A. Definition: Reduction in the O2-carrying capacity of the blood, due to decreased or
ineffective Hgb 1. Microcytic, hypochromic anemia B Epidemiology 1. MC cause of anemia worldwide 2. Seen in 3rd world countries (malnutrition) 3. F>M B Etiology 1. Inadequate dietary intake of Fe 2. Blood loss: GI, menstrual, trauma 3. Decreased absorption: Crohns, gastric resection 4. States of reqs: pregnancy/lactation, rapid growth periods 5. Prolonged ASA or NSAID use B Pathophysiology 1. Fe absorbed most efficiently in duodenum 2. Occurs gradually: Fe stores are slowly depleted and RBC are normal (iron deficiency w/o anemia); eventually no stores remain leading to anemia B Signs 1. General signs: pallor, splenomegaly, jaundice 2. Severe anemia: a. Skin/mucosa cheilosis, glossitis, brittle nails b. Dysphagia w/ esophageal webs (Plummer-Vinson) c. Tachycardia B Symptoms 1 Mild anemia: usually asymptomatic 2 Moderate to severe sx: a. General sx: fatigue, weakness b. Palpitations; DOE; Syncope; Neuro symptoms; Pica B Diagnosis 1 CBC with diff a. Decreased Hgb/Hct b. Low serum Fe <30 mcg/dL c. Low serum Ferritin < 20 mcg/L d. Decreased transferrin saturation < 15% e. Increased TIBC (total iron binding capacity) f. Low MCV < 80 (microcytic) g. Low MCHC < 32 (hypochromic) h. Platelets increased in severe disease i. Reticulocyte count may be high or normal 2 Peripheral Blood Smear a. Microcytic, hypochromic RBCs b. Anisocytosis, poikilocytosis c. Severe: nucleated RBCs, target & pencil-shaped cells d. If etiology unknown after CBC and PBS: i. Check for occult blood losses ii. Do BM aspiration & Bx w/Fe stain B Treatment 1 ID and treat underlying cause 2 Fe replacement therapy: a Ferrous sulfate 325mg PO TID until Fe stores replenished (~6-8 mo) b Parenteral Iron Dextran (IM or IV) wt.-based dosing B Complications 1 Pregnancy; Growth retardation