Iron deficiency anaemia
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Hypochromic red cells showing pencil cells |
Iron deficiency anaemia (IDA) is not an uncommon problem in primary care. While it is often present in hospitalised patients, it is generally not the primary reason for admission and may go unnoticed.
IDA occurs at all stages of life, being most prevalent among at risk groups due to physiological, nutritional or social factors.
It may also be an indication of an important underlying disorder (eg asymptomatic GI cancer), which should be identified and managed.
Management involves two concurrent components: determination and treatment of the underlying cause (eg bleeding) and iron therapy to normalise the haemoglobin and replenish iron stores.
Sub-optimal identification, investigation and management of IDA is an important contributor to unnecessary and reflex decisions to transfuse.
In compensated patients who do not require an immediate increase in oxygen carrying capacity, transfusion carries unnecessary risks and fails to replenish deficient iron stores.
If transfusion is required (eg for cardiac compromise or in the setting of serious acute blood loss) it is still important to ensure that iron therapy is given.
Improving the management of IDA is important for ensuring optimal health outcomes for patients and making effective use of healthcare resources.
Iron therapies are effective at addressing both the haematological and non-haematological consequences of iron deficiency (such as impaired physical and cognitive function).
The cost of blood components and products is largely hidden but consumes more than $600 million every year in Australia. This does not include the cost of the transfusion process or complications.
We have an ethical responsibility to blood donors to ensure the best use of their precious gifts and a need to ensure sufficiency of a limited resource.
Effective strategies to improve the management of iron deficiency will reduce the burden of anaemia, which will increase with our ageing population.
