250mg of iron; chronic blood loss typically results in negative iron balance despite increased absorption.
- Infants, adolescents, pregnant women, lactating women, and menstruating individuals are at higher risk due to increased iron demand.
- Newborns receive iron from cord blood; mixed feeding with iron-fortified foods from 6 months can prevent deficiency.
- In pregnancy, iron needs rise for increased maternal blood volume and fetal iron transfer; supplementation is often warranted if hemoglobin is low.
Laboratory Findings
- Falling red cell indices and a blood film showing hypochromic, microcytic cells occur early in iron deficiency, with low reticulocyte counts.
- Severe deficiency may reveal a dimorphic blood film with both macrocytic and microcytic red cell populations.
- Bone marrow examination typically indicates complete iron absence in macrophages and erythroblasts.
- Serum iron levels decrease while total iron-binding capacity (TIBC) increases, showing low saturation levels.
- Serum ferritin, reflecting body iron stores, is very low in anemia, while normal or high ferritin indicates either iron overload or inflammation.
Investigation of Iron Deficiency Cause
- In premenopausal women, menorrhagia is often responsible; further examination is required if absent.
- Gastrointestinal blood loss is the main cause in men and postmenopausal women, assessed via medical history, physical exams, and diagnostic tests.
- Testing may include upper/lower gastrointestinal imaging, looking for autoimmune gastritis or malabsorption causes.
- Hookworm and schistosomiasis are relevant in certain geographic areas; specific tests may confirm.
- Evaluations of iron loss via urine occurrence may be warranted if other causes are excluded.
Treatment of Iron Deficiency
- Treatment emphasizes addressing the underlying cause, along with iron supplementation to correct anemia and restore iron stores.
- Oral iron preparations, primarily ferrous sulfate, provide effective treatment and are typically given on an empty stomach.
- New dosing guidelines recommend once-daily administration due to hepcidin-induced absorption inhibitions.
- Common side effects may be mitigated through lower iron content formulations or dietary adjustments.
- Oral therapy duration should span at least six months, targeting a hemoglobin rise of approximately 20g/L every three weeks.
- Parenteral iron is reserved for high demand situations or when oral forms are ineffective or intolerable.
Parenteral Iron Administration
- Various parenteral preparations exist, typically containing ferric iron; dosing is often based on body weight and severity.
- Ferric hydroxide is administered via slow infusion or injection; rapid-release forms are available for quick treatment.
- Monitoring for hypersensitivity reactions is essential, especially in patients with prior allergies.
- Parenteral iron may be necessary in cases of severe menorrhagia, gastrointestinal bleeding, pregnancy, chronic renal failure, or significant iron malabsorption.
- The clinical response to parenteral iron is comparable in speed to effective oral supply, but stores replenish more quickly, showing added benefits in specific conditions like congestive heart failure.
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Description
Explore the clinical features of iron deficiency, including symptoms such as anaemia, glossitis, stomatitis, and koilonychia. This quiz covers the progression of the condition and its effects on the body. Test your understanding of the signs and symptoms associated with iron deficiency.
