50
?% of anemia is due to iron deficiency
1 million
deaths per year globally caused by IDA
1.4
US morbidity and mortality of IDA is ?%
RBCsFerritinHemosiderin
where is iron found?
liver
iron bound to ferriton is stored in the ?
macrophages
iron boud to hemosiderin is stored in the ?
meat and veggies
dietary sources of iron
GI tract (stomach, duodenum, upper jejunum)
where is iron absorbed?
increases body's demand for ironincreases iron lossdecreases iron intake/absorption
IDA can be casued by an condition that:
blood loss
most common cause of IDA in the US
outside the US
where is IDA caused by decrease in iron intake or absorption more common?
mentruationpregnancy/lactation
IDA etiology more specific for women
GI bleedtrauma/bleeding from rectum/anus/urethrablood donation/excessive testinggrowth spurts
examples of blood loss that causes IDA
NSAIDs
if a patient has IDA caused by a GI bleed, ask if they take ?
pregnancy, lactation, growth spurts
increase the demand for iron
duodenum
what is the primary site of absorption of iron?
H. pylori infectionatrophic/autoimmune gastritisceliac diseasecancerbariatric surgery
things that decreased absorption of iron
fatiguabilitytachycardiatachypneapalpitationsDOEpallorirritabilityanorexiaheadache
clinical findings of IDA caused by hypoxia
smooth tonguebrittle nailskoilonychiacheilosis
signs and symptoms of severe anemia
koilonychia
a malformation of the nails in which the outer surface is concave or scooped out like the bowl of a spoon
cheilosis
a disorder of the lips characterized by crack-like sores at the corners of the mouth
dysphagiapicacraving specific foodsesophageal websbeeturia
rare clinical findings of IDA
dysphagia
difficulty swallowing
pica
eating mud/dirt
esophageal webs
Plummer-Vinson Syndrome
beeturia
dark red urine
Pica
what is the textbook PANCE sign of IDA?
labs
what must you order to diagnose IDA?
CBCperipheral smearIron Panel
what labs should you order if you suspect IDA?
H/H lowMCV normal or lowRetic count high
typical CBC findings of IDA (H/H, MCV, retic count)
IDAhemolysisblood loss
high retic count could indicate ?
hypochromicanisocytosispoikilocytosis
what should you look for on a peripheral smear for IDA?
target cellspencil-shapedcigar-shaped
poikilocytosis shapes found on an IDA peripheral smear
serum iron
amount of iron in blood
serum transferrin
amount of iron transport protein in blood (or iron being transported in the blood)
TIBC
capacity of iron binding to transferrin and other proteins
total iron binding capacity
TIBC
serum ferritin
amount of iron stored in the body (namely liver)
marrow iron stores decreaseserum ferritin decreasesTIBC increasesserum iron decreasessaturation decreasesmarrow sideroblasts decreaseRBC protoporphyrin increases
what happens to the following as iron deficiency progresses?marrow iron stores serum ferritin TIBC serum iron saturation marrow sideroblasts RBC protoporphyrin
negative iron balance (early stage)
marrow iron stores 0-1+serum ferritin < 20TIBC > 360
iron-deficient erythropoeisis (body using stores)
SI < 50saturation < 20marrow sideroblasts < 10RBC protoporphyrin > 100
iron-deficiency anemia (final stage)
microytic hypochromic RBC morphology
transferrin saturation
TSAT
serum ferritin < 30ng/mLTSAT < 19%anemia resolves w/ ironno stainable iron in bone marrow
how do we confirm an IDA diagnosis?
bone marrow biopsy
gold standard for IDA confirmation that is rarely required
thalassemiaanemia of chronic disease/inflammationlead poisoningsideroblastic anemiamyelodysplasia
differential diagnosis (conditions that present like IDA)
replace iron and storagefind and treat underlying cause
goals of IDA treatment
PO or IV
routes for iron replacemen
ferrous sulfate 325 mg
best iron supplement to use for oral iron replacement
70
oral iron replacement causes side effects in up to ?% of patients
nauseaconstipation
common side affects of oral iron replacement that cause noncompliance
milkcalcium supplementscerealsfibereggscoffee tea
food items that inhibit absorption of iron
6 hours
inhibitory foods must be separated from ferrous dose by ?
2, 12
iron replacement with oral ferrous should reach normal levels at ? months, but should be continued for up to ? months to replace storage as well
noncomliance
primary cause of treatment failure
ascorbic acid
what can. you add to ferrous to help with the adverse effects?
revisit DDxIV iron replacement
what do you do if your patient fails treatment w/ ascorbic acid addition?
pt can't tolerate POGI diseasechild birth
reasons to give patient IV iron replacement
oral Fe replacement failsDx of IDA is not clear
when should you refer to a hematologist?
RBC transfusion
last line option for iron replacement
CV instabilitypersistent blood loss
reasons to use RBC transfusion for iron replacement
chronic GI disease
when should you NOT give oral iron?
severe IDA (acute heart failure, chest pain, unstable/concerning vital signs)
when do you admit an IDA patient to the hospital?
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