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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Contents

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Anemia

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Practice questions Anemia I

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Practice questions Anemia I © Jun Wang, MD, PhD   Abbreviations: Hb: hemoglobin HCT: hematocrit MCV: Mean Corpuscular Volume MCHC: Mean Corpuscular Hemoglobin RDW: Red Cell Distribution Width TIBC: total iron binding capacity   1. Use this case for the next three questions . A 25-year-old woman is brought to the emergency department 2 hours after being involved in a motor vehicle accident. She is conscious but feels dizziness and weakness.   Her blood pressure is 90/60 mmHg, and her heart rate is 120 beats per minute. Physical examination reveals pale skin and mucosa and a 15 cm laceration on her left thigh with significant bleeding. What are most likely the CBC and TIBC results? A. Low Hb, low HCT, high MCV, high RDW, high TIBC B. Low Hb, low HCT, slightly low MCV, normal RDW, normal TIBC C. Low Hb, low HCT, slightly high MCV, normal RDW, normal TIBC D. Normal Hb, normal HCT, normal MCV, normal
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