Iron deficiency anaemia management

Overview

Iron deficiency anaemia results from inadequate body iron stores, most commonly due to:

• Nutritional iron deficiency

• Chronic blood loss

• Malabsorption

• Hookworm infestation

• Increased iron requirements, such as during pregnancy

Clinical presentation

Patients may present with:

• Fatigue

• Palpitations

• Dizziness

• Glossitis

• Koilonychia (spoon-shaped nails)

• Pica

Investigations

Perform the following investigations as appropriate:

• Full blood picture (FBP)

• Peripheral blood smear

• Iron studies:

  • Serum iron

  • Total iron-binding capacity (TIBC)

  • Serum ferritin

• Stool examination for hookworm ova

• Stool occult blood test

If stool occult blood is positive:

• Perform oesophagogastroduodenoscopy (OGD) to evaluate for upper gastrointestinal bleeding.

Non-pharmacological management

Preventing iron deficiency

Advise patients to consume iron-rich foods, including:

• Meat

• Eggs

• Legumes (beans, lentils and peas)

• Spinach

• Dark green leafy vegetables

• Iron-fortified cereals and bread

• Nuts

• Seeds

Improving iron absorption

Advise patients to:

• Avoid tea or coffee with meals.

• Increase intake of vitamin C-rich foods during meals, including:

  • Citrus fruits

  • Broccoli

  • Cauliflower

  • Guava

  • Tomatoes

  • Bell peppers

  • Strawberries

Vitamin C helps maintain iron in its reduced form, improving absorption.

Pharmacological management

Treat the underlying cause of iron deficiency whenever possible.

Oral iron therapy

Adults

Ferrous sulphate (PO)

• 200 mg every 8 hours for 3 months.

Children

Ferrous sulphate (PO)

• 5 mg/kg every 8 hours.

• Continue treatment for 3 months after haemoglobin has returned to normal.

Blood transfusion

Blood transfusion is indicated only when anaemia is life-threatening, such as:

• Anaemic heart failure

• Tissue hypoxia

Intravenous iron therapy

Iron sucrose (IV)

• 200 mg diluted in 100 mL of 0.9% sodium chloride

• Infuse over 15 minutes

• Administer once daily, three times per week, for 2 weeks

Parenteral iron is indicated for patients who:

• Cannot tolerate oral iron therapy, or

• Have inadequate response to oral iron therapy.

Total iron requirement

• Calculate the total cumulative iron requirement according to the patient's body weight and the desired increase in haemoglobin.

• The total cumulative dose corresponds to the required number of 100 mg iron sucrose ampoules.

• Administer the calculated dose as 200 mg doses every 24 hours until the total cumulative dose has been given.

• Treatment may need to continue for up to 4 weeks, depending on the total iron requirement.

Estimated number of 100 mg iron sucrose ampoules required

Monitoring

• Monitor haemoglobin and other blood counts monthly.

• Perform regular clinical assessment to evaluate treatment response.

Notes

• Iron preparations combined with other nutritional supplements, including vitamins, folic acid (0.4–5 mg), zinc, and amino acids, may be used to improve iron absorption and correct concurrent nutritional deficiencies.