Iron deficiency diagnosis and management 2019 identification of patients at risk for iron deficiency and iron deficiency anemia screening of the general population for iron deficiency is not recommended. Images in clinical medicine from the new england journal of medicine koilonychia in irondeficiency anemia. Evidence is now accumulating to show that ida is associated with developmental delay, and that the association is causal. Anaemia total iron binding capacity tibc will be very low in iron overload totally saturatecd normal thalassaemia do hemoglobin electrophoresis to check for hglobinopathy low iron iron deficiency. Iron deficiency anaemia is diminished red blood cell production due to low iron stores in the body it is the most common cause of microcytic anaemia, hypochromic anaemia, in which the two red cell indices, mean cell volume mcv and mean cell haemoglobin. Acquired koilonychia is most commonly associated with iron deficiency anemia. It is the most common disorder globally and one of the conditions that general practitioners most frequently encounter. The most common cause of anaemia is iron deficiency, affecting more than 2. Koilonychia is taught to medical students as a sign of iron deficiency anaemia. Etiological evaluation for iron deficiency anaemia showed negative stool parasites and occult blood with the normal colonoscopic study. Ida may be normocytic if anemia is mild or in early iron deficiency. The following laboratory findings are typical for ida.
The waterdrop test for the diagnosis of koilonychia journal of the. Key clinical message koilonychia is a nail abnormality characterized by thin, brittle. One can encourage consumption of iron rich food like green leafy vegetables, spinach, jaggeryand heme iron containingfood like meat and fish. Ida is readily preventable, even in a profoundly socially disadvantaged population, by the provision of an iron supplemented formula in place of. It is frequently observed in chronic iron deficiency secondary to. The ironbinding capacity increases in iron deficiency, while the transferrin saturation decreases. However, the majority of adults with koilonychia demonstrate a familial pattern that may be an autosomaldominant trait. Dietary changes, medicines, supplements and surgery can all be part of the treatment.
Prolonged achlorhydria may produce iron deficiency because acidic conditions are required to release ferric iron from food starch and clay eating produce malabsorption of iron and iron deficiency anemia extensive surgical removal of proximal small bowel or chronic diseases e. Inadequate dietaryiron, iron absorption, bleeding, or loss of body iron in the urine maybe the cause. Level of severity of the anaemia age group multiple disorders. A lateral view of nail highlighting koilonychia at baseline visit. A 54yearold woman presented with fatigue, intermittent hemorrhoidal. Diagnosis and management of iron deficiency anaemia. Apr 17, 20 inadequate dietaryiron, iron absorption, bleeding, or loss of body iron in the urine maybe the cause. Hgb iron deficiency, and a ferritin of less than 15ngml 15 mgl rules in iron deficiency.
In the uk, it is particularly frequent in ethnic and socioeconomically deprived toddlers, and 428% of older infants. Spooning of the nails and webbing of the esophagus. Irondeficiency anemia an overview sciencedirect topics. Drugs details koilonychia causes, symptoms and treatment. Anemia definition reduced haemoglobin level below the reference level for the age and sex of the individual causes of anemia nutritional reduced absorption blood loss haemolysis bone marrow suppression chronic infection other chronic diseases clinical features of anemia fatigue headache faintness breathlessness angina intermittent claudication palpitations signs 1. Anemia is defined as a decrease in the number of red blood cells or the amount of hemoglobin in the blood. Iron deficiency anemia low transferrin saturation, and a high total iron binding capacity. The iron profile was suggestive of irondeficiency anemia. Serum ferritin levels closely correlate with total body iron stores.
Your body uses iron for a variety of functions, crucially to help transport oxygen from the lungs to your organs and tissues. Dec 06, 2019 nutritional deficiency anemia happens when the body does not get enough iron or a few other nutrients from the diet. In early stages nails may be brittle and chip or break easily. Although iron deficiency may be due to physiological. Meat provides a source of heme iron, which is less affected by the dietary constituents that markedly diminish bioavailability than nonheme iron is. T he diagnosis and management of iron deficiency anaemia ida remains a challenge. Hgb 70, the corresponding prevalence of anaemia resulting from this haematinic deficiency being 2% in this age group, using haemoglobin cut off concentrations of 118 gl and 124 gl for female and males respectively. Anaemia american spelling, anemia is a deficiency of red blood cells. Irondeficiency anemia is anemia caused by a lack of iron. In a sense, koilonychia is the opposite of nail clubbing. Hepatocytes are thought to be a longterm reservoir for iron and release it more slowly than macrophages. The iron deficiency spectrum ranges from iron depletion to iron deficiency anaemia. Koilonychia spoonshaped nail can be hereditary, acquired or idiopathic.
In addition to classic symptoms of anaemia pallor, fatigue, headache, dyspnoea, etc, in severe cases of iron deficiency anaemia, specific signs might be present, such as dry and rough skin, dry and damaged hair, alopecia, koilonychia spoonshaped fingernails or atrophic glossitis. Symptoms of iron deficiency anemia include fatigue, dizziness, pale or sallow skin, a rapid heart rate, cold hands and feet, a swollen or inflamed tongue and feeling weak. In adults, id is associated with fatigue in the absence of anemia, restless legs syndrome, pica and, in neonates, delayed growth and. Anaemia is defined as a condition in which the number of red cells or their oxygencarrying capacity is insufficient to meet physiological needs. Overall findings were consistent with chronic iron deficiency anemia. Aug 07, 2019 iron deficiency can reduce oxygen transport, and because iron also helps maintain your skin, hair and nails, a lack of oxygen can affect all of those things. How we diagnose and treat iron deficiency anemia michael auerbach1 and john w. Iron deficiency anemia hematology and oncology msd manual. Aug 09, 2016 approximate 2 g of iron exist in the form of hb, and 3 mg of iron is bound to transferrin in plasma, and mg of iron exists as storage iron in the form of ferritin or hemosiderin hepcidine is a regulator o intestinal iron absorption, iron recycling, and iron mobilizatin from hepatic stores. Feb 03, 2007 a 40 year old woman with persistent fatigue has come back to you for the results of blood tests. The diagnosis of iron deficiency is a major public health goal and an important aspect of the care of many adults. Iron deficiency anemia hematology and oncology msd.
It appears that at least some of the reduction in compartment thickness must be due to a reduced epithelial cell size. Three essential elements must be present to produce red blood cells. It is an important public health problem in australia, with the world health organization who estimating that 8% of preschool children, 12% of pregnant women and 15% of nonpregnant women of reproductive age in australia have anaemia, with ida a major cause. The mean corpuscular volume mcv and mean corpuscular hb mch are reduced, and hypochromia, microcytosis, and characteristic pencil cells. Iron deficiency anemia nursing care management nurseslabs. Stool sample, look for blood endoscopy, look for ulcer total iron binding capacity tibc will drop in iron. Iron deficiency anaemia ida occurs in 25% of adult men and postmenopausal women in the developed world and is a common cause of referral to gastroenterologists. Newly diagnosed iron deficiency anaemia in a premenopausal. Moderate iron deficiency anemia in the treatment of. Introduction iron deficiency anaemia ida is associated with classical signs and symptoms such as pallor and koilonychia.
Newly diagnosed iron deficiency anaemia in a premenopausal woman. Aug 24, 2015 in addition to classic symptoms of anaemia pallor, fatigue, headache, dyspnoea, etc, in severe cases of iron deficiency anaemia, specific signs might be present, such as dry and rough skin, dry and damaged hair, alopecia, koilonychia spoonshaped fingernails or atrophic glossitis. Iron deficiency can reduce oxygen transport, and because iron also helps maintain your skin, hair and nails, a lack of oxygen can affect all of those things. Immunoglobulin a antitissue transglutaminase was elevated, at 43 uml normal. Soluble transferrin receptor and erythrocyte protoporphyrin testing. The treatment therapy of iron deficiency anemia is dependent on the severity as well as its cause. Pallor on the skin, mucosal linings and nail beds signs of specific causes of anemia like koilonychia in iron deficiency, jaundice in haemolytic anaemia bone deformities in thalassaemia major or leg ulcers in sickle cell disease in severe anaemia there may be signs of hyperdynamic circulation. We also assessed patients tolerance to oral iron supplements and subjective response. The iron binding capacity increases in iron deficiency, while the transferrin saturation decreases. The world health organization lists iron deficiency as the most common nutritional disorder in the world. Why would anemia cause koilonychia spoon shaped nails. Laboratory studies were negative for iron deficiency anemia and thyroid abnormalities, while those resulting in acquired koilonychia. Aim we recorded the classical signs and symptoms of iron deficiency in patients presenting to 2 week wait ida clinic. Functional iron deficiency is present in many acute and chronic inflammatory states 17.
Treatment of iron deficiency in adults is discussed separately. Very rare familial spoon nails koilonychia hashizume 2017. Iron deficiency anaemia ida occurs in 25% of adult men and postmenopausal women in the developed world and is a common cause. Koilonychia can be idiopathic or associated with a variety of conditions such as iron deficiency anemia plummer vinson syndrome, malnutrition. When onset is slow, symptoms are often vague such as feeling tired, weak, short of breath, or having decreased ability to exercise. Learn about the signs of low iron, its causes and more. Absolute iron deficiency and functional iron deficiency can coexist. Pdf anemia is one of the most frequent complications related to pregnancy. Pdf koilonychia in irondeficiency anemia researchgate.
Reticulocyte hemoglobin content and reticulocyte hemoglobin equivalent, as an early sign of functional iron deficiency, can easily be generated by automated cell counters, but its diagnostic usefulness in older patients with ida is limited. Iron deficiency anemia is anemia caused by a lack of iron. Koilonychia is associated with irondeficiency anemia and may also be hereditary, idiopathic, or associated with nail trauma or solvent exposure. Hbiron deficiency in mg body weight kg x normal hb actual hb in gl x 0. One can also increase the iron contentoffood by giving adequate calories in diet which itselfwill increase the iron contentby 2530percent. Iron deficiency anemia induced sign and symptoms may be due to the tissue hypoxia andor iron deficiency alone since iron takes additional roles in the various tissues and enzymes in the body. Iron deficiency anemia is when your body lacks red blood cells due to loo little iron in your body. Koilonychia in iron deficiency anemia list of authors. Although iron deficiency anemia is a laboratory diagnosis, a carefully obtained history can facilitate its recognition. Acquired causes are common which include inflammatory dermatoses like psoriasis or lichen planus, onychomycosis, secondary to anaemia and traumatic or occupational. Adamson2 it is estimated that onethird of the worlds population is anemic, the majority being due to iron deficiency id. Clinical features of iron deficiency anaemia depend on the severity of the anaemia. It can occur either through the reduced production or an increased loss of red blood cells.
Serum iron levels should not be used to diagnose iron deficiency. The deficiency of iron further leads to the deficiency of enzymes which require or contain iron. The history can also be useful in establishing the etiology of the anemia and, perhaps, in estimating its duration. Iron deficiency is defined as the reduction of iron stores that. Iron deficiency anemia often develops gradually, with small amounts of. The pathogenesis of koilonychia has never been explained but one theory of how anemia causes spooning of the nails is that the lack of iron causes structural stress during the keratinization process of nail formation, a difference in the angle of. The range of normal in most laboratories is 30 to 300 ngml 67. The clinical features of iron deficiency anaemia depends on the following factors. Familial koilonychia prathap p, asokan n indian j dermatol. Ida may be effectively diagnosed in most cases by full blood examination and serum ferritin level. Esophageal webs, iron deficiency anemia, koilonychia, plummer vinson syndrome. A 40 year old woman with persistent fatigue has come back to you for the results of blood tests. Iron deficiency anaemia in infancy and early childhood.
Nutritional koilonychia in 32 iraqi subjects who emro. In inner cities in the uk, iron deficiency anaemia ida occurs in infants with the same frequency as in developing countries. Glossitis, angular cheilitis, koilonychia spoonshaped. Iron deficiency is the result of many causes table 5. Iron deficiency anemia often develops gradually, with small amounts of blood loss. The first three digits may be preferentially affected. Koilonychia is defined as spooning of finger nails.
Sep 10, 2018 causes of iron deficiency anemia may include. The patient was treated with oral iron supplementation. Koilonychia is an abnormality of the nails that is also called spoonshaped concave nails. Iron deficiency anaemia ida remains prevalent in australia and worldwide, especially among highrisk groups.