Iron deficiency anemia (IDA)

Vignette says a 35 year old woman presents to her primary care physician with a history of fatigue and generalized weakness over the past 6 months; She also complains of shortness of breath with mild physical exertion; Over the last few weeks, she has also developed cravings for ice and eats ice frequently; She is vegetarian by diet; Additionally, she has been experiencing rectal bleeding for the past several months and describes blood being present on the toilet paper after bowel movements and also on the surface of the stool; She denies any pain during bowel movements but has occasional anal itching and discomfort; She has a history of chronic constipation and has been straining during bowel movements for years; Per rectal examination (PRE) shows external hemorrhoids with mild rectal tenderness; Examination shows pallor in the skin and conjunctiva; There are no signs of lymphadenopathy or hepatosplenomegaly; CBC shows low hemoglobin and low MCV; Iron studies show ↓ferritin, ↑TIBC, ↓serum iron, ↓% saturation; Diagnosis?

Diagnosis is Iron deficiency anemia (IDA).

Iron deficiency anemia is defined as hemoglobin below two standard deviations of the mean for the age and gender of the patient.

Pathogenesis:- ↓iron →↓heme →↓hemoglobin → microcytic anemia

Etiologies are insufficient iron intake, decreased absorption, increased requirement or blood

loss.

Presents with features of anemia (i.e. pallor, fatigue, SOB, palpitations), koilonychia, and

pica; Associated with Plummer vinson triad (i.e. IDA, esophageal webs and dysphagia,

glossitis).

Diagnosis:-

1. CBC shows low hemoglobin, microcytic and hypochromic RBCs with ↑red cell distribution

width and MCV < 80.

2. Iron profiling shows ↓ferritin, ↑TIBC, ↓serum iron, ↓% saturation. ↑Soluble transferrin

receptor (STFR) is elevated in IDA as in IDA there is an increased number of transferrin

receptors as they try to acquire more iron to compensate for deficiency.

3. ↑ Free erythrocyte protoporphyrin.

4. Mentzer index >13 suggests IDA; Mentzer index is MCV/RBC (million/uL).

Management:-

1. Iron supplementation (e.g. oral, intravenous); oral iron (e.g. Ferrous sulfate) is given along

with vitamin C to facilitate iron absorption; Reticulocytes are the first of improvement in iron

deficiency anemia.

2. Treat the underlying cause.