| Functional ID | ID | IDA | ACD | IDA + ACD | IRIDA | |
| Hb | normal | normal | low | low | low | low |
| MCV & MCH | normal | normal | low | low-N | loew | v. low |
| Ferritin (mcg/L) | normal | low (< 30) | low (< 30) | N or high | N (up to 100) | variable |
| TFS (15 – 45 %) | low-normal | low-N / low | low | low-N | low-N | low |
| Serum iron (10 – 30 mmol/L) | low-normal | low | low | low | low | low |
Functional Iron Deficiency: inadequate iron supply to the bone marrow despite iron stores being present.
Iron Deficiency (ID): decreased levels of total body iron, especially iron stores, but inadequate levels of erythroid iron.
Iron Deficiency Anaemia: decreased levels of total body iron resulting in anaemia.
Anaemia of chronic disease (ACD) or inflammation: multifactorial anaemia with up-regulation of hepcidin and abnormal iron homeostasis.
Iron Refractory Iron-Deficiency Anaemia (IRIDA): an iron-deficiency anaemia unresponsive to oral iron therapy – i.e. indication for iron injection.
Treatment and Investigations of Iron Deficiency should occur concurrently:
- history
- physical examination
- medications review
- coeliac screen
- urinalysis + MSU (1% renal tract malignancy)
- renal function
- faecal immunohistochemical test (colonoscopy)
Male / postmenopausal female –> GI investigations
Premenopausal female –> GI investigations for high-risk or those with persistent ID after empirical treatment.
Screen and manage preoperative patients for ID:
- check Hb / iron / RFT / CRP if expect significant blood loss at surgery
- optimise iron / Hb prior to surgery (patients who have blood transfusions do worse)
References
Baird-Gunning, Jonathan and Bromley, Jonathan. “Correcting iron deficiency.” Aus Prescr 39(6); Dec 2016: 193-9. http://www.nps.org.au/australianprescriber.
Pasricha, Sant-Rayn S., Flecknoe-Brown, Stephen C., Allen, Katrina J., Gibson, Peter R., McMahon, Lawrence P., Olynyk, John K., Roger, Simon D., Savoia, Helen F., Tampi, Ramdas; Thomson, Amanda R., Wood, Erica M. and Robinson, Kathryn L. “Diagnosis and management of iron deficiency anaemia: a clinical update.” MJA 193(9); Nov 1, 2010: 525-32.