Iron deficiency anaemia — structured viva

Structured oral on iron deficiency: defending the GI investigation mandate, ferritin's inflammation caveat and low-normal trap, the hepcidin case against twice-daily iron, the non-response ladder, and IV iron formulation choice with hypophosphataemia numbers.

Prompt

The examiner opens: 'Half your iron-deficiency patients never see a gastroenterologist and most of your prescriptions say three times a day. Defend both habits — or change them.' The viva branches through investigation thresholds, laboratory interpretation, dosing physiology, response expectations and intravenous iron.

Stem

You are the GP. Your practice audit shows that only a third of men diagnosed with iron deficiency anaemia had bidirectional endoscopy within six months. ^[5]

References10Show

[1]Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women. Lancet Haematology, 2017.PMID 29032957
[2]Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood, 2015.PMID 26289639
[4]Stoffel NU, Zeder C, Brittenham GM, et al. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica, 2020.PMID 31413088
[5]Goddard AF, James MW, McIntyre AS, Scott BB Guidelines for the management of iron deficiency anaemia. Gut, 2011.PMID 21561874
[7]Mahadev S, Laszkowska M, Sundström J, et al. Prevalence of Celiac Disease in Patients With Iron Deficiency Anemia — A Systematic Review With Meta-analysis. Gastroenterology, 2018.PMID 29689265
[8]Zoller H, Wolf M, Blumenstein I, et al. Hypophosphataemia following ferric derisomaltose and ferric carboxymaltose in patients with iron deficiency anaemia due to inflammatory bowel disease. Gut, 2023.PMID 36343979
[9]Wang SA, Fadare O, Nagar A, Shafi NQ, Rose MG Gastrointestinal endoscopic findings in men with unexplained anemia and low normal ferritin values. American Journal of Hematology, 2006.PMID 16628728
[10]Ganz T, Nemeth E Hepcidin and iron homeostasis. Biochimica et Biophysica Acta, 2012.PMID 22306005
[12]Hudak L, Jaraisy A, Haj S, Muhsen K An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter, 2017.PMID 27411077
[6]Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology, 2012.PMID 22512001

Iron deficiency anaemia — structured viva

Stem

You are the GP. Your practice audit shows that only a third of men diagnosed with iron deficiency anaemia had bidirectional endoscopy within six months. ^[5]

References10Show

[1]Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women. Lancet Haematology, 2017.PMID 29032957
[2]Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood, 2015.PMID 26289639
[4]Stoffel NU, Zeder C, Brittenham GM, et al. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica, 2020.PMID 31413088
[5]Goddard AF, James MW, McIntyre AS, Scott BB Guidelines for the management of iron deficiency anaemia. Gut, 2011.PMID 21561874
[7]Mahadev S, Laszkowska M, Sundström J, et al. Prevalence of Celiac Disease in Patients With Iron Deficiency Anemia — A Systematic Review With Meta-analysis. Gastroenterology, 2018.PMID 29689265
[8]Zoller H, Wolf M, Blumenstein I, et al. Hypophosphataemia following ferric derisomaltose and ferric carboxymaltose in patients with iron deficiency anaemia due to inflammatory bowel disease. Gut, 2023.PMID 36343979
[9]Wang SA, Fadare O, Nagar A, Shafi NQ, Rose MG Gastrointestinal endoscopic findings in men with unexplained anemia and low normal ferritin values. American Journal of Hematology, 2006.PMID 16628728
[10]Ganz T, Nemeth E Hepcidin and iron homeostasis. Biochimica et Biophysica Acta, 2012.PMID 22306005
[12]Hudak L, Jaraisy A, Haj S, Muhsen K An updated systematic review and meta-analysis on the association between Helicobacter pylori infection and iron deficiency anemia. Helicobacter, 2017.PMID 27411077
[6]Pavord S, Myers B, Robinson S, Allard S, Strong J, Oppenheimer C UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology, 2012.PMID 22512001