LabDx

10/18/99

 

Iron deficiency anemia

• Microcytic
• Nutritional anemia
• Has a few granules of RNA—reticulocytes
• 1-2% of normal RBC count
• W/anemia, can go to 4%
• Reticulocytes are counted separate from a CBC
• Compensatory elevation of reticulocytes
• Underproduction or hemolysis
• Tumor cells don't allow RBC's to function properly
• No reticulocyte or RBC count (both are low)

 

Iron Deficiency Anemia

• Most common form
• Esp. in females
• Causes

1.      Deficiency of intake

§         Too little iron in the diet

2.      Malabsorption

3.      Excessive utilization

§         Heavy menstrual bleeding

 

§         Normal stores of iron have to be depleted

§         Women have less iron available

§         Increased loss through menses

§         Men and postmenopausal women who develop this are thought to have some sort of bleed—pathologic GI or GU

§         GI—colon carcinoma, chronic ulcers

§         GU—renal carcinoma

§         Aspirin and NASIDS are common types of blood loss in GI system

§         May be responsible for blood loss in kidneys when used on a long term basis

§         High Risk groups

o       Women of child bearing age

o       Lactating women

o       Pregnant women

o       Infants and children and adolescents—growth bursts

o       Vegetarian diet (lack of intake)

o       Repeated blood donation

§         2/1000 people of iron deficiency

 

Prevention

• Red meat
• Fortified foods
• Supplements
• Esp. during high risk times

 

Symptoms

• Pale skin color (pallor)
• Fatigue
• Irritability
• Weakness
• Shortness of breath
• Low blood pressure (w/position change from lying or sitting to standing) (orthostatic hypotension)
• Brittle nails
• Unusual food cravings (pica)
• Decreased appetite
• Headache
• Sore tongue

 

Signs and tests:

• First line
• Low hematocrit and hemoglobin in a CBC
• Door into iron deficient anemia
• If elevated hematocrit—polycythemia
• ¯ MCV
• Second line
• Serum ferritin
• Serum iron
• A good portion of iron is in the form of hemoglobin
• TIBC levels—higher than normal (iron binding)
• If these are negative the pt doesn't have iron deficiency
• Third line
• Stool guaiac
• Stool for occult blood—hemacult
• UA
• Repeat CBC at 3 wks if it is positive
• Blood loss is pathologic in the adult until proven otherwise
• If just treat for low iron, may miss the cancer