Iron Deficiency Anemia

A. Definition: Reduction in the O2-carrying capacity of the blood, due to decreased or

ineffective Hgb
1. Microcytic, hypochromic anemia
B Epidemiology
1. MC cause of anemia worldwide
2. Seen in 3rd world countries (malnutrition)
3. F>M
B Etiology
1. Inadequate dietary intake of Fe
2. Blood loss: GI, menstrual, trauma
3. Decreased absorption: Crohns, gastric resection
4. States of reqs: pregnancy/lactation, rapid growth periods
5. Prolonged ASA or NSAID use
B Pathophysiology
1. Fe absorbed most efficiently in duodenum
2. Occurs gradually: Fe stores are slowly depleted and RBC are normal (iron
deficiency w/o anemia); eventually no stores remain leading to anemia
B Signs
1. General signs: pallor, splenomegaly, jaundice
2. Severe anemia:
a. Skin/mucosa cheilosis, glossitis, brittle nails
b. Dysphagia w/ esophageal webs (Plummer-Vinson)
c. Tachycardia
B Symptoms
1 Mild anemia: usually asymptomatic
2 Moderate to severe sx:
a. General sx: fatigue, weakness
b. Palpitations; DOE; Syncope; Neuro symptoms; Pica
B Diagnosis
1 CBC with diff
a. Decreased Hgb/Hct
b. Low serum Fe <30 mcg/dL
c. Low serum Ferritin < 20 mcg/L
d. Decreased transferrin saturation < 15%
e. Increased TIBC (total iron binding capacity)
f. Low MCV < 80 (microcytic)
g. Low MCHC < 32 (hypochromic)
h. Platelets increased in severe disease
i. Reticulocyte count may be high or normal
2 Peripheral Blood Smear
a. Microcytic, hypochromic RBCs
b. Anisocytosis, poikilocytosis
c. Severe: nucleated RBCs, target & pencil-shaped cells
d. If etiology unknown after CBC and PBS:
i. Check for occult blood losses
ii. Do BM aspiration & Bx w/Fe stain
B Treatment
1 ID and treat underlying cause
2 Fe replacement therapy:
a Ferrous sulfate 325mg PO TID until Fe stores replenished (~6-8 mo)
b Parenteral Iron Dextran (IM or IV) wt.-based dosing
B Complications
1 Pregnancy; Growth retardation