IRON DEFICIENCY ANEMIA

By: Ilustrisimo, Natasha F.

 CASE
MJ, 50 yo, male, came in with a CC of increasing fatigue
for the past 4-5 months. He exercises everyday, but lately he
has noticed becoming short of breath while jogging. He
denies orthopnea, paroxysmal nocturnal dyspnea, or swelling
in his ankle. The patient reports occasional joint pain, for
which he uses OTC ibuprofen. He denies bowel changes,
melena, or bright red blood per rectum, but he reports vague
left-sided abdominal pain for a few months off and on, not
related to food intake. The patient denies fever, chills, N/V. He
has also lost a few pounds intentionally with diet and
exercise.
 CASE
ROS: Unremarkable

PMH:
(-) HTN (-) DM (-) Asthma
(+) OA (-) Allergy to food/drug

PSH:
(-) Smoker (-) Non-alcoholic beverage drinker

FH: Unremarkable
 CASE
>On examination, he weighs 205 lb, and he is afebrile.
>There is a slight pallor of the conjunctiva, skin and palms.
>No lymphadenopathy is noted.
>Clear breath sounds.
>CVS reveals AP, NRRR, with systolic murmur.
>Abdomen is soft, nontender, without hepatosplenomegaly
>No edema, cyanosis or clubbing
>His peripheral pulses are palpable and symmetric
 CASE

>What is the most likely diagnosis?

>What is your next diagnostic step?
 CASE
SALIENT FEATURES:
(+) fatigue
(+) shortness of breath
(-) orthopnea, PND, swelling of the ankle
(+) intake of NSAIDS
(-) Signs of GIT bleeding
(+) L sided abd pain
(-) fever, chills, N/V
Unremarkable ROS, PMH, PSH & PE
 CASE

Initial Impression:

Anemia, etiology to be determined

r/o cardiac and pulmonary pathology
 CASE

P>
For complete workup (CBC PC, BC, ECG, CXR PAV, U/A)
TCB once with result or anytime if with problem
Advised
 CASE
CBC
Hbg 8.2g/dL
Hct 31%
WBC 6.1
Plt 215
>U/A and BC are unremarkable
>ECG is within normal limit and unremarkable CXR
 ANEMIA
>>Decreased in red cell mass

WHO: <13g/dL in men

<12g/dL in female

AAFP: haemoglobin level 2 SD below N for age and sex

Pregnancy: <11g/dL (1st or 3rd trimester)

<10.5g/dL (2nd trimester)
 ANEMIA

FUNCTIONAL CLASSIFICATION OF ANEMIA

1. Hypoproliferative
2. Ineffective erythropoiesis
3. Blood loss/hemolysis
ANEMIA
 IDA
IDA is diminished red blood cell production due to low iron
stores in the body.
It is the most common nutritional d/o worldwide
causes: inadequate iron intake
decreased iron absorption
increased iron demand
increased iron loss

Identifying the underlying etiology & administering

the appropriate therapy
 IDA

CAUSES
ANEMIA
 IDA
STAGES of Iron Deficiency
I NEGATIVE IRON BALANCE
-the demands for Fe exceed the bodys ability to absorb Fe
-decrease iron store, other parameters are N

II IRON DEFICIENT ERYTHROPOIESIS

-iron store is depleted (ferritin <15 ug/L)
-N synthesis, microcytic, hypochromic, inc TIBC

III IRON DEFICIENCY ANEMIA

-fall in Hgb and Hct (Mod: 10-13, Severe: 7-8)
-morphology (target cells and pencil/cigar shape)
 IDA

CLINICAL PRESENTATION:
>Fatigue, pallor, exercise intolerance, loss of stamina,
breathlessness, tachycardia
>Cheilosis, koilonychias, pica
 IDA
SCREENING
1. Men & Postmenopausal Women
not recommended if not symptomatic
2. Pregnant Women routine screening
3. Children universal screening at 1 year of age
risk factors: LBW, Prematurity, lead exposure,
exclusive breastfeeding, weaning to
whole milk/CF w/o iron-fortified foods
not recommended to asymptomatic 6-12 y/o
IDA
IDA
IDA
 IDA
TREATMENT
Empiric treatment in children up to 2 months of age and
pregnant women
If hgb does not increase by 1 g/dL in 1month, further
evaluation may be indicated
120mg/day or 3mg/kg/d
Parenteral Therapy: cannot tolerate/absorb oral prep
Blood transfusion: No universally accepted threshold
Monitoring: q3months up to 1 year then 12mo after
 CASE
CBC Hematology Iron Study
Retic 1.8 Serum iron 15
Hbg 8.2g/dL MCV 80 TIBC 400
Hct 31% MCH 80 ferritin 10 ng/mL
MCHC 80 Transferrin 8%
WBC 6.1
Plt 215
 CORRELATION
FINAL Dx:

Iron Deficiency Anemia prob secondary to chronic blood loss

P>
Eat variety of foods
t/s Ferrous fumarate 324mg/tab, 1tab BID
For repeat CBC after 1 month
Advised endoscopy
TCB once with result or anytime if with problem