Hypochromic/Microcytic Anemia Flashcards
Serum Ferritin
Storage (Male <30/Female <15)
Serum Iron
Total iron in the blood
Absorption of iron occurs in the:
Duodenum and proximal jejunum
To be absorbed, iron must be in _____
Ferrous (Fe2+) state or bound to heme
Iron from plants in the _______ state must be converted to
Ferric (Fe3+) ;Ferrous iron
IDA accounts for ____ of anemia in people
60%
Populations typically affected by IDA
> 65 years (insufficient)
-infants w/ nutrition from cow’s milk (6 months -2 years)
-adolescent females (1st period/growth)
-pregnancy (3rd trimester)
-pica
Iron intake is insufficient for the following reasons: (IDA)
-Iron intake not high enough
-Adequate intake but not available through erythropoiesis (malabsorption)
-Increased loss of body iron not replaced by intake (blood loss)
Situations where iron is not available through erythropoiesis (IDA)
-Malabsorption diseases: celiac disease, chronic diarrhea, gastrectomy
-Alchlorhydria: Gastric bypass, antacids
Situations of increased loss of body iron not adequately replaced by normal intake (Blood loss)
-Males: GI (Ulcer, carcinoma, hemorrhoids)
-Females: GI or vaginal (Heavy menstrual flow-MCC, GI bleeds (2nd most common)
Clinical Findings (IDA)
-Asymptomatic: 1st 2 stages
-General Sx: Weakness, fatigue, SOB, headache
-Pica: Craving for dirt, paint chips, grass
-Pagophagia: Craving for ice
-Pallor, Koilonychia, Cheliosis
-Restless Legs Syndrome
Lab Findings (IDA)
-CBC: Decreased RBC count/Hb/Hct, MCV/MCH/MCHC, increased RDW
-Iron Panel: Decreased ferritin, serum iron, transferrin/TIBC, iron saturation
-Special Tests: Stainable iron in bone marrow aspiration, occult blood in stool (GI endoscopy/colonoscopy)
Stages of IDA
- Iron Depletion
-Decreased ferritin - Iron deficient erythopoiesis
-Iron panel abnormalities, RBC indices change, RDW - IDA
-Decreased hemoglobin w/ signs & symptoms
Management of IDA (Heme vs. Non-Heme)
-Non-Heme: Epigstric px, darkened stool, nausea, diarrhea/constipation
-Heme Iron: More expensive, easier to absorb, not an option for vegans
Other Factors to consider when treating IDA
-Consume on an empty stomach (30 mins before meal or 2 hours after meal)
-Vitamin C: Enhances absorption
-Calcium/maganese/copper/zinc: Interfere w/ absorption
Food sources in treatment of IDA
-Red meat, liver, fish, beans, green leafy vegetables, dried fruits, whole-grain and enriched breads
Iron-Utilization (Sideoblastic) Anemia: Etiology
-Hereditary
-Acquired: Primary (Idiopathic), Secondary (Alcoholism, Drug/toxin induced, B6 deficiency)
Iron-Utilization Anemia: Clinical Findings
-Moderate to severe anemia
-Hepatosplenomegaly
Iron-Utilization anemia: Lab Findings
-CBC: Hypochromic/microcytic anemia, High RDW
-Iron Panel: Increased-ferritin,serum iron, % saturation/normal or low-TIBC/transferrin
-Peripheral blood smear: May show ringed sideroblasts
-Chem panel: Liver enzymes elevated
Iron Utilization anemia: Special tests
Low reticulocyte count, bone marrow examination to confirm diagnosis (sideroblasts)
2nd most common anemia in the world
Iron-reutilization anemia
Iron-Reutilization Anemia: Etiology
-Chronic Infections (ACD)
-Inflammatory Diseases: RA, SLE, LT inflammatory bowel conditions
-Certain malignancies: Hodgkin’s lymphoma, multiple myeloma
-Liver, Lung, breast cancers
Iron-Reutilization Anemia: Clinical Findings
-Anemia symptoms, underlying disease symptoms
Iron-Reutilization Anemia: Lab Findings
-CBC: Anemia, RDW NL
-Additional Tests: CRP/ESR elevated
Hypo/Micro vs. Normo-Normo Anemia
-Ferritin: HM (Increased)/NN (Increased)
-Serum Iron: HM (Decreased)/NN (NL)
-Transferrin/TIBC: HM (Decreased)/NN (NL)
-% saturation: HM (decreased)/NN (NL)
Combined IDA/ACD
-Difficult to identify in acute reactant phases
-Serum transferrin receptor (sTfR): Increase (IDA)/NL (ACD)
-Ferritin: >100 w/ underlying evidence of inflammation
-After tx of underlying condition: If s/Sx + iron panel indicates IDA, then treat IDA
Renal disease is associated with
Aplastic anemia
Endocrine failure is associated with
Myeloplastic anemia
