CWM Hospital Fiji School of Medicine Depts' of Medicine

1
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 6/3/2002

• Severe Iron Deficiency Anemia. (IDA)

2
History

• 27 Year old Fijian Male
• Generalised weakness, anorexia, loss of appetite
  since few weeks.
• History of eating mud Pica
• No organomegaly, marked skin pallor
• Moderate cardiac failure.

3
Full Blood Count

• Hemoglobin 1.4gm
• WBC 10,700/cumm Neut 90, Lymph 10
• RBC count 0.86 millions/cumm
• PCV 5
• MCV 61 fl
• MCHC 27
• Retics 7.2 (uncorrected)
• Platelets 314,000/cumm

4
Blood Film Morphology

• Marked Microcytic Hypochromic
• Anisopoikilocytosis, Tear drop, pencil, target
  forms., few schistocytes (fragments)
• Polychromasia, many nucleated RBC (12/100 WBC)
• Occassional immature myeloid cell.
• WBC- Increased, neutrophilia.
• Platelets normal in number and distribution.

5
IDA - Blood Smear

• Note scanty cells Low RBC count (0.85m)
• Microcytic hypochromic
• Marked anisocytosis.
• Target forms
• Elongated pencil forms

6
IDA - Blood Smear

• Note scanty cells Low RBC count (0.85m)
• Microcytic hypochromic
• Marked anisocytosis.
• Normal neutrophil

7
IDA - Blood Smear

• Note scanty cells Low RBC count (0.85m)
• Microcytic hypochromic
• Marked anisocytosis.
• Pencil forms
• Normal neutrophil

8
IDA - Blood Smear

• Note scanty cells Low RBC count (0.85m)
• Target forms
• Aniso-poikilocytosis
• Pencil forms

9
IDA - Blood Smear

• Note scanty cells Low RBC count (0.85m)
• Aniso-poikilocytosis
• Nucleated RBC
• Target form

10
IDA - Blood Smear

• Note scanty cells Low RBC count (0.85m)
• Aniso-poikilocytosis
• Pencil forms
• Tear drop forms

11
Iron Deficiency Anemia

• Most abundant metal, common deficiency..!
• Limited absorption and no excretory mech.
• Recycling of iron dead cells to new cells
• 1mg/day ? 3-6G body ? 1mg/day

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Iron Metabolism

• 10 of the 10 to 20 mg of dietary iron is
  absorbed each day to balance the 1 to 2 mg daily
  loss.
• Iron is absorbed in Jejunum.
• Stored as Ferritin Hemosiderin.
• Laboratory tests
• Serum iron(1mg/l)
• Serum iron binding capacity (3mg)
• Serum ferritin (gt20ug)

13
Causes of Iron deficiency Anemia

• Chronic Blood loss parasites, ulcers, hernia,
  drugs (NSAID), Carcinoma, colitis, diverticulosis
  etc. Rarely hematuria.
• Increased need Pregnancy, children
• Malabsorption gastrectomy, coeliac disease.
• Poor diet Contributory but rarely the sole
  cause.

14
Clinical Features

• Anemia
• Pallor, Weakness, Lethargy
• Breathlessness on exertion
• Palpitations may lead to heart failure - edema
• Iron Deficiency Anemia
• Angular cheilosis, atrophic glossitis,
• dysphagia, kiolonychia(spoon nails), gastric
  atrophy.
• Oesophageal web (Plummer Vinson sy)