Iron deficiency anemia

Iron deficiency anemia

Updated: 7/23/2024

© Jun Wang, MD, PhD

 

General features

  • The most common nutritional deficiency worldwide and most common cause of anemia
  • Impaired erythropoiesis due to severe iron deficiency
  • Reduce iron leads to reduced Hb formation
  • Must rule out cancer caused GI blood loss in iron deficiency anemia in men and postmenopausal women

Etiology

  • Decreased intake

o   Adults: diet with limited sources of iron

o   Infants: unmodified milk/exclusive breastfeeding

  • Decreased iron absorption

o   Celiac disease

o   Gastric disorders: autoimmune gastritis, H. pylori, bariatric surgery

o   Medications reducing gastric acidity

  • Blood or iron loss

o   Chronic bleeding: GI tract, uterus, bleeding disorders, etc

o   Pregnancy and lactation

o   Gastrointestinal parasites

o   Frequent blood draws, including blood donation

o   Surgical blood loss

o   Hemodialysis

Pathogenesis

  • Increased hepcidin

o   Synthesized in liver

o   Suppress GI iron absorption and release from macrophages

o   Factors increasing hepcidin synthesis

§  Increased plasma transferrin iron saturation 

§  IL6 (chronic inflammatory states)

o   Factors decreasing hepcidin synthesis

§  Erythroferrone: produced by erythroblasts

§  Erythropoietin

§  Low plasma transferrin saturation

§  Hypoxia

Key clinical findings

Key Laboratory and pathological findings

  • Reduced

o   Hb, MCV, MCHC, serum iron, serum ferritin, transferrin saturation

o   Microcytosis: smaller than 7 um (black arrows)

o   Anisocytosis (High variation of RBC sizes, elevated RDW)

o   Hypochromia: enlarged central pallor area (blue arrow)

o   Low reticulocyte count

o   Poikilocytosis (possible target cells, pencil cells)

o   May have reactive thrombocytosis

o   Mild to moderate increase in erythroid precursors

o   No stainable iron in erythroblasts or bone marrow macrophages

Diagnosis

  • Anemia
  • Confirmed iron deficiency

Management

  • Iron supplementation
  • Treatment of underlying causes

 

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