Hypochromic/Microcytic Anemia

Question 1

Serum Ferritin

Answer 1

Storage (Male <30/Female <15)

Question 2

Serum Iron

Answer 2

Total iron in the blood

Question 3

Absorption of iron occurs in the:

Answer 3

Duodenum and proximal jejunum

Question 4

To be absorbed, iron must be in _____

Answer 4

Ferrous (Fe2+) state or bound to heme

Question 5

Iron from plants in the _______ state must be converted to

Answer 5

Ferric (Fe3+) ;Ferrous iron

Question 6

IDA accounts for ____ of anemia in people

Answer 6

60%

Question 7

Populations typically affected by IDA

Answer 7

> 65 years (insufficient)
-infants w/ nutrition from cow’s milk (6 months -2 years)
-adolescent females (1st period/growth)
-pregnancy (3rd trimester)
-pica

Question 8

Iron intake is insufficient for the following reasons: (IDA)

Answer 8

-Iron intake not high enough
-Adequate intake but not available through erythropoiesis (malabsorption)
-Increased loss of body iron not replaced by intake (blood loss)

Question 9

Situations where iron is not available through erythropoiesis (IDA)

Answer 9

-Malabsorption diseases: celiac disease, chronic diarrhea, gastrectomy
-Alchlorhydria: Gastric bypass, antacids

Question 10

Situations of increased loss of body iron not adequately replaced by normal intake (Blood loss)

Answer 10

-Males: GI (Ulcer, carcinoma, hemorrhoids)
-Females: GI or vaginal (Heavy menstrual flow-MCC, GI bleeds (2nd most common)

Question 11

Clinical Findings (IDA)

Answer 11

-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

Question 12

Lab Findings (IDA)

Answer 12

-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)

Question 13

Stages of IDA

Answer 13

1. Iron Depletion
   -Decreased ferritin
2. Iron deficient erythopoiesis
   -Iron panel abnormalities, RBC indices change, RDW
3. IDA
   -Decreased hemoglobin w/ signs & symptoms

Question 14

Management of IDA (Heme vs. Non-Heme)

Answer 14

-Non-Heme: Epigstric px, darkened stool, nausea, diarrhea/constipation
-Heme Iron: More expensive, easier to absorb, not an option for vegans

Question 15

Other Factors to consider when treating IDA

Answer 15

-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

Question 16

Food sources in treatment of IDA

Answer 16

-Red meat, liver, fish, beans, green leafy vegetables, dried fruits, whole-grain and enriched breads

Question 17

Iron-Utilization (Sideoblastic) Anemia: Etiology

Answer 17

-Hereditary
-Acquired: Primary (Idiopathic), Secondary (Alcoholism, Drug/toxin induced, B6 deficiency)

Question 18

Iron-Utilization Anemia: Clinical Findings

Answer 18

-Moderate to severe anemia
-Hepatosplenomegaly

Question 19

Iron-Utilization anemia: Lab Findings

Answer 19

-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

Question 20

Iron Utilization anemia: Special tests

Answer 20

Low reticulocyte count, bone marrow examination to confirm diagnosis (sideroblasts)

Question 21

2nd most common anemia in the world

Answer 21

Iron-reutilization anemia

Question 22

Iron-Reutilization Anemia: Etiology

Answer 22

-Chronic Infections (ACD)
-Inflammatory Diseases: RA, SLE, LT inflammatory bowel conditions
-Certain malignancies: Hodgkin’s lymphoma, multiple myeloma
-Liver, Lung, breast cancers

Question 23

Iron-Reutilization Anemia: Clinical Findings

Answer 23

-Anemia symptoms, underlying disease symptoms

Question 24

Iron-Reutilization Anemia: Lab Findings

Answer 24

-CBC: Anemia, RDW NL
-Additional Tests: CRP/ESR elevated

Question 25

Hypo/Micro vs. Normo-Normo Anemia

Answer 25

-Ferritin: HM (Increased)/NN (Increased)
-Serum Iron: HM (Decreased)/NN (NL)
-Transferrin/TIBC: HM (Decreased)/NN (NL)
-% saturation: HM (decreased)/NN (NL)

Question 26

Combined IDA/ACD

Answer 26

-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

Question 27

Renal disease is associated with

Answer 27

Aplastic anemia

Question 28

Endocrine failure is associated with

Answer 28

Myeloplastic anemia