{"id":5223,"date":"2021-05-13T12:29:51","date_gmt":"2021-05-13T10:29:51","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/iron-deficiency-anemia\/"},"modified":"2021-05-22T16:54:19","modified_gmt":"2021-05-22T14:54:19","slug":"iron-deficiency-anemia","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/anemias\/iron-deficiency-anemia\/","title":{"rendered":"Iron deficiency anemia"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Iron is the central component in heme. Iron deficiency leads to\u00a0<strong>hypochromic microcytic anemia<\/strong> with decreased MCH and MCV.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is often considered a symptom rather than a diagnosis, and the etiology must be found, especially in young females.<\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Iron metabolism<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>Iron is an essential nutrient; it is absorbed from our diet using <strong>ferroportin <\/strong>transporters.<ul><li>Typical iron intake is 10-15mg\/day, out of which 10-15% are absorbed.<\/li><li>The absorbed amount can increase in iron deficiency.<\/li><\/ul><\/li><li>In the blood, it is transported bound to <strong>transferrin<\/strong> (binds up to 2 iron atoms).<\/li><li>It is then stored mainly in the liver and in RBCs:<ul><li>Hemoglobin (RBCs)<\/li><\/ul><ul><li>Ferritin (liver, with a small amount in the serum)<\/li><li>Smaller amounts in other tissues of the body (as hemosiderin, myoglobin, and enzymes).<\/li><\/ul><\/li><li>Its excretion is minimal (through the skin, blood, and stool)<\/li><li><strong>Hepcidin <\/strong>decreases ferroportin activity, decreasing iron absorption<ul><li>Hepcidin levels are elevated during inflammation<\/li><\/ul><\/li><li>During iron overload, ferritin levels increase while transferrin receptors decrease, while the reverse happens in iron deficiency (ferritin levels drop, transferrin receptors increase).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>In the Western world, the most common cause is chronic hemorrhage (chronic GIT and uterine bleeding)<\/li><li>In the underdeveloped world, inadequate intake due to malnutrition is the most common cause.<\/li><li>Malabsorption (celiac disease)<\/li><li>Chronic inflammation (through hepcidin)<\/li><li>The iron demand is elevated during growth, lactation, pregnancy, and menstruation; failure to meet the demand will lead to iron deficiency anemia.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Clinical presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The symptoms and signs of iron deficiency anemia overlap with other forms of anemia:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Weakness, fatigue<\/li><li>Dyspnea on exertion<\/li><li>Visual disturbances (severe anemia)<\/li><li>Pallor of mucous tissues, conjunctiva, and nailbed (easiest diagnosis sign)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A specific sigs of iron deficiency anemia is <strong>koilonycia <\/strong>&#8211; spoon-shaped nails.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">Based on clinical presentation and:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Red cell indexes (MCV below 80fL and MCH below 27pg)<\/li><li>Reticulocyte count (reduced)<\/li><li>Blood film (hypochromic, microcytic RBCs)<ul><li>In combined megaloblastic and iron deficiency anemias (or iron-deficient patients who have recently started iron supplementation) the cell population appears dimorphic, with both macrocytic\/normal and microcytic cells.<\/li><\/ul><\/li><li>Serum iron, serum ferritin, and total iron-binding capacity (TIBC)<ul><li>In pure iron deficiency anemia, serum iron and ferritin are reduced while TIBC is elevated.<\/li><\/ul><ul><li>In <em>chronic inflammation-induced<\/em> iron deficiency anemia, all three parameters are reduced.<\/li><\/ul><\/li><li>Rarely, a bone marrow sample can be taken<ul><li>It is possible to visualize iron stores using <strong>Perl Prussian Blue<\/strong> staining; it stains ferric (Iron III), binding to ferritin and hemosiderin (but not hemoglobin) and staining them with blue. It can also be used for the demonstration of hemosiderosis as well as hemochromatosis.<ul><li>Iron-deficient bone marrow will demonstrate a lack of blue color, whereas normal bone marrow will demonstrate blue staining due to the hemosiderin.<\/li><li>It can demonstrate <em>Pappenheimer bodies<\/em>, which are abnormal inclusion bodies containing clumps of ferritin, found within RBCs (which are then known as <em>siderocytes<\/em>) in some conditions (MDS, hemolytic anemia, sideroblastic anemia, lead poisoning, and sickle-cell disease).<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Investigations<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">To find the cause of the iron deficiency anemia:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>History<\/li><li>Tests for bleeding and coagulation disorders (complete blood work, PFA, Willebrand antigen, and ristocetin cofactor levels)<\/li><li>Tests for GI bleeding and tumors (rectal exam, occult blood tests, H. pylori and parasite tests, gastro- and colonoscopy)<\/li><li>Tests for celiac disease (anti-endomysial and anti-TTG antibodies in the serum)<\/li><li>Urine tests for hematuria and hemolysis<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Therapy<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">The therapy involves treatment of the underlying cause and iron supplementation given PO and (less commonly) parenterally.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Oral iron supplementation is cheap and readily available, using ferrous-fumarate or gluconate (lower concentration), taken on an empty stomach, x3\/day, for at least 6 months.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In iron overdose:<ul><li>Gastric pumping<\/li><li>Deferoxamine (binds to iron and aluminum)<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Iron metabolism<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Clinical presentation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Investigations<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Therapy<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Iron is the central component in heme. Iron deficiency leads to\u00a0hypochromic microcytic anemia with decreased MCH and MCV. It is often considered a symptom rather than a diagnosis, and the etiology must be found, especially in young females. Iron metabolism Iron is an essential nutrient; it is absorbed from our diet using ferroportin transporters. Typical [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5221,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5223","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Iron deficiency anemia &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/anemias\/iron-deficiency-anemia\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/anemias\\\/iron-deficiency-anemia\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/anemias\\\/iron-deficiency-anemia\\\/\",\"name\":\"Iron deficiency anemia &#8211; 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