Iron deficiency anemia

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    • Iron deficiency anemia
      • Etiology
        • Blood loss (chronic GI bleed or menorrhagia most common)
        • Malnutrition
        • Pregnancy
      • Signs and symptoms
        • Fatigue, exertional dyspnea
        • Glossitis ,Angular cheilosis
        • Pallor ,Koilonychia (spoon nails) ,Pica
      • Diagnosis

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      • Clinical Pearls
        • Serum ferritin < 12 mcg/L. (MCQ)
        • Iron deficiency is the most common cause of anemia worldwide.
        • Absorption occurs in the stomach, duodenum, and upper jejunum..
        • In general, iron metabolism is balanced between absorption of 1 mg/d and loss of 1 mg/d. (MCQ)
        • Pregnancy may also upset the iron balance, since requirements increase to 2–5 mg of iron per day during pregnancy and lactation
        • The average monthly menstrual blood loss is approximately 50 mL, or about 0.7 mg/d. (MCQ)
        • Many iron-deficient patients develop pica, craving for specific foods (ice chips, etc) often not rich in iron.
        • After iron stores have been depleted, red blood cell formation will continue with deficient supplies of iron.
        • Iron deficiency anemia
          • Serum iron values decline to less than 30 mcg/dL(MCQ)
          • Transferrin levels rise, leading to transferring saturation of less than 15%(MCQ)
          • In the early stages, the MCV remains normal(MCQ)
          • Subsequently, the MCV falls and the blood smear shows hypochromic microcytic cells (see blood smear).
          • With further progression, anisocytosis (variations in red blood cell size) and poikilocytosis (variation in shape of red cells) develop.
          • Severe iron deficiency will produce a bizarre peripheral blood smear, with (MCQ)
            • severely hypochromic cells, target cells
            • hypochromic pencil-shaped cells
            • small numbers of nucleated red blood cells
          • The platelet count is commonly increased(MCQ)
        • Causes of microcytic anemia (MCQ)
          • anemia of chronic disease
          • thalassemia
          • sideroblastic anemia.
          • Iron deficiency anemia
        • Anemia of chronic disease is characterized by (MCQ)
          • normal or increased iron stores in the bone marrow
          • normal or elevated ferritin level(MCQ)
          • serum iron is low
          • total iron-binding capacity (TIBC) is either normal or low(MCQ)
        • Oral Ferrous sulfate is the preferred therapy.
          • 325 mg three times daily(MCQ)
          • provides 180 mg of iron daily of which up to 10 mg is absorbed (MCQ)
          • An appropriate response is a return of the hematocrit level halfway toward normal within 3 weeks with full return to baseline after 2 months.
          • Iron therapy should continue for 3–6 months after restoration of normal hematologic values to replenish iron stores(MCQ)
        • Parenteral Iron therapy
          • Sodium ferric gluconate is available and has been shown to result in a lower incidence of severe anaphylaxis, allowing wider use of parenteral therapy. (MCQ)
          • Parenteral Iron dose :
            • The dose (total 1.5–2 g) may be calculated by estimating the decrease in volume of red blood cell mass and then supplying 1 mg of iron for each milliliter of volume of red blood cells below normal. (MCQ)
            • Approximately 1 g should then be added for storage iron(MCQ)
            • Total body iron ranges between 2 g and 4 g(MCQ)
            • approximately 50 mg/kg in men
            • 35 mg/kg in women.
            • Most (70–95%) of the iron is present in hemoglobin in circulating red blood cells.
            • One milliliter of packed red blood cells (not whole blood) contains approximately 1 mg of iron. (MCQ)
            • In men
            • red blood cell volume is approximately 30 mL/kg.
            • A 70-kg man will therefore have approximately 2100 mL of packed red blood cells and consequently 2100 mg of iron in his circulating blood. (MCQ)
            • In women,
            • the red cell volume is about 27 mL/kg(MCQ)
            • a 50-kg woman will thus have 1350 mg of iron circulating in her red blood cells.
          • Hemoglobin iron deficit (mg) = weight (kg)  x (14 – Hgb) x (2.145)
          • Volume of product required (mL) = [weight (kg) x (14 – Hgb) x (2.145)] / C
            • Where C= concentration of elemental iron (mg/ml) in the product being used: (MCQ)
              • Iron dextran: 50 mg/mL
              • Iron sucrose: 20 mg/mL. 
              • Ferric gluconate: 12.5 mg/mL


      Iron-Deficiency Anemia – USMLEntertainment
      Part 1 of 3: Pathophysiology of Iron Deficiency Anemia (Khan Academy NCLEX-RN)
      This is the first of of three video on Iron Deficiency Anemia for preparation for the NCLEX-RN examination (Pathophysiology). Khan Academy is holding a competition for individuals to demonstrate their ability to help prepare future nurses for this exam. If you find this video beneficial and wish to see more NCLEX-RN exam preparation videos, then please like, share and comment so that Khan Academy hears your voices!
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      Description of three classifications of anemia, and an explanation of the pathophysiology of iron deficiency anemia. To be continued
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