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Source: Cook K, Ineck BA, Lyond WL. Anemias. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8 ed. http://www.accesspharmacy.com/content.aspx?aid=7999561. Accessed June 12, 2012.

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  • Decreased oxygen-carrying capacity of blood characterized by a decrease in hemoglobin (Hb) or red blood cells (RBCs)
  • World Health Organization (WHO) definition
    • Men: Hb <13 g/dL (<130 g/L; <8.07 mmol/L)
    • Women: Hb <12 g/dL (<120 g/L; <7.45 mmol/L)

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  • Microcytic anemia resulting from iron deficiency or impaired iron utilization

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  • Result of long period of negative iron balance
    • Excessive blood loss
      • Hemorrhage
      • Trauma
      • Peptic ulcer
      • Gastritis
      • Hemorrhoids
    • Chronic hemorrhage
      • Vaginal bleeding
      • Peptic ulcer
      • Intestinal parasites
      • Aspirin and other NSAIDs
    • Excessive RBC destruction
    • Inadequate production of mature RBCs; result of nutrient deficiency
  • Three phases:
    • Iron stores are reduced without reduced serum iron levels.
      • Assess with serum ferritin.
    • Iron stores are depleted, resulting in iron deficiency
      • Assess with serial CBC measurements; Hb may still be in normal range.
    • IDA diagnosed: Hb falls to less than normal values.

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  • Iron deficiency is most common nutritional deficiency.

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  • Age
    • Children <2 years
    • Adolescent girls
    • Adults >65 years
  • Pregnancy/lactation

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  • Severity of symptoms does not always correlate with degree of anemia.
    • Elderly may not tolerate levels of Hb tolerated by younger patients.
    • Patients with cardiac or pulmonary disease may be less tolerant of mild anemia.

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  • Rapid onset of anemia, observable in cardiorespiratory symptoms:
    • Tachycardia
    • Palpitations
    • Angina
    • Hypotension
    • Lightheadedness
    • Breathlessness
    • Hypovolemia (with acute bleeding)
  • Chronic onset of anemia
    • Fatigue
    • Weakness
    • Headache
    • Symptoms of heart failure
    • Vertigo
    • Faintness
    • Sensitivity to cold
    • Pallor
    • Loss of skin tone
  • Manifestations of IDA (Hg ≤9 g/dL [90 g/L; 5.59 mmol/L])
    • Glossal pain
    • Smooth tongue
    • Reduced salivary flow
    • Pica (compulsive eating of nonfood items)
    • Pagophagia (compulsive eating of ice)

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Means of Confirmation and Diagnosis

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Laboratory Tests

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  • CBC (Table 1)
    • Focus on Hb, hematocrit (Hct) and RBC indices
    • May initially be normal and then decrease as anemia progresses.
  • Reticulocyte index
  • Stool sample (for occult blood)
  • Serum iron (low with IDA)
  • Ferritin
    • Low with IDA
    • Earliest and most sensitive indicator of iron deficiency
    • Interpret in conjunction with transferring saturation and TIBC.
  • Transferrin saturation (serum iron divided by TIBC)
  • Total iron binding capacity (high with IDA)

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Table Graphic Jump Location
Table 1. Normal Hematologic Values

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