Iron Supplementation in Gut Diseases

Questions and Answers

What is a potential reason for inadequate response in patients?

Increased iron intake

Non-compliance (correct)

Incorrect diagnosis (correct)

Continued blood loss (correct)

Parenteral iron is recommended for all patients with iron deficiency.

False

What brown skin discoloration might develop at the injection sites?

Tattoo-like discoloration

Iron is typically administered via _____ for patients with malabsorption.

parenteral injection Signup and view all the answers

What formula is mentioned for calculating the required iron dose?

Body weight (kg) x 2.3 × (15 - patient's hemoglobin, g/dL) + 500 or 1000 mg Signup and view all the answers

Which preparation of iron has fewer allergic effects?

Iron isomaltose Signup and view all the answers

What is anaemia?

A state in which the level of hemoglobin in the blood is below the normal range appropriate for age and sex. Signup and view all the answers

What are the clinical features of anaemia influenced by?

All of the above Signup and view all the answers

Menorrhagia is a common cause of anaemia in females still menstruating.

True Signup and view all the answers

What is the most common type of anaemia worldwide?

Iron deficiency anaemia. Signup and view all the answers

What diagnostic test is best to confirm iron deficiency?

Plasma ferritin Signup and view all the answers

Iron absorption primarily occurs in the _____.

duodenum Signup and view all the answers

Which of the following is NOT a common cause of iron deficiency anaemia?

Excessive exercise Signup and view all the answers

There is a physiological mechanism for excreting iron.

False Signup and view all the answers

What are the common symptoms of anaemia?

Pallor, fatigue, decreased exercise capacity, shortness of breath. Signup and view all the answers

Match the following types of anaemia with their causes:

Iron deficiency anaemia = Blood loss or nutritional deficiency Macrocytic anaemia = Vitamin B12 or folate deficiency Microcytic anaemia = Iron deficiency or thalassaemia Anemia of chronic disease = Chronic infections or inflammatory conditions Signup and view all the answers

Study Notes

Definitions and Types of Anemia

Anemia is characterized by hemoglobin levels below the normal range, influenced by factors like age, sex, pregnancy, and altitude.
Types of anemia include iron deficiency anemia (IDA), macrocytic anemia (vitamin B12 or folate deficiency), and normocytic anemia (e.g., anemia of chronic disease).
Common causes of anemia include decreased marrow production, blood loss, and hemolysis.

Clinical Presentation

Symptoms depend on anemia severity, development speed, and underlying cardiorespiratory diseases.
Rapid onset (e.g., from blood loss) leads to more severe symptoms than gradual onset.
Typical symptoms include pallor, fatigue, decreased exercise capacity, and shortness of breath.
Severe IDA may cause glossitis, koilonychia (spooning of nails), and pica (craving unusual substances).

Investigation and Diagnosis

Diagnosis involves full blood count, blood film, and careful history taking.
Reticulocyte count distinguishes between production failure and increased destruction of red blood cells.
The mean cell volume (MCV) classifies anemia:
- Normal MCV indicates acute blood loss or anemia of chronic disease.
- Low MCV suggests iron deficiency or thalassemia.
- High MCV indicates vitamin B12 or folate deficiency.

Iron Deficiency Anemia (IDA)

Around 30% of the global population is anemic; half of these suffer from IDA, prevalent in developing countries.
Blood loss, especially gastrointestinal (e.g., ulcers, malignancies), is the leading cause in men and postmenopausal women.
Nutritional deficiencies and malabsorption syndromes (like coeliac disease) contribute to IDA.

Mechanism of Iron Absorption and Regulation

Iron is absorbed in the duodenum and jejunum, with only 5-10% of dietary iron absorbed.
Absorption is regulated by intestinal mucosal cells, reflecting body iron stores; high stores decrease absorption, while low stores increase it.
There is no physiological excretion mechanism for iron; losses occur through shedding of intestinal cells, urine, nails, hair, skin, and menstruation.

Body Iron Distribution

Total body iron in adults ranges from 3.5g to 2.5g, with most present in hemoglobin (65-70%).
Ferritin and hemosiderin store excess iron in the reticuloendothelial system.
Plasma iron, carried by transferrin, constitutes only 0.1% of total body iron.

Investigations for IDA

Plasma ferritin is the best single test to confirm iron deficiency; levels below 15 μg/L indicate IDA.
Total iron binding capacity (TIBC) and serum iron levels help assess iron availability.
Diagnostic procedures may include endoscopy or duodenal biopsy if gastrointestinal causes are suspected.

Differential Diagnosis of IDA

Consider thalassemia, sideroblastic anemia, lead poisoning, and anemia of chronic disorders based on history and lab findings.

Management of IDA

Oral iron supplementation (e.g., ferrous sulfate 200 mg three times daily) is the first-line treatment, continued for 3-6 months.
Parenteral iron is indicated for malabsorption cases or intolerance to oral iron.
Monitoring includes hemoglobin increases (expected at 10 g/l every 7-10 days) and reticulocyte response within one week.
Newer iron formulations, such as iron isomaltose and iron carboxymaltose, are preferred due to fewer allergic reactions.

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Description

This quiz covers the protocols for iron supplementation in patients with malabsorption or chronic gastrointestinal conditions. It includes details about parenteral iron administration and potential side effects like skin discoloration. Test your knowledge on appropriate iron therapy and patient management.