Internal Diseases · MU Sofia

Theory · 46. Iron deficiency anemia

Covers iron deficiency anaemia from its latent stage through to established anaemia, then its causes such as blood loss, increased demand, poor absorption and poor intake. It goes on to the general and iron-specific symptoms, including koilonychia and angular stomatitis, the physical findings, and the blood, iron-study and marrow results. The note closes with diagnosis, treatment, prognosis and the choice of gold-standard test, with serum ferritin singled out as the best marker of iron stores.

Inside: 1 section · 3 labelled pictures · 14 flashcards · 4 min

Topic 43 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 1 section, about 588 words (4 min of reading), with 14 flashcards.

In this note

  1. Iron Deficiency Anemia

Iron Deficiency Anemia

Definition:

Iron deficiency anemia is a condition where there is inadequate iron for hemoglobin synthesis. The body compensates by maintaining normal hemoglobin levels as long as possible even after iron stores are depleted. This early phase is referred to as latent iron deficiency. When iron is fully depleted, anemia develops. It is the most common cause of anemia worldwide.

Etiology:

Iron deficiency anemia can be caused by:

  • Blood loss: The most common cause is chronic blood loss, particularly from the gastrointestinal (GI) tract or uterus (e.g., heavy menstrual bleeding).
  • Increased demand: This includes periods of rapid growth (children) and pregnancy.
  • Decreased absorption: Conditions like postgastrectomy (after stomach surgery) or celiac disease may impair iron absorption.
  • Poor intake: Insufficient dietary intake of iron, especially in individuals with restrictive diets (e.g., vegans).

Pathogenesis:

The pathophysiology involves a reduction in iron available for hemoglobin production. Initially, iron stores are used to maintain hemoglobin levels. However, with prolonged depletion of stores, the body is unable to produce sufficient hemoglobin, leading to microcytic (small cell size) and hypochromic (pale cells) anemia.

Symptoms:

  • General Anemia Symptoms:
  • Fatigue
  • Headache
  • Faintness
  • Breathlessness
  • Angina (chest pain)
  • Intermittent claudication (pain in the limbs)
  • Palpitations
  • Specific to Iron Deficiency Anemia:
  • Brittle nails (koilonychia): Spoon-shaped nails
  • Atrophy of tongue papillae
  • Angular stomatitis: Cracks at the corners of the mouth
  • Brittle hair

These features are associated with the lack of iron, which is required for proper cellular function in various tissues.

Physical Examination:

  • Pallor: Visible paleness due to reduced hemoglobin.
  • Tachycardia: Increased heart rate as the heart works harder to compensate for the reduced oxygen-carrying capacity of the blood.
  • Systolic flow murmur: Due to increased blood flow to compensate for anemia.
  • Cardiac failure: In severe cases, especially if the anemia is longstanding.

Lab Tests:

  • Complete Blood Count (CBC):
  • RBC count will be low.
  • Microcytic, hypochromic RBCs (small and pale).
  • Variation in RBC size (anisocytosis) and shape (poikilocytosis).
  • Serum Iron Studies:
  • Serum iron: Decreased.
  • Total iron-binding capacity (TIBC): Elevated as the body increases production of transferrin to capture more available iron.
  • Serum ferritin: Low (reflects depleted iron stores).
  • Reticulocyte Count: May be low since reticulocytes (immature red blood cells) are not adequately produced in iron deficiency.
  • Bone Marrow: Shows erythroid hyperplasia (increase in red cell precursors), and ragged normoblasts (immature RBCs).
  • Serum Soluble Transferrin Receptors: Elevated (indicating iron deficiency).

Diagnosis:

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