Pumping iron
Describe possible History for a person who is sus for iron def anemia
hx of:
dietary lack of iron
decreased absorption (Gastric issues)
increased requirements
chronic blood loss by way of the GI/GU tract
What could be seen in platelet counts in patients with SEVERE iron def anemia?
reactive thrombocytosis= plts <800k but pretty high
What labs would you see with a person who has AOCD
Ferritin: HIGH
serum iron level: decreased
TIBC: decreased
Transferring saturation: decrased
How do we treat iron def anemia and what are the pros and cons of each choice?
Oral: pros: cheap, noninvasive, simple admin, convenient- cons: malabsorption, N/V, poor compliance, interactions, can only absorb 10-20 mg a day
IV iron: pros: high iron content, 100% bioavailable, compliance, fast-acting, well tolerated- cons: adverse reactions, invasive, inpatient, cost
Blood tx: pros: replaces RBCs, compliance, great for CV instability- cons: tx reactions, cost, invasive, limited supply, complex admin
How would you test for thalassemia?
hemoglobin electophoresis
what is the presentation of iron def anemia?
Common:
fatigue
headache
exertional dyspnea
difficulty concentrating
Rare:
pica
glossitis
koilonychia
dysphagia
What should you check immediately if someone comes in with a microcytic anemia
ferritin level
What are the 3 catergories of AOCD
chronic inflammation, organ failure, elderly
Will Alpha thalassemia trait have anemia?
What will their hgb electrophoresis and iron levels show?
minimal to none hgb is greater than 9
normal and normal
Is beta or alpha not being made in utero?
Explain how this might present
Beta-
What is the best indicator of total body iron?
ferritin levels
what is a ddx for iron def anemia
thals
lead poisoning
What will the iron studies of someone with AOCD d/t being elderly or in organ failure show?
They will be normal
Wil hemoglobin H disease have anemia?
Will they need transfusions?
What will their hgb electrophoresis and iron levels show?
3/4 alpha genes are abnormal
moderately severe anemia (hgb 4-9)
sometimes they need transfusions
10-40% hgh, normal to increased iron levels
What are two types of macrocytic anemias and how can you quickly determine if they are macrocytic
B12 and folate
a blood smear
which blood test for iron def anemia would you want to check in the AM
Serum iron
if ferritin level is low what can you treat iron def anemia with?
iron! duh
Beta thalassemia minor:
describe if they are anemic, what is there hgb, do they need transfusions, and what would you see on hgb electrophresis and how to treat
mild to no anemia
9-normal hgb
no transfusions
HbA- 80-95% (Normal 97-99%)
HbA2- 4-8 % (Normal less than 1%)
HbF- 1-5% (Normal less than 1%)
No treatment needs- do not give iron
Will hydrops fetalis- hemoglobin barts have anemia
Will they need transfusions?
What will their hgb electrophoresis and iron levels show?
life-threatening anemia- 4/4 genes abnormal (lethal in utero without transfusion)
transfusions required for life
hgb barts on electrophoresis
highly abnormal iron levels
What are the causes of b12 def and who is the "typical patient"
not getting enough from diet- strict vegans after 3 yrs
lack of intrinsic factor
- autoantibodies to gastric mucosa
-gastrectomy or gastric bypass
- SUPER bad celiacs/ chrons
-H.pylori
-pancreatic insufficiency
white female age 60
What are the labs you could use for diagnosing iron def anemia and what would you see?
CBC: decreased H and H, decreased MCV, increased RDW
Ferritin: LOW
Serum iron:LOW
transferrin: HIGH
soluble transferrin receptor: HIGH
if ferritin is normal but you still suspect iron def, what should you look at?
serum iron: low
transferrin saturation: low
TIBC: increased
Beta thalassemia intermedia:
describe if they are anemic, what is there hgb, do they need transfusions, and what would you see on hgb electrophresis and how to treat
moderate to severe anemia
6-11 hgb
usually dont need transfusion
HGA: 0-30%
HgA2: 4-10%
HbF6-10%
Treatment depends if blood transfusion is needed
Beta thalassemia major:
describe if they are anemic, what is there hgb, do they need transfusions, and what would you see on hgb electrophresis and how to treat
severe anemia
always less than 4 without a transfusion
always need transfusions
HGA: close to 0%
HbA2:4-10%
HbF: more than 90%
These patients need a stem cell transplant
S/S of b12 def anemia
if mild- none
anorexia, diarrhea, glossitis
Complex neuro syndrom
-peripheral paresthesias
-ataxia
dementia if anemia is SUPER severe
pale, sallow, mile icterus
**first sense to go is vibratory sense