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READING SUB-TEST – TEXT BOOKLET: PART A
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Sedation: Iron deficiencies
Text A
Iron deficiency and iron deficiency anaemia are common. The serum ferritin level is the most useful
indicator of iron deficiency, but interpretation can be complex. Identifying the cause of iron
deficiency is crucial. Oral iron supplements are effective first-line treatment. Intravenous iron
infusions, if required, are safe, effective and practical.
Key Points
• Measurement of the serum ferritin level is the most useful diagnostic assay for detecting iron
deficiency, but interpretation may be difficult in patients with comorbidities.
• Identifying the cause of iron deficiency is crucial; referral to a gastroenterologist is often
required.
• Faecal occult blood testing is not recommended in the evaluation of iron deficiency; a
negative result does not impact on the diagnostic evaluation.
• Oral iron is an effective first-line treatment, and simple strategies can facilitate patient
tolerance.
• For patients who cannot tolerate oral therapy or require more rapid correction of iron
deficiency, intravenous iron infusions are safe, effective and practical, given the short
infusion times of available formulations.
• Intramuscular iron is no longer recommended for patients of any age.
Text B
Treatment of infants and children
Although iron deficiency in children cannot be corrected solely by dietary change, dietary advice
should be given to parents and carers. Cows’ milk is low in iron compared with breast milk and
infant formula, and enteropathy caused by hypersensitivity to cows’ milk protein can lead to
occult gastrointestinal blood loss. Excess cows’ milk intake (in lieu of iron-rich solid foods) is the
most common cause of iron deficiency in young children. Other risk factors for dietary iron
deficiency include late introduction of or insufficient iron-rich foods, prolonged exclusive
breastfeeding and early introduction of cows’ milk.
Adult doses of iron can be toxic to children, and paediatric-specific protocols on iron
supplementation should be followed. The usual paediatric oral iron dosage is 3 to 6mg/kg
elemental iron daily. If oral iron is ineffective or not tolerated then consider other causes of
anaemia, referral to a specialist paediatrician and use of IV iron.
Text C
AN ALGORITHM FOR THE IDENTIFICATION AND MANAGEMENT OF ADULTS WITH IRON DEFICIENCY
Patient presents with clinically suspected iron deficiency
• member of high-risk population (infants, children, menstruating or pregnant
women, vegetarians)
• clinical or laboratory evidence of iron deficiency or anaemia
• micocytosis or hypochromasia (MCV or MCH below laboratory lower limit of
normal)
• Evaluate clinically for
- potential contributors and risk factors for iron deficiency
- inflammatory states or other disorders that may influence interpretation of FBC or iron studies
• Measure serum ferritin level if not already measured
Serum ferritin <30mcg/L Serum ferritin 30-100 mcg/L Serum ferritin >100 mcg/L
Iron deficiency • Borderline iron stores • Iron deficiency unlikely
• Iron deficiency not excluded as serum • If anaemia present then consider
ferritin level may be raised because of functional iron deficiency; specialist input
inflammation may be required
Evaluate for cause (see If iron deficiency felt If inflammatory state
Box 2) to be contributory identified
• Replace iron • Correct inflammatory state
- give oral iron preparation • Selected patients may still
- if rapid correction required (poorly tolerated anaemia) benefit from iron replacement;
or oral therapy unsuccessful then give intravenous iron specialist input advised
• Re-evaluate 1 to 2 weeks after therapy to ensure iron stores are replete and anaemia improving
• Re-evaluate 3 to 6 months after therapy to ensure iron repletion is maintained and anaemia resolved
If iron deficiency recurs If anaemia identified
• repeat evaluation for additional or recurrent source of blood loss; with normal iron stores
consider all diagnoses in Box 2 • evaluate for other
• refer men aged over 40 years and women over 50 years for causes of anaemia
endoscopy and colonoscopy regardless of gastrointestinal symptoms
Text D
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