questions 1

Iron Deficiency Anemia

Author:
Topic updated on 06/09/17 5:30pm

Snapshot
  • A 28-year-old woman presents to her primary care physician with fatigue and pelvic pain. She states that her menses has been more painful with increased bleeding. On physical exam there is conjunctival pallor and diffuse uterine enlargement that is tender to palpation. Laboratory testing is significant for a microcytic anemia and negative β-hCG. (Adenomyosis leading to iron deficiency anemia.)
Introduction

  • A microcytic anemia
    • as a result of decreased heme synthesis
  • Most common anemia worldwide
  • Causes include
    • chronic blood loss
      • colon cancer until proven otherwise in elderly 
      • PUD
      • menstruation
      • hookworm infestation
    • dietary deficiency
    • celiac sprue
  • Stages of disease (from earliest to latest)
    • consumed iron stores
    • ↓ serum ferritin/serum iron levels
    • normocytic normochromic anemia
    • microcytic hypochromic anemia
Presentation
  • Symptoms
    • fatigue
  • Physical exam
    • tachycardia
    • smooth tongue
    • spoon/brittle nails (koilonychia)
    • esophageal webs
    • pallor
    • pica (craving for ice chips)
Evaluation
  • Labs
    • Elevated
      • TIBC
      • RDW
      • serum free erythrocyte protoporphyrin (FEP)
        • lack of iron to incorporate results in free protoporphyrin release
    • Low
      • serum iron
      • serum ferritin
      • reticulocyte count 
        • due to decreased production (no iron to support)
  • Blood smear shows
    • hypochromatic RBCs
      • doughnut cells - large central area of pallor
      • not seen immediately
    • moderate poikilocytosis
Treatment
  • Medical
    • iron sulfate
Prognosis, Prevention, and Complications
  •  Plummer Vinson syndrome 


  RATE CONTENT
5.0
AVERAGE 5.0 of 1 RATINGS

Qbank (1 Questions)

TAG
(M1.HE.105) A 70-year-old male presents to his primary care physician for complaints of fatigue. The patient reports feeling tired during the day over the past 6 months. Past medical history is significant for moderately controlled type II diabetes. Family history is unremarkable. Thyroid stimulating hormone and testosterone levels are within normal limits. Complete blood cell count reveals the following: WBC 5.0, hemoglobin 9.0, hematocrit 27.0, and platelets 350. Mean corpuscular volume is 76. Iron studies demonstrate a ferritin of 15 ng/ml (nl 30-300). Of the following, which is the next best step?
Topic Review Topic

1. MRI abdomen
2. Blood transfusion
3. CT abdomen
4. Gel electrophoresis
5. Colonoscopy

PREFERRED RESPONSE ▶


Evidence & References Show References




Topic Comments

Subscribe status: