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Snapshot
  • A 28-year-old woman presents to her primary care physician with fatigue and pelvic pain. She states that her menses has been more painful with increased bleeding. On physical exam there is conjunctival pallor and diffuse uterine enlargement that is tender to palpation. Laboratory testing is significant for a microcytic anemia and negative β-hCG. (Adenomyosis leading to iron deficiency anemia.)
Introduction

  • A microcytic anemia
    • as a result of decreased heme synthesis
  • Most common anemia worldwide
  • Causes include
    • chronic blood loss
      • colon cancer until proven otherwise in elderly 
      • PUD
      • menstruation
      • hookworm infestation
    • dietary deficiency
    • celiac sprue
  • Stages of disease (from earliest to latest)
    • consumed iron stores
    • ↓ serum ferritin/serum iron levels
    • normocytic normochromic anemia
    • microcytic hypochromic anemia
Presentation
  • Symptoms
    • fatigue
  • Physical exam
    • tachycardia
    • smooth tongue
    • spoon/brittle nails (koilonychia)
    • esophageal webs
    • pallor
    • pica (craving for ice chips)
Evaluation
  • Labs
    • Elevated
      • TIBC
      • RDW
      • serum free erythrocyte protoporphyrin (FEP)
        • lack of iron to incorporate results in free protoporphyrin release
    • Low
      • serum iron
      • serum ferritin
      • reticulocyte count 
        • due to decreased production (no iron to support)
  • Blood smear shows
    • hypochromatic RBCs
      • doughnut cells - large central area of pallor
      • not seen immediately
    • moderate poikilocytosis
Treatment
  • Medical
    • iron sulfate
Prognosis, Prevention, and Complications
  •  Plummer Vinson syndrome 
 

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