Deficiency anemia

Hypotransferrinemiacan result from protein malnutrition and accompanies hypoalbuminemia. Since transferrin has a much shorter half-life (8 days) than albumin (19 days), measurement of the transferrin level may be a more sensitive indicator of protein malnutrition than albumin measurement (see also chapter 17). Hypotransfer-rinemia also results from excessive renal loss of plasma proteins (e.g., in nephrotic syndrome). 

In the initial phase of depletion of the iron content of the body, the iron stores maintain normal levels of hemoglobin and of other iron proteins. With exhaustion of storage iron, hypochromic and microcytic anemia becomes manifest. 

The clinical characteristics of iron deficiency anemia are nonspecific and include pallor, rapid exhaustion, muscular weakness, anorexia, lassitude, difficulty in concentrating. 

Physiological adjustments take place during the gradual progression of the disorder, so that even a severe hemoglobin deficiency may produce few symptoms. Iron deficiency may affect the proper development of the central nervous system. Early childhood iron deficiency anemia may lead to cognitive abnormalities. 

Before treatment is initiated, the cause of the negative iron balance must be established. Treatment should correct the underlying cause of anemia and improve the iron balance. In general, oral therapy with ferrous salts is 

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Transferrin is essential for movement of iron and without it, as in genetic absence of transferrin, iron overload occurs in tissues. This hereditary atransferrinemia is coupled with iron-deficiency anemia. The iron overload in hereditary or acquired hemochromatosis results in fully saturated transferrin and is treated by phlebotomy (10). 

Thus, our attention should shift from the concern of potential adverse effects to the health benefits imparted by hormonal contraceptives. The use of oral contraceptives for at least 12 months reduces the risk of developing endometrial cancer by 50%. Furthermore, the risk of epithelial ovarian cancer in users of oral contraceptives is reduced by 40% compared with that on nonusers. This kind of protection is already seen after as little as 3-6 months of use. Oral contraceptives also decrease the incidence of ovarian cysts and fibrocystic breast disease. They reduce menstrual blood loss and thus the incidence of iron-deficiency anemia. A decreased incidence of pelvic inflammatory disease and ectopic pregnancies has been reported as well as an ameliorating effect on the clinical course of endometriosis. 

Anemia is a decrease in the number of red blood cells (RBCs), a decrease in die amount of hemoglobin in RBCs, or bodi a decrease in die number of RBCs and hemoglobin. When diere is an insufficient amount of hemoglobin to deliver oxygen to die tissues, anemia exists. There are various types and causes of anemia For example, anemia can be die result of blood loss, excessive destruction of RBCs, inadequate production of RBCs, and deficits in various nutrients, such as in iron deficiency anemia Once the type and cause have been identified, die primary health care provider selects a method of treatment. 

The anemias discussed in this chapter include iron deficiency anemia, anemia in patients witii chronic renal disease pernicious anemia, and anemia resulting from a folic acid deficiency. Table 45-1 defines these anemias. Drugp used in treatment of anemia are summarized in die Summary Drug Table Drugp Used in die Treatment of Anemia. 

Iron deficiency anemia is by far die most common type of anemia Iron is a component of hemoglobin, which is in RBCs. It is the iron in the hemoglobin of RBCs diat... 

Iron salts, such as ferrous sulfate or ferrous gluconate, are used in the treatment of iron deficiency anemia, which occurs when there is a loss of iron that is greater than the available iron stored in the body. Iron preparations act by elevating the serum iron concentration, which replenishes hemoglobin and depleted iron stores. 

Iron dextran is a parenteral iron that is also used for die treatment of iron deficiency anemia It is primarily used when the patient cannot take oral drugs or when the patient experiences gastrointestinal intolerance to oral iron administration. Other iron preparations, both oral and parenteral, used in the treatment of iron deficiency anemia can be found in the Summary Drug Table Dragp Used in the Treatment of Anemia... 

Iron deficiency Anemia characterized by an inadequate amount of iron in the body to produce hemoglobin... 

Taking the contraceptive hormones provides health benefits not related to contraception, such as regulating the menstrual cycle and decreased blood loss, and incidence of iron deficiency anemia, and dysmenorrhea Health benefits related to the inhibition of ovulation include a decrease in ovarian cysts and ectopic pregnancies. hi addition, there is a decrease in fibrocyctic breast disease, acute pelvic inflammatory disease endometrial cancer, ovarian cancer, maintenance of bone density, and symptoms related to endometriosis in women taking contraceptive hormones. Newer combination contraceptives such as norgestimate and ethinyl estradiol... 

Ferrous gluconate is the black dye used to color ripe olives. It is also used as an iron supplement to treat iron-deficiency anemia. 

Inorganic iron is absorbed only in the (reduced) state, and for that reason the presence of reducing agents will enhance absorption. The most effective compound is vitamin C, and while intakes of 40-60 mg of vitamin C per day are more than adequate to meet requirements, an intake of 25-50 mg per meal will enhance iron absorption, especially when iron salts are used to treat iron deficiency anemia. Ethanol and fructose also enhance iron absorption. Heme iron from meat is absorbed separately and is considerably more available than inorganic iron. However, the absorption of both inorganic and heme iron is impaired by calcium—a glass of milk with a meal significantly reduces availabiUty. 

Attention to iron metabolism is particularly important in women for the reason mentioned above. Additionally, in pregnancy, allowances must be made for the growing fetus. Older people with poor dietary habits ( tea and toasters ) may develop iron deficiency. Iron deficiency anemia due to inadequate intake, inadequate utilization, or excessive loss of iron is one of the most prevalent conditions seen in medical practice. 

Transferrin binds iron, transporting it to sites where it is required. Ferritin provides an intracellular store of iron. Iron deficiency anemia is a very prevalent disorder. Hereditary hemochromatosis has been shown to be due to mutations in HFE, a gene encoding the protein HFE, which appeats to play an important role in absorption of iron. 

Iron deficiency anemia Inadequate intake or excessive loss of iron... 

GABRiELLi G B and DE SANDRE G (1995) Excessive tea consumption can inhibit the efficacy of oral iron treatment in iron-deficiency anemia , Haematologica, 80(6), 518-20. 

Iron (Feosol, FeroSul) 27 mg elemental iron daily Increase to 60-120 mg daily if iron-deficiency anemia present... 

In patients with iron-deficiency anemia, appropriate oral iron therapy that delivers sufficient elemental iron should be administered before giving parenteral iron. 

Since there is no true excretion of iron from the body, iron-deficiency anemia occurs mostly because of inadequate absorption of iron or excess blood loss. Inadequate absorption may occur in patients who have congenital or acquired intestinal diseases, such as inflammatory bowel disease, celiac disease, or bowel resection. Achlorhydria and diets poor in iron also may contribute to poor absorption of iron. In contrast, iron deficiency also may occur in patients who exhibit a higher rate of iron loss from the body. This is manifested in... 

History of blood loss, such as hemorrhoids, melena, or menorrhagia (iron-deficiency anemia)... 

Serum ferritin—the best indirect determinant of body iron stores. It is commonly decreased in patients with iron-deficiency anemia. 

Total iron-binding capacity (TIBQ—quantifies the ironbinding capacity of transferrin and is increased in iron-deficiency anemia... 

Transferrin saturation (serum iron/TIBC)—indicates the amount of transferrin that is bound with iron it is lower in iron-deficiency anemia. 

Mean cell hemoglobin (MCH) 27-33 pg/cell Amount of Hgb per RBC may be decreased in iron deficiency anemia. 

Mean cell hemoglobin concentration (MCHC) Iron Studies Serum iron 33.4-35.5 g/dL (334-355 g/L) Hemoglobin divided by the hematocrit also low in iron-deficiency anemia. 

Females 30-160 mcg/dL (5.4-31.3 pmol/L) transferrin low in iron-deficiency anemia. 

Serum ferritin Less than 1 0-20 mcg/L (22-44 pmol/L) Ferritin is the protein-iron complex found in macrophages used for iron storage low in iron-deficiency anemia. 

Transferrin saturation (TSAT) Other Tests 30-50% (0.30-0.50) Transferrin saturation = (serum iron/TIBC) x 100 a saturation of less than 15% is common in iron-deficiency anemia. 

The initial treatment of iron-deficiency anemia is oral iron therapy with 200 mg of elemental iron daily for those who are able to tolerate the oral route. In order to attain this amount of elemental iron daily, many different iron products and salt forms are available. Table 63-3 lists the various salt forms of oral iron available, the amount of elemental iron in each product, and the approximate daily dose of the salt to attain 200 mg of elemental iron daily. 

The patient is diagnosed with iron-deficiency anemia and is started on ferrous sulfate 325 mg orally three times daily to be taken on an empty stomach. Follow-up CBC 1 month later reveals a Hgb of 10 g/dL (100 g/L or 6.2 mmol/L), previously 9.3 g/dL (93 g/L or 5.77 mmol/L). The patient complains of shortness of breath on exertion and constipation. She also admits to taking only one tablet a day because of nausea. 

Parenteral iron therapy may be appropriate in cases where patients are unable to tolerate the oral formulation because of toxicities or compliance. In addition, those who have documented iron-deficiency anemia and have not responded to... 

Parenteral iron therapy currently is available in three different formulations, which are listed in Table 63-3. Iron dex-tran was the first parenteral iron formulation to be approved, followed by ferric gluconate, and then iron sucrose. Although these newer agents are only approved by the Food and Drug Administration (FDA) to treat anemia associated with CKD in patients receiving erythropoietin products, they are effective in treating iron-deficiency anemia as well. Iron dextran is FDA approved for treating documented iron deficiency in patients who are unable to tolerate the oral formulation. 

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