DR Medhat MRCP

• Investigations :
CBC :
- Microcytic hypochromic anemia.
- High RDW (red blood cells distribution width ) : indicate anisocytosis.
Peripheral blood film :
- Anisocytosis ( i.e variation in RBCs volume , i.e mixed micro & macrocytes)
- Poiklocytosis ( i.e variation in shape of RBCs).
- Pencil cells (P)
- Target cells (T).
Iron profile :
1) S. iron : low.
2) Total iron binding capacity (TIBC) :
3) Transferrin saturation % : low < 20%.
4) S.ferritin : low ( N.=30-300 µg/dl).
o It`s the most sensitive test (but not specific) for Fe anemia.
Low S.ferritin causes :
1. Fe anemia.
2. Restless leg syndrome.
High S.ferritin causes :
1. Hemochromatosis.
2. Porphyria.
3. Acute phase reaction ( infection , chronic illness,….).
If high S.ferritin do CRP if normal CRP , this R/O that high ferritin is
due to acute phase reaction.
Stool for occult blood : if +ve upper GI endoscopy to R/O upper GI bleeding
Upper & lower GI endoscopy : to R/O GI bleeding.
Stool R/M & C/S : to R/O parasitic infestation e.g ankylostoma.
• Treatment :
Oral iron (with meals) : [ SE : GIT upset , constipation, black stool]
1) Ferrous sulphate ( 200 mg TDS x 3-6 months , to restore Fe stores)
2) Ferrous gluconate or fumarate.
I.V iron ( if intolerant or irresponsive to oral iron, CRF):
1) Iron sucrose (ferrosac) : less allergic
2) Iron dextran (cosmofer).
3) Iron gluconate (ferrlecit)
4) Ferric carboxynaltose ( ferinject) : most recent & least allergy , 2 doses.
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