However, ferritin is an acute-phase reactant, and levels increase in inflammatory and infectious disorders eg, hepatitis Overview of Acute Viral Hepatitis Acute viral hepatitis is diffuse liver inflammation caused by specific hepatotropic viruses that have diverse modes of transmission and epidemiologies. A nonspecific viral prodrome is followed The reticulocyte count is low in iron deficiency. The peripheral smear generally reveals hypochromic red cells with significant anisopoikilocytosis, which is reflected in a high red cell distribution width RDW.
The most sensitive and specific criterion for iron-deficient erythropoiesis is absent bone marrow stores of iron, although a bone marrow examination is rarely needed.
Stage 1 is characterized by decreased bone marrow iron stores; hemoglobin Hb and serum iron remain normal, but the serum ferritin level falls to During stage 2, erythropoiesis is impaired. Although the transferrin level is increased, the serum iron level decreases; transferrin saturation decreases. Diagnosis of iron deficiency anemia prompts consideration of its cause, usually bleeding. Patients with obvious blood loss eg, women with menorrhagia may require no further testing. Men and postmenopausal women without obvious blood loss should undergo evaluation of the gastrointestinal GI tract, because anemia may be the only indication of an occult GI cancer.
Rarely, chronic epistaxis or genitourinary bleeding is underestimated by the patient and requires evaluation in patients with normal GI study results. Iron deficiency anemia must be differentiated from other microcytic anemias see table Differential Diagnosis of Microcytic Anemia Due to Decreased RBC Production Differential Diagnosis of Microcytic Anemia Due to Decreased Red Blood Cell Production Iron deficiency is the most common cause of anemia and usually results from blood loss; malabsorption, such as with celiac disease, is a much less common cause.
If tests exclude iron deficiency in patients with microcytic anemia, then the anemia of chronic disease Anemia of Chronic Disease The anemia of chronic disease is a multifactorial anemia. Diagnosis generally requires the presence of a chronic inflammatory condition, such as infection, autoimmune disease, kidney disease It is caused by homozygous inheritance of genes for hemoglobin Hb S.
Clinical features, Hb studies eg, Hb electrophoresis and Hb A2 , and genetic testing eg, for alpha-thalassemia Alpha-thalassemia Thalassemias are a group of inherited microcytic, hemolytic anemias characterized by defective hemoglobin synthesis. Alpha-thalassemia is particularly common among people of African, Mediterranean Iron therapy without pursuit of the cause is poor practice; a bleeding site should be sought even in cases of mild anemia.
Oral iron can be provided by various iron salts eg, ferrous sulfate , ferrous gluconate , ferrous fumarate or saccharated iron given 30 minutes before meals food or antacids may reduce absorption.
A typical initial dose is 60 mg of elemental iron eg, as mg of ferrous sulfate given once a day or every other day 1 Treatment reference Iron deficiency is the most common cause of anemia and usually results from blood loss; malabsorption, such as with celiac disease, is a much less common cause.
Larger doses are largely unabsorbed due to increased hepcidin production but increase adverse effects, especially constipation or other GI upset. Ascorbic acid either as a pill mg or as orange juice when taken with iron enhances iron absorption without increasing gastric distress.
Parenteral iron causes a more rapid therapeutic response than oral iron does but can cause adverse effects, most commonly allergic reactions or infusion reactions eg, fever, arthralgias, myalgias. Severe anaphylactoid reactions Anaphylactoid reactions Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen.
Parenteral iron is reserved for patients who do not tolerate or who will not take oral iron or for patients who steadily lose large amounts of blood because of capillary or vascular disorders eg, hereditary hemorrhagic telangiectasia Hereditary Hemorrhagic Telangiectasia Hereditary hemorrhagic telangiectasia is a hereditary disorder of vascular malformation transmitted as an autosomal dominant trait affecting men and women.
See also Overview of Vascular Bleeding The dose of parenteral iron is determined by a hematologist. The response to treatment is assessed by serial Hb measurements until normal RBC values are achieved.
Hb rises little for 2 weeks but then rises 0. Anemia should be corrected within 2 months. A subnormal response suggests continued hemorrhage, underlying infection or cancer, insufficient iron intake, or malabsorption of oral iron.
If the symptoms of anemia, such as fatigue, weakness, and shortness of breath, do not abate following resolution of the anemia, an alternative cause should be sought. Moretti D, Goede JS, Zeder C, et al : Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women.
Blood 17 , These tests may help rule out a source of blood loss. Iron-rich diet. Eating a diet with iron-rich foods can help treat iron-deficiency anemia.
Good sources of iron include the following:. Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans. Iron supplements. Iron supplements can be taken over several months to increase iron levels in the blood. Iron supplements can cause irritation of the stomach and discoloration of bowel movements. They should be taken on an empty stomach, or with orange juice, to increase absorption.
They are much more effective than dietary interventions alone. In cases of malabsorption or intolerance, IV iron may be needed. Evaluation for a source of blood loss. This may include upper endoscopy or colonoscopy. The bone marrow needs enough dietary iron and some vitamins to make haemoglobin.
Once this reservoir is depleted, the red blood cells will not be able to carry oxygen around the body effectively. Please note: Take iron supplements only when advised by your doctor. For example, if the anaemia is caused by dietary deficiencies, correcting the cause and the use of appropriate supplements for some weeks or months will resolve the condition. Relapses may occur, so changes to diet and, perhaps, regular supplements may be necessary. In other cases, the anaemia may be permanent and lifelong treatment is needed.
No matter what the cause, it is important to have a doctor regularly monitor your blood to make sure your red blood cell and haemoglobin levels are adequate and to adjust treatment if required. Anaemia caused by dietary deficiency can be prevented by making sure that you eat food from certain food groups on a regular basis, including dairy foods, lean meats, nuts and legumes, fresh fruits and vegetables.
If you follow a vegan diet one that does not include any animal products talk to your health professional about recommended vitamin and mineral supplements. This page has been produced in consultation with and approved by:. A person with amyloidosis produces aggregates of insoluble protein that cannot be eliminated from the body. An aneurysm may have no symptoms until it is either very large or it ruptures.
Bleeding may be minor or it may be a life-threatening medical emergency. Pernicious anemia and anemia due to small intestinal malabsorption can be treated with an intramuscular B injection by your physician. High dose oral vitamin B supplementation may be an effective option for some people with pernicious anemia, as well.
In people with vitamin B deficiency anemia where the body can absorb B, oral vitamin B supplementation and diet adjustments may be an effective treatment. Your doctor will usually need to do several tests to diagnose you with pernicious anemia. These include:. In a healthy immune system, antibodies are responsible for finding bacteria or viruses. They then mark the invading germs for destruction. In this case, autoantibodies destroy the stomachs cells that make IF.
The treatment for pernicious anemia is a two-part process. Your doctor will treat any existing vitamin B deficiency. Vitamin B injections can be given daily or weekly until the B levels return to normal or close to normal.
During the first few weeks of treatment, your doctor may recommend limiting physical activity. After your vitamin B levels are normal, you may only need to get the shot once per month.
You may be able to administer the shots yourself or have someone else give them to you at home to save you trips to the doctor. After your B level is normal, your doctor may recommend you take oral doses of B supplements instead of the injection. However, depending on how deficient you are in intrinsic factor, where you then may have poor intestinal absorption of vitamin B due to this, you may require vitamin B injections as your sole treatment of pernicious anemia.
Your doctor will likely want to see you on a long-term basis. This will help them identify possible serious effects of pernicious anemia. A dangerous potential complication is gastric cancer. They can monitor you for symptoms of cancer at regular visits and through imaging and biopsies, if needed. Many people with pernicious anemia require lifelong treatment and monitoring.
This can help prevent long-term damage from setting in to different body systems.
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