Pathology
Haematology
In iron deficiency anaemia, which of the following would you NOT expect to see:
Answer:
Typical features:- Hypochromic microcytic anaemia
- Blood film appearances: hypochromic/microcytic cells, anisocytosis/poikilocytosis, target cells, 'pencil' cells
- Iron status
- ↓ Serum ferritin
- ↓ Serum iron
- ↑ Transferrin
- ↓Transferrin saturation
- ↑ Total iron binding capacity (TIBC)
Iron Deficiency Anaemia
Pathology / Haematology / Anaemia
Last Updated: 16th July 2019
Iron deficiency anaemia is the most common cause of microcytic anaemia and of any anaemia worldwide.
Causes
- Inadequate Intake:
- Dietary iron deficiency is fairly uncommon in the UK
- Growing children and elderly people with iron-poor diets may become deficient
- Excessive requirements:
- Pregnancy, menstruation, lactation
- Times of rapid growth in children
- Exfoliative skin disease
- Malabsorption:
- Drugs e.g. tetracyclines, quinolones, antacids and proton pump inhibitors
- Partial or total gastrectomy
- Coeliac disease, inflammatory bowel disease (IBD), gastritis
- Excessive loss:
- Blood loss from the gastrointestinal (GI) tract is the most common cause of iron deficiency anaemia in adult men and postmenopausal women.
- Blood loss due to menorrhagia is the most common cause of iron deficiency anaemia in pre-menopausal women.
- In tropical countries, infestation of the gut is a common cause of iron deficiency, especially with hookworm and schistosomiasis.
Clinical Features
- General features of anaemia
- Specific features of iron deficiency:
- koilonychia (spoon-shaped nails with longitudinal ridging)
- angular cheilitis (ulceration at the corners of the mouth)
- atrophic glossitis (painful smooth red tongue)
- pica (unusual dietary cravings)
- hair thinning
Laboratory Findings
- Hypochromic microcytic anaemia
- Blood film appearances: hypochromic/microcytic cells, anisocytosis/poikilocytosis, target cells, 'pencil' cells
- Iron status
- ↓ Serum ferritin
- ↓ Serum iron
- ↑ Transferrin
- ↓Transferrin saturation
- ↑ Total iron binding capacity (TIBC)
Ferritin, Transferrin and Iron Levels
The key parameters of iron status are the serum ferritin, transferrin and iron levels.
Ferritin is the main storage protein for iron and therefore roughly correlates with the amount of tissue-storage iron. However ferritin is also an acute phase reactant, which is typically raised in infection and inflammation. Thus normal serum ferritin levels may be found in the presence of reduced iron stores in for example infection or malignancy.
Serum iron also falls in the context of iron deficiency, but there is often marked diurnal and day-day changes in serum iron concentration, making it an unreliable indicator of iron status when assayed alone. Serum iron can however be interpreted in the context of the transferrin concentration, to give a measure of transferrin saturation.
Transferrin, synthesised in the liver, is generally increased in states of iron deficiency, and together with the reduced serum iron, this leads to an increased total iron binding capacity (TIBC) and a reduction in transferrin saturation (where levels < 20% generally represent iron depletion). This can also be unreliable in isolation as chronic liver disease and chronic inflammatory states will cause the serum transferrin level to fall, while its production is often increased in women taking the OCP.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
