Anaemia, iron deficiency

ICD-10 codes: D50.0/D50.8/D50.9

Description
General measures
Medicine treatment
Referral

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DESCRIPTION

A common cause of anaemia in young children and women of childbearing age.
A full blood count showing a low MCV suggests the diagnosis of iron deficiency anaemia.
A full blood count is not required for children, unless referral criteria above are present.

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Note: Iron deficiency anaemia in children > 5 years of age, adult males and non-menstruating women, is generally due to occult or overt blood loss. Refer all cases for investigation and treatment of the underlying cause.

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GENERAL MEASURES

• Identify and treat the cause.
• Exclude other causes. See referral criteria in Anaemia.
• Dietary advice:
  • Avoid drinking tea/coffee with meals.
  • Increase vitamin C intake (e.g. citrus fruit, orange juice, broccoli, cauliflower, guavas, strawberries) with meals to increase iron absorption from the diet.
• Increase dietary intake of iron. Foods rich in iron include: liver, kidney, beef, dried beans and peas, green leafy vegetables, fortified wholegrain breads, cereals.

MEDICINE TREATMENT

Treatment

Treat the underlying cause.

Children < 5 years of age

• Iron, oral, 1 - 2 mg/kg/dose of elemental iron 8 hourly with meals.
  • Follow up Hb after 14 days.
  • Hb lower than before: refer.
  • Hb the same/higher: continue treatment and repeat after another 28 days.
  • Continue treatment for 3 months after Hb normalises.

Empiric treatment for worms (this will not treat tapeworm)

• Mebendazole, oral.
  • Children 1 - 2 years: 100 mg 12 hourly for 3 days.
  • Children > 2 - 5 years: 500 mg as a single dose.

OR

• Albendazole, oral, single dose.
  • Children 1 - 2 years: 200 mg as a single dose.
  • Children ≥ 2 years and adults: 400 mg as a single dose.

LoE:IIb¹

Adults

• Ferrous sulfate compound BPC (dried), oral, 170 mg (± 55 mg elemental iron) 12 hourly with meals.

LoE:IIIb²

OR

• Ferrous fumarate, oral, 200 mg (± 65 mg elemental iron) 12 hourly.
  • Do not ingest with tea, antacids or calcium supplements/milk.
  • Doses should be taken on an empty stomach, but if gastrointestinal side effects occur doses should be taken with meals
  • Continue with treatment for 3 - 6 months once Hb has normalised to replace iron stores.

Follow the patient after one month of treatment and Hb should rise by at least 2 g/dL in 4 weeks in the adherent patient without ongoing blood loss.

If daily iron is poorly tolerated (e.g. epigastric pain, nausea, vomiting and constipation), intermittent iron supplementation may be administered:

• Ferrous sulphate compound BPC (dried), oral, 340 mg per week, (± 110 mg elemental iron), with meals.

OR

• Ferrous fumarate, oral, 400 mg per week (± 130 mg elemental iron).

LoE:IVb³

Pregnant women

See: Anaemia in pregnancy.
Consider the following if there is failure to respond to iron therapy:

• non-adherence,
• continued blood loss,
• wrong diagnosis,
• malabsorption, or
• mixed deficiency; concurrent folate or vitamin B12 deficiency.

LoE: IVb⁴

Prophylaxis

Infants from 6 weeks
ICD-10 code: Z29.2

If < 2.5 kg at birth:

• Ferrous lactate, oral, 0.6 mL daily (provides ± 15 mg elemental iron) until 6 months of age.

OR

• Ferrous gluconate syrup, oral, 2.5 mL daily (provides ± 15 mg elemental iron) until 6 months of age.

LoE: IIIb⁵

Pregnant women

See: Antenatal supplements.

Elemental iron per preparation

_{Click on table to enlarge}

LoE:IVb⁶

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CAUTION
Iron is extremely toxic in overdose, particularly in children. Store all medication out of reach of children.

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REFERRAL

• As in Anaemia.
• Children > 5 years of age, men and non-menstruating women.
• No or inadequate response to treatment.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 Edition