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Give 3 examples where women can have iron loss secondary to blood loss or iron loss by the fetus
childbearing & menstruation, & pregnant women
blood loss or RBC DESTRUCTION
there are three stages of iron deficiency anemia. in this stage, the body's iron stores are depleted and erythropoiesis is normal and Hgb content of RBCs are also normal. pt may have few, if any symptoms and some pt may have a vague expression of fatigue.
stage 1 IDA
The way to dignose this stage of IDA is by trial of iron supplement, increase dietary iron intake.
stage 1 IDA
this have a normal life expectancy of a bout 120 days.
this may result in postural hypotension, dizziness, weakness, gastritis, irritability, numbness, and lethargy.
severe IDA with Hgb less than 7
in this stage of IDA. 1. Iron transpotationto bone marrow is diminished and iron-deficient erythropoiesis takes place. 2.laboratory values beging to show changes
stage 2 IDA
This stage begins when small hemoglobin-deficient cells enter the circulation in sufficient number and replace normal erythrocytes that have reached maturity and been removed from the circulation.
stage 3 IDA
in this stage, you have a depleted iron store, diminished Hgb production. Hgb levels are now 7 to 11 g/dl, serum levels are low,and that the most stage where you can diagnose IDA.
stage 3 IDA
This is critical component and is recommended in a pregnant womem diet.
this associate with neural tube defects of the fetus and heart desease, several cancers like colorectal cancers ane in older adults
folate and anemia defiency
this is absorbed primarily in the upper intestines then circulate to the liver where is stored.
deficiency often associated with alcoholism, chronic malnutration, fad diets, and diets low in vegetables.
folic acid defiency
these drugs interfer and compete with with folate metabolism and storage in the liver
methotrexate & fluorouracil; dilantin, sulfamethoxazole/trimethotrexate and oral contraceptive
Pt with this defiency will present with complain of glossitis, stomatitis, nausea and nausea, diarrhea, systolic ejection murmur, +Romberg's sign and increase deep tendon reflexes (DTRs)
Folic deficiency anemia
when the cause of vit B12 deficiency is autoimmune and linked to heredity then this occur
Penicious anemia
this assocaited with autoimmune conditions particularly that affect the endocrine system such as Hashimoto's thyroiditis, DM type 1, addison disease, graves disease
Pernicious Anemia
This anemia develop slowly, often over years and frequently severe before it is diagnose.
pernicious Anemia
pt that are vegetarians -mostly vegan, pt who has Grohn's disease- in which a section of the small interstines may distroy. what kind of anemia are you going to suspect that they have?
Pernicious Anemia
In order for this vitamin to absorbed, these 2 things need to permit it.
hydrochloric acid & intrinsic factor
causes of this anemia are absence of intrinsic factor, gastrectomy and gastric atrophy of parietal cells associated with type a chronic gastric.
pernicious anemia
the ultimate goal for this disease is provide adequate oxygen transport tp body tissues and to return to normal in the # and character of RBCs and to normal Hgb values.
anemia, IDA, FDA, PA
at what age you would you recommend a breastfed infant to supplemental iron drop? what is the rational behind that?
4 month. because breastmilk doen not contain enough iron to allow maximum growth of an infant who is more than 4 months.
the primary goal of IDA is what?
anemia is common in older adult but what causes most of the anemia sometimes?
GI blood loss associated with ulcers, the use of aspirin or NSAIDs or chronic diseases.
what would you tell a new mother who are not sure about breastfeeding her infant?
breastfeeding reduces the risk of iron deficiency anemia and the early addition of solid food to the infants diet may impair the ability absorb iron.
what would you recomment to a new mother who is planing to use formula and not breastfed.
iron supplement is recommended for formula fed infant.
at what age would you recommend that parents screened their children for Hgb and Hct test. what would be the rational behind that?
9 to 12 months. That's when the iron stores may be depleted and the possibility of anemia exists.
Who are at high risk group of iron deficiency? what age they should be screened?
teanage girls--because of rapidgrowth spur and onset of menstruation. age 12-14
according to the CDC, at what age children are prone to Iron Deficiency Anemia.
BTW age 1 and 2
lead poisonning can lead to IDA in young children. If you know they are at risk, at what age should you advise parents to screened them.
btw 12 to 72 months.
this iron supplement is expensive but recommended because of its slower release of iron cause less GI upset.
Carbonil iron (Feosol).
if you prescribe iron supplement for a patient and you see poor utilization, what would you evaluate and treat for?
chronic inflamation, and lead poisoning.
if Hgb is < 7 and you suspect malabsorption of iron, what would you recommend?
where does most iron bypas
small bowel
to reduce GI upset when pt taking iron, what would you do and recommend pt do?
lower the dose and take iron with food.
after 10 days of iniatiating iron therapy, what would be the first change you would note in blood values.
increase in reticulocyte count followed by a rise in Hgb concentration and ferintin level at 3 months.
if your pt has persistent unrecognized blood loss, what would be your action?
get stool specimens for occult blood and ova for parasites and refer to gastroenterologist for x-rays and endoscopy.
what would be the result of poor iron utilization?
chronic inflamation, lead poisoning or sideroblastic anemia.
what labs value would indicate malabsortion from chronic inflamation?
increase sedimentation rates, increase iron level and iron-binding capacity level. low percentage iron saturation. high ferritin level
what would be the indication for lead poisonning?
increase serum lead level basophilic stippling on RBC morphology.
what would be an indication for sideroblastic anemia which usually seen in infancy.
high ferintin normal to high iron and iron-binding capacity level elevated bone marrow store of iron.
what is the common side effect of iron?
GI upset (nausea, constipation) which may decrease by asking pt to take iron with food.
who would be at risk for developing Folic acid deficiency anemia?
infant who are fet powdered and goat milk (this product has low folic and vit B12 vegetarian (vegan) severe nutritional pt pt with absorption problems chilkdren with tapeworms infestation
which patient would you monitor for folate deficiency?
pregnant women---low folate can cause risk for neural tube defect in the fetus. sprue. heavy giardial infection. short bowel syndrome

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