Iron deficiency

{Iron deficiency} [+] yes, present, positive [-] no, absent, negative [~] equivocal [\] not applicable, not performed [?] unknown, unsure, unavailable { } annotation, comment PRESENTING COMPLAINTS OR ISSUES Presenting symptoms: [-] fatigue or exercise intolerance [-] pica (craving for non-food substances such as clay or paper, ice) [-] restless legs [-] hair loss [-] headache [-] irritability or other mood changes [-] dyspnea [-] tachycardia [-] orthostatic symptoms History of presenting complaint: - Management to date: - Iron deficiency risk factors: [-] genetic [-] IRIDA: iron-refractory iron deficiency anemia (mutations in the gene TMPRSS6 which causes elevated levels of hepcidin, which impairs the body’s ability to both absorb and use iron) [-] blood loss [-] traumatic/surgical haemorrhage [-] GI bleeding [-] gastric/gastritis [-] angiodysplasia [-] malignancy [-] haemorrhoids [-] GI parasites (eg hook worm, whipworm) [-] menorrhagia [-] pregnancy/delivery-related bleeding [-] frequent blood donation/phlebotomy [-] intravascular haemolysis [-] mechanical heart valves [-] increased iron requirement [-] pregnancy [-] growth [-] decreased iron absorption [-] malabsorption [-] genetic disorders of iron absorption: IRIDA [-] coeliac disease [-] post gastrectomy [-] atrophic (autoimmune) gastritis [-] Helicobacter pylori infection [-] gastric acid supressing medication (PPIs, H2 blockers, antacids) [-] diet [-] dietary deficiency (vegan/vegetarian) [-] foods that impair iron absorption (tannins [tea], phosphates, calcium) [-] exercise-induced (high-intensity athletics) [-] occult GI blood loss [-] reduced iron intake [-] iron loss in sweat [-] traumatic haemolysis Relevant diagnostic investigation results: [\] Hb: [\] MCV: [\] Serum ferritin: [\] CRP: PAST MEDICAL HISTORY Relevant past medical history: [+] [-] PHYSICAL EXAMINATION Relevant examination findings: [-] pallor [-] dry or rough skin [-] atrophic glossitis [-] angular cheilitis [-] koilonychia (spoon nail) [-] alopecia (rare) [-] chlorosis (pale, faintly green complexion, rare) ASSESSMENT Clinical summary: [+] [~] [-] Diagnosis/es: 1. 2. MANAGEMENT PLAN Diagnostic investigations requested: [-] FBE [-] ferritin [-] iron studies (S-Iron, Transferrin saturation) [-] CRP [-] coeliac autoantibodies (transglutaminase Ab) - if coeliac disease is suspected [-] faecal occult blood x 3 - if GIT blood loss is suspected [-] B12 - if vegetarian or anaemic Referrals: - Patient information and advice: - Medication: - FOLLOW-UP Outstanding issues: - Next appointment: -

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Iron studies

NOTE: Ferritin is an acute phase reactant, low or normal ferritin levels may be seen in iron deficiency where there is inflammation, liver disease, metabolic syndrome, chronic alcohol use, malignancy, and some instances of immune compromise. If clinically indicated repeat with CRP level.

Normal iron stores

• Serum ferritin 30–100 ug/L
• Transferrin saturation ≥20%
• CRP <5 mg/L
• Trial of iron–no change in Hb or reticulocyte count

Iron deficiency

• Serum ferritin <30 ug/L
• Transferrin saturation <20%
• CRP <5 mg/L
• Trial of iron–increased Hb and reticulocyte count

Normal iron stores + acute phase response

• Serum ferritin >30 ug/L
• Transferrin saturation <20%
• CRP >5 mg/L
• Trial of iron–no change in Hb or reticulocyte count

Iron deficiency + acute phase response

• Serum ferritin 30–70 ug/L
• Transferrin saturation <20%
• CRP >5 mg/L
• Trial of iron–increased Hb and reticulocyte count

Iron deficiency + heart failure

• Serum ferritin >100 ug/L
• Transferrin saturation <20%
• Trial of iron–increased Hb and reticulocyte count

Iron overload

• Serum ferritin (male) ≥200–300 ug/L
• Serum ferritin (female) ≥150–200 ug/L
• Transferrin saturation ≥45%

Related items

• Anaemia
• Iron infusion