Clinical symptoms other systems due to lack of its

Clinical Symptoms
•
Other systems due to lack of its enzymatic presence
•
Gastritis, irritability, headache, numbness/tingling, vasomotor
disturbance
•
Confusion/memory loss in the elderly; may be missed as part of aging

+ Iron Deficiency Anemia

Evaluation

Clinical manifestations and lab tests
 Iron: normal is 50-160mcg/dL

Total Iron binding capacity (TIBC): normal is 250-350mcg/dL
 Amount of iron in blood IF all sites were saturated with iron
 Ferritin: normal varies greatly with age

Proportional to the body’s iron stores
 Treatment
 Find cause of blood loss and correct it

Replacement therapy with oral iron

150-200mg/day until ferritin level reaches 50mg/L (adequate replacement)
 Will also see resolution of symptoms
 Continue for an additional 6-12 months
 May be continuous until menopause for menorrhagia

+
Sideroblastic Anemia

Group of anemias with abnormal hemoglobin synthesis in
the marrow caused by inefficient iron uptake

Ringed sideroblasts in the marrow

Ring is made of iron granules that circle the nucleus instead of being
synthesized into hemoglobin
 Acquired sideroblastic anemia

Most common and idiopathic
 Hereditary sideroblastic anemia

Rare, X-linked and generally involves males
 Usually not detected until midlife when complications arise (cardiac failure)
 Reversible sideroblastic anemia
 Associated with alcoholism, nutritional folate deficiencies

+
Sideroblastic Anemia
 Clinical picture

Similar to general anemia
 Also show signs of iron overload (hemosiderosis)
 No usual skin or neurologic alterations
 Mild to moderate enlargement of spleen and liver with normal
function
 Bronze-tinted skin
 Rhythm disturbances due to hemosiderosis of cardiac tissue (later
on)

Growth and development issues in infants/children

+
Sideroblastic Anemia
 Evaluation
 Bone marrow biopsy showing sideroblasts with rings
 Treatment
 Pyridoxine therapy with varied response
 Goal: Normal hemoglobin levels but cell morphology remains abnormal

If pyridoxine is not successful, blood transfusions for symptom relief

Monitor for iron overload from multiple transfusions

Deferoxamine(iron-chelating agent) to reduce iron levels

+
Normochromic-Normocytic
Anemias

Cell size: normal

Cell color: normal

Five anemias in this category
1. Aplastic: rare, hault in production of RBCs
2.Posthemorrhagic: severe blood loss with normal iron stores
3. Hemolytic: breakdown of RBCs
4. Anemia of chronic inflammation: decreased RBC lifespan
5. Sickle cell disease: change in shape

All involve the loss of RBCs or decreased lifespan

+
Myeloproliferative Red Cell
Disorders

Polycythemia: excessive red cell production
 Relative

Hemoconcentration of blood related to dehydration
 Resolves with fluid; assess via the CBC and electrolytes

Absolute
 Not related to fluid loss; two types

Primary
 Polycythemia Vera

Secondary
 More common and due to erythropoietin secretion from
hypoxia

High altitude, increased CO
2
levels (smokers), COPD, CHF

+
Polycythemia Vera (Primary)
