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Iron Deficiency Anemia
Is the most common anemias worldwide
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Causes of Iron Deficiency Anemia:
- Nutritional deficiency
- GI disease
- Increased demand for erythropoiesis
- Excess iron loss (excessive bleeding)
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Types of iron anemias:
- Sideroblastic anemias
- Chronic inflammation
- Decreased plasma transferrin
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When does the demand for iron increase?
- Pregnancy
- Menustration
- Growth
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How many grams of iron per person?
- 3-5
- Conservation of iron is normally very efficient
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Iron need in infants and children:
- Full term infants have 4 months iron storage.
- 50% iron absorption from human milk
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Milk anemia
Occur in infants that depend solely on cow's milk.
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Diet Iron:
- 90% of dietary iron is non-heme
- 10% heme iron is well absorbed.
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Factors that increase non-heme iron absorption:
Meats, ascorbic acid (OJ)
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Factors that decrease non-heme iron absorption
Vegetable fibers and tea
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Ingested ferric iron (Fe3+) is reduced to __________ iron by stomach acid.
ferrous (Fe2+)
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Where is most iron absorbed?
Upper jejunum
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__________ delivers iron to bone marrow.
Transferrin
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Papillodema:
Dents in forehead of infants
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PICA syndrome:
Eat dirt, weird things
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Labs of iron deficiency anemia:
- Decreased RBC, HGB, HCT, MCH,MCHC, MCV
- Hypochromic-Microcytic RBCs
- WBC=normal
- Platelets=Normal to increased
- Total serum iron=decreased
- TIBC=Increased
- %Fe saturation=Decreased
- Plasma ferritin= Decreased
Decreased plasma ferritin is the best single test, and earliest, indication of iron deficiency.
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- Severe iron anemia
- Teardrops and elliptocytes (common in Fe deficiency)
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Anemias of Inflammation or Chronic Disorders:
- Associated with chronic inflammatory conditions (RA, SLE, Cancers,Liver and renal diseases)
- Not an iron deficiency.
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Labs of (ACD)
- Mild anemia.
- Normal to hypo-micro RBC morphology
- Decreased=plasma iron and TIBC
- Increased=plasma ferritin
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Sideroblastic Anemias
- Ineffective erythropoiesis with excess iron accumulation in the mitochrondia or bone marrow precurssors.
- Iron is "trapped" in cytoplasma
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Sideroblastic anemia causes:
- Genetic
- Leukemias
- Drug/Toxins
- Myelodysplastic syndromes
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Sideroblastic anemia labs:
- 10-40% ringed sideroblasts in the bone marrow.
- Hypochromic-microcytic RBCs
- Basophilic stippling, target cells, dimorphic RBCs.
INCREASED=Plasma iron, TIBC, Ferritin
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(HH) Hereditary Hemochromatosis:
- Genetic (autosomal recessive) disorder of excessive GI iron absorption.
- Excess iron accumulations in the tissues can cause damage.
- Common in Celtic ancestry.
- 1 in 10 persons are estimated to carry the gene.
INCREASED=Plasma ferritin, transferrin saturation
Treated by therapeutic phlebotomy (removes iron)
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Top 10
- Iron deficiency is common.
- Iron conservation prevents loss of iron.
- Hypo-Micro anemia
- Transferrin: Iron transport plasma protein
- Ferritin: Iron storage molecule
- Sideroblastic anemias: Iron trapped in marrow NRBCs
- Hemochromatosis: excess iron
- Anemias of inflammation: Iron not released from RE system
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