Iron Metabolism and Microcytic, Hypochromic Anemias
Terms
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Body Iron Distribution
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- total body iron is 3-4 gms
- 66% hemoglobin
- 33% other forms stored
- 30% as Ferritin and hemosiderin
- 3% in myoglobin (not available, hgb of muscle)
- 1% associated with transferrin and plasma
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Nutritional sources of Iron
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- green veggies
- cereal
- muscle meats
- fish
- fowl
- prunes
- yeast
- wheat germ
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Nutritional requirements for Iron
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- Intake
- 10-25 mgs/day
- 1-2 mgs absorbed
- varies with age and sex
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Disorder of Iron Metabolism:
Iron Deficiency Anemia - Stages
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- Stage 1:
- iron depletion in bone marrow
- Stage 2:
- iron-deficient erythropoiesis in bone marrow
- Stage 3:
- iron-deficiency anemia visible in peripheral blood
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Disorder of Iron Metabolism:
Iron Deficiency Anemia - Etiology
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- Neonates: multiple births, Fe-deficient mother
- Infants/ children: growth spurts, diet
- Adults: chronic blood loss, inadequate diet
- Others: menstrual cycle, pregnancy, GI bleeding disorders, repeated blood donations
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Disorder of Iron Metabolism:
Iron Deficiency Anemia - Clinical features
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- Pallor, fatigue
- headaches, dizziness, difficulty breathing
- tachycardia, increase in heart size
- splenomegaly, heptomegaly
- Pica syndrome: eats dirt, wood
- Glossitis: fleshy beefy tongue
- Koilonychi
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Disorder of Iron Metabolism:
Iron Deficiency Anemia - Lab findings -
- RBC: 3-5 x10^6/ul
- Hgb: 4-10 g/dL
- Hct; 20-25%
- MCV: 60-80 fL; MCH: 5-25 pg; MCHC: 20-30%
- Microcytic, hypochromic blood picture with Anisocytosis & Poikilocytosis (A&P)
- increased reticulocyte count: bo
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Disorder of Iron Metabolism:
Iron Deficiency Anemia - Treatment
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- dietary changes
- supplemental oral iron
- iron injections
- correct underlying GI abnormalities
- blood transfusions
- Hemochromatosis
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- Opposite of iron deficiency (not anemia)
- iron overload in liver, spleen,pancreas
- progresses slowly
- usually diagnosed between 50-60 yrs
- must be monitored so that liver is not destroyed
- patients sometimes loo
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Disorder of Heme Synthesis:
Sideroblastic anemia - Etiology
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- abnormal heme synthesis resulting in abnormal iron deposition in mitochondria
- inherited (sex-linked or autosomal)
- acquired
- idiopathic
- lead, alcohol, drugs
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Disorder of Iron Metabolism:
Iron Deficiency Anemia - Lab findings
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- decreased RBC and Hgb
- variable Hct, MCV, MCH, MCHC
- increased serum iron
- decreased or normal TIBC
- hypochromia, A&P, basophilic stippling on peripheral blood smear (Hgb ppt due to lead, alcohol, drugs)
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Disorder of Iron Metabolism:
Iron Deficiency Anemia - Treatment
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- Remove exposure to lead
- discontinue alcohol and drug use
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Disorders of Globin synthesis
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- Thalassemia
- alpha
- beta