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Iron Deficiency Anemia: Causes, Complications, and Diagnosis

This case discusses an 18-year-old female presenting with symptoms of fatigue, weakness, and excessive bleeding during menstruation. The physician suspects iron deficiency anemia based on physical examination and laboratory findings. The causes, complications, and diagnostic tests for iron deficiency anemia are explored.

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Iron Deficiency Anemia: Causes, Complications, and Diagnosis

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  1. Case No. 1 IDA

  2. Case Details • An 18 –year- old female reported to the physician for consultation. She complained of generalized weakness, lethargy and inability to do the routine work from the previous few months. • On further questioning she revealed that she was having excessive bleeding during menstruation from the previous six months. She complained of breathlessness and palpitations while climbing stairs for her house. She also had experienced periods of light-headedness, though not to the point of fainting. • Other changes she had noticed were cramping in her legs, a desire to crunch on ice, There was no history of any fever, drug intake or abdominal discomfort. Her appetite had also decreased and she was taking meals only once a day.

  3. Cont, • Upon examining, her physician found that she had tachycardia, pale gums and nail beds, and her tongue was swollen. Given her history and the findings on her physical examination, the physician suspected that the patient was anemic and ordered a sample of her blood for examination. • The results were as shown below:

  4. Lab. Findings • Red Blood Cell Count -3.5 million/mm3 • Hemoglobin (Hb) -7 g/dl • Haemtocrit (Hct)- 30% • Mean Corpuscular Volume (MCV) – low • Mean Corpuscular Hb Concentration (MCHC)- low • Serum Iron – low • Total Iron Binding Capacity in the Blood (TIBC)- high

  5. Questions • What is the cause of anemia in this patient? • What are the possible complications in the untreated cases?

  6. Case Discussion • The most likely diagnosis is iron deficiency anemia: - Generalized weakness, exercise intolerance, dyspnea, palpitations, history of blood loss during menstruation, tachycardia and low Hb, all are suggestive of iron deficiency anemia. - Iron deficiency is the most prevalent single deficiency state on a worldwide basis. Iron deficiency, is related in part to abnormal iron metabolism.

  7. Points for Discussion • The balance of iron? • Iron requirement? • Iron absorption? • Mechanism of iron absorption? • Iron Transport & utilization? • Iron storage? • Causes of iron deficiency ?

  8. Factors affecting iron absorption 1)      Erythroid hyperplasia 2)      Hypoxia 3)      Body Stores 4)      Interfering substances 5)      Other Minerals 6)    Inflammation

  9. Free Iron toxicity • Free iron, which is highly toxic in that it generate free radicals such as singlet O2 or OH–.

  10. Laboratory Findings • CBC count • The cellular indices show a microcytic and hypochromic erythropoiesis, ie, both (MCV) and (MCHC) have values below the normal range. Reference range values (MCV= 83-97 fL) and (MCHC =32-36 g/dL. • Often, the platelet count is elevated (>450,000/µL). • The WBC count is usually within reference ranges (4500-11,000/µL).

  11. Peripheral smear • Severe iron deficiency will show anisocytosis, poikilocytosis and produce a bizarre peripheral blood smear, with severely hypochromic cells, target cells, hypochromic pencil-shaped cells, and occasionally small numbers of nucleated red blood cells. • The platelet count is commonly increased.

  12. Serum iron, total iron-binding capacity (TIBC), and serum ferritin • The serum ferritin will become abnormally low. • A ferritin value less than 30 mcg/L is a highly reliable indicator of iron deficiency. • The serum total iron-binding capacity (TIBC) rises. • These test findings are useful in distinguishing iron deficiency anemia from other microcytic anemias

  13. A bone marrow aspirate • can be diagnostic of iron deficiency. Bone marrow biopsy for evaluation of iron stores is now rarely performed because of variation in its interpretation.

  14. Other laboratory tests • Testing stool • Hemoglobinuria and hemosiderinuria • Hemoglobin electrophoresis and measurement of hemoglobin A2. • Serum Levels of Transferrin Receptor Protein

  15. Serum Levels of Transferrin Receptor Protein • Because erythroid cells have the highest numbers of transferrin receptors, and because transferrin receptor protein (TRP) is released by cells into the circulation, serum levels of TRP reflect the total erythroid marrow mass. • Another condition in which TRP levels are elevated is absolute iron deficiency. • TRP and serum ferritin tests has been proposed to distinguish between iron deficiency and the anemia of chronic inflammation

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