Iron def anaemia

Aetiology
1> physiological-postnatal growth sprut,aldolescent growth spurt,menstruation,pregnancy
2> iron loss due 2 bleding-hook worm inf,menorrhagia,postpartum hemorrhage,peptic ulcer
3>inadequate diet-
4>malabsorption-inflamatory bowel disease,postgastrectomy

C/F
A>symptoms-
a>fatigue,lassitude,dyspnoea,palpitation
b>dizziness,headache,syncope,tinnitus
c>irritability,sleep disorder,lack of concentration
d>throbbing in head n ear
e>anorexia,indigestion,nausea
f>angina,intermitent claudication

B>signs-
a>pallor of skin,palms,oral mucus membrane,nail bed,palpebral conjunctiva
b>tachycardia,wide pulse pressur
c>oedema
d>cervical venus hum,hyperdynamic precordium
e>ejection systolic murmur
f>cardiac dilatation  

C>characteristic of iron def-
1>angular stomatitis,glossitis,britle finger nails,polynachia,koilonychia,pica
2>plumer vinson syndrome-
  a>iorn def anaemia
  b>glossitis
  c>koilonychia
  d>postcricoid web resulting in     dysphagia
  e>increased risk of sqamous      cell carcinoma of phyrnx n   esophagous
 treatment-wth iron

INVESTIGATION-
A>2 confirm iron def anaemia
1>Hb reduced
2>MCV reduced
3>PS-microcytosis,hypochromia
        elliptical cells n poikilocytes
4>reticulocytes count normal
5>bone marrow-a>moderate erythroid hyperplasia b>iron stores r markedly reduced
6>plasma iron reduced n TIBC raised
7>plasma tranferin saturation reduced
8>serum ferritin level reduced

B>2 determine cause iron def
1>stool 4 ocult bld n hook worm infestation
2>sigmoidoscopy n colonoscopy
3>upper GI endoscopy
4>barium meal n enema
5>urine 4 schistomiasis

MANGEMENT

A>oral iron therapy-
a>ferous sulfate,glucoate,fumerate,
b>1 tab 2-3 times day
c>side effect-dyspepsia,constipation or diarrhoea
d>response-wthin 7 day
e>failure 2 respond 2 oral therapy
1>not taking tab
2>continuing bld loss
3>ingestion of drug wth iron which reduce its absorption(antacid,H2 receptor blocker,proton pump inhibitor
4>severe malabsorption
f>duration of therapy -6 weeks

B>parentaral therapy
iron dextran/sorbitol
Indication-
.1>GIT intolerance
2>severe malabsorption
3>when rate of iron loss exceeds rate at which iron absorbed
4>anaemia asso wth rheumatoid arthritis,late pregnancy,major operation
5>noncompliance
iron needed mg=(n)Hb-pt Hb*wt in kg *2.21+1000
Iron soraitol IM 1.5 mg/kg wt
Iron dextran IM 100mg z track
                 IV
side effect
1>pain n sweling at site
2>arthralgia
3>fever
4>splenomegaly
5>rash