microcytic anemias Flashcards
definition of microcytic anemia
- MCV < 80
common microcytic anemias
- iron def anemia
- anemia of chronic disease
- thalassemia
- sideroblastic anemia
what is the most common cause of anemia
- iron deficiency anemia
what is the most common cause of iron def anemia
- GI bleeding
- menstrual bleeding
stages of iron def anemia
- depletion of iron stores without anemia
- anemia with normal RBC size
- anemia with reduced RBC size
clues in pts hx to think of iron def anemia
- diet
- PICA
- phagophagia
- glossitis
- mouth soreness
- angular cheilitis
- Koionychia
- dysphagia
where is iron absorbed
- acidic conditions
- stomach, duodenum, jejunum
- avg diet has 10-15 mg of iron, only absorb 1.5%
iron requirement in males and non-menstruating females
- 1 mg/d
iron requirements in menstruating females
- 3-4 mg/d
iron requirements in pregnant females
- 2-5 mg/d
what is the role of transferrin
- transports iron
what is the role of ferritin
- stores iron (simple)
what is the role of hemosiderin
- complex iron stores in macrophages
- helpful with insoluble Fe
iron deficiency categories
- deficient intake/ decreased absorption
- increased requirement
- blood loss
- other: hemoglobinuria, idiopathic, Fe sequestration
work up for iron def anemia
- low serum iron, transferrin, ferritin
- high TIBC
- usu low retic count
- low MCV and MCH
- peripheral smear: hypochromic and microcytic
si/sx of iron def anemia
- easily fatigued
- conjunctival pallor
- tachycardia, palpitations
- DOE
- pica
- severe: smooth tongue, brittle nails, koilonychia, chelosis
treatment for iron def anemia
- ferrous sulfate TID- tae with vit C/ OJ to increase absorption
- try cooking in cast iron skillet
- parenteral options
why give parenteral options in iron def anemia
- pt cant tolerate PO
- refractory to PO
- GI dz that limits absorption
- continued blood loss
side effect of iron supplementation
- constipation
- GI upset
- give colase
- titrate up to TID to mitigate
anemia of chronic disease
- usu MCV < 80 but can also be normocytic
- problem with iron utilization
- bone marrow unable to respond to EPO
causes of anemia of chronic disease
- inflammation
- endocrine disorders
- infection
- chronic liver dz
- CT disorders- SLE, RA
- endocarditis
- cancers- liquid and solid tumors
- *IS NOT the same as anemia of CKD
what disease states is anemia of chronic disease NOT seen in
- DM
- COPD
- CHF
- HTN
etiology of anemia of chronic disease
- “iron is there but vault is locked”
- lg amount of inflam cytokines released
- stim hpatocytes to make massive amounts of hepcidin
- prevents release of iron from macrophages and liver stores
lab findings for anemia of chronic disease
- microcytic or normocytic
- normochromic
- low retic count
- normal/ elevated serum ferritin
- decreased iron
- decreased-normal TIBC
- ferritin up or normal
- increased ESR and CPR
- bone marrow bx only in difficult cases