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Anemia - Pathophysiology I - Lecture 1 (1)

Measurement of the iron binding capacity of

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Measurement of the iron-binding capacity of transferrin 220 – 420 mcg/dL Percent Transferrin Saturation Typically between 30% - 50% Serum Ferritin Iron storage in the liver, spleen 10 – 150 ng/mL (female) 20 – 250 ng/mL (male)
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IDA LABORATORY FINDINGS Decreased RBC Hgb and Hct MCV MCH MCHC Serum iron Serum ferritin Transferrin saturation Increased TIBC
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IDA TREATMENT GOALS Goals of therapy Replenish iron stores Dietary supplements and therapeutic iron preparations Treat the underlying cause/disease to aid in the correction of iron deficiency anemia Establish improvement in clinical symptoms Establish improvement in laboratory findings Complete blood count (i.e. Hgb, Hct) Iron studies (i.e. % saturation, ferritin)
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Nutritional deficiency anemia Iron deficiency Vitamin B 12 deficiency Folic acid deficiency
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B 12 Deficiency Anemia Epidemiology Prevalence ~ 151 per 100,000 Slightly more common in women Role of B 12 in the body: Coenzyme involved in nucleic acid synthesis B 12 assists in the development of RBCs B 12 assists in maintenance of nerve function
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Iron deficiency anemia ETIOLOGY – B 12 DA Inadequate dietary intake (rare) ↓ systemic absorption (most common)
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ETIOLOGY – B 12 DA Pernicious anemia Absence of gastric intrinsic factor Autoimmune destruction of the gastric parietal cells Atrophy of the gastric mucosa Gastric surgery Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach – It is vital for the absorption of B 12
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DIETARY B 12 INTAKE Daily requirements RDA: 2.4 mcg Food sources Animal containing: Meat, fish, poultry, eggs, milk/dairy Fortified cereals Inadequate Intake Diet limited in meat, cereal, dairy (i.e. alcoholics)
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CLINICAL CHARACTERISTICS Signs and symptoms Neurologic changes Symmetric paresthesias of the hands and feet Loss of vibratory and position sense Spastic ataxia Dementia (severe deficiency)
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LABORATORY FINDINGS Peripheral Smear: RBCs are placed on a microscope slide, stained and viewed Macrocytic RBCs Normochromic RBCs Laboratory findings (blood sample): Large MCV Normal MCHC
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B 12 DA LABORATORY FINDINGS (blood sample) Decreased RBC Hgb and Hct Reticulocyte count B 12 level (< 150 pg/mL) Normal Normal MCHC Normal folate level Increased MCV
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B 12 DA TREATMENT GOALS Goals of therapy Replenish B 12 body stores Dietary supplements and therapeutic B 12 preparations Treat the underlying cause/disease to aid in the correction of B 12 body stores Reversal of hematologic laboratory findings Prevention or resolution of neurologic manifestations
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Nutritional deficiency anemia Iron deficiency Vitamin B 12 deficiency Folic acid deficiency
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FOLATE DEFICIENCY ANEMIA Epidemiology Relatively common in the US Associated with excessive alcohol use and pregnancy Role of folic acid in the body: Coenzyme in amino acid and protein metabolism Promotes RBC formation
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Iron deficiency anemia ETIOLOGY – FOLIC ACID
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