Iron deficiency anemia

Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.

1. Iron deficiency anemia

2. Morphological classification of anemia

3. Red cell indices Microcytic anemia have MCV < 80 fL and macrocytic anemia have MCV> 100 fL. MCH < 26 pg is seen in microcytic anemia and MCH > 33 pg is seen in macrocytic anemia. It is of limited value in differential diagnosis of anemias MCHC<31 g/dL is seen in hypochromic RBC such as IDA and thalassemia. MCHC >36 g/dL is an indication of hyperchromic RBCs. It is a better indicator of hypochromasia than MCH 4. Red Cell Distribution Width (RDW) •• RDW is a quantitative measure of anisocytosis. •• Normal RDW is 11.5% to 14.5%. •• A normal RDW indicates that RBCs are relatively uniform in size. A raised RDW indicates that red cells are heterogeneous in size and/or shape. In early iron deficiency anemia, RDW increases along with low MCV while in thalassemia trait, RDW is normal with low MCV. RDW = (Standard deviation ÷ mean cell volume) × 100

4. Causes of iron deficiency anemia

5. Pathogenesis of Iron Deficiency Anemia Stages of IDA in sequence: absent of iron stores→ decreased serum ferritin→ decreased serum iron→ increased TIBC → decreased iron saturation→ microcytic hypochromic anemia.

6. Diagrammatic appearance of peripheral blood smear with microcytic hypochromic red blood cells

7. Reduced: serum iron, ferritin, % transferrin saturation. Increased: TIBC, TFR and red cell protoporphyrin.

8. Clinical Features of IDA Nonspecific and related to both severity and the cause of the anemia (e.g. gastrointestinal disease) •• Onset: insidious. •• Nonspecific symptoms: fatigue, palpitations, breathlessness, weakness and irritability. •• Pharyngeal/esophageal webs formed cause dysphagia. •• Patterson-Kelly or Plummer-Vinson syndrome: –– Microcytic hypochromic anemia –– Atrophic glossitis –– Esophageal webs •• Congestive heart failure in severe anemia. •• Central nervous system: pica -unusual craving for substances with no nutritional value like clay or chalk. Craving for ice (pagophagia) specific to iron deficiency. Pica may be the cause rather than effect of IDA.

9. Physical Findings Diminished tissue enzymes cause characteristic epithelial changes of iron deficiency anemia. • • Angular stomatitis and glossitis • • Chronic atrophic gastritis • • Koilonychia (spoon nails) Koilonychia (spoon nails) is a physical finding seen in iron deficiency. First fingernails become thin and flat- platonychia , then brittle and finally spoon shaped.

10. Additional hx in anemia

11. Hx in anemia

12. management Treatment of the cause Oral Ferrous sulphate 200 mg – 1+1+1 B/M Check Hb after 4-8 weeks and then continue for 3-6 months IV Iron if Severe anemia/late stage of pregnancy/intolerance/CRF/malabsorption : 500 mg Iron carboxymaltose with DA or NS Blood transfusion if Hb less than 7 or Angina Heart failure Evidence of cerebral hypoxia