Anemia

decrease RBC mass:
男: Hct <41 or Hb <13.5
女: Hct <36 or Hb <12

IDA: Iron deficiency (NEJM 1999;341:1986 )
• ↑ marrow iron & depleted body iron stores  -> ↓ heme synthesis  -> microcytosis  -> anemia
• Special clinical manifestations:
   angular cheilosis, atrophic glossitis,
   pica (consumption of nonnutritive substances such as ice, clay),
   koilonychia (nail spooning)
   Plummer-Vinson syndrome (iron deficiency anemia, esophageal web & atrophic glossitis)

• Etiologies:
chronic bleeding (GI—including cancer, menstrual, etc.),
↓ supply (mal-nutrition;
↓ absorp. due to celiac sprue, Crohn’s, ↑ gastric pH, subtotal gastrecto-my),
↑ demand (preg., epo).
Rare Fe-refractory genetic disorder due to hepcidin dysregulation (Nat Genet 2008;40:569).

• Diagnosis:
↓ Fe, ↑ TIBC, ↓ ferritin (espec. 15), ↓ transferrin sat (Fe/TIBC; espec. 15%), ↑ soluble transferrin receptor; ↑ plt; unless hx c/w different etiology,
initiate workup for GIB; incl. H. pylori serology,
? celiac sprue labs (anti-TTG, antigliadin, antiendomysial Ab)

Treatment (Fe supplementation):
  -oral Fe tid ( 6 wk to correct anemia; 6 mo to replete Fe stores);
  -in cases of excessive/persistent GI losses or for dialysis or cancer Pts prior to EPO Rx, IV iron (Fe-sucrose, -gluconate, -dextrose) should be considered