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Hematopathology — Image #12 — Iron Deficiency Anemia

Iron Deficiency

Iron Deficiency

Iron Deficiency

Iron deficiency can be seen with loss (eg. hemorrhage) or inadequate intake or absorption of iron. The red cells become microcytic and hypochromic. Microcytes have a diameter less than 6µ, a MCV less than 82 fL. Reduced MCHC reflects their hypochromic state. On the blood smear the cells are sparce and far apart, reflecting their reduced numbers. They are small and show only a thin rim of hemoglobin. The Hb in photo above was only 4.0 mg/dL. What symptoms would you expect? In early iron deficiency the RDW will be increased, as new, small, iron deficient cells circulate with older, normal cells. Also, curiously, platelets are transiently increased. Iron studies will show:

  • Decreased serum iron
  • Decreased serum ferritin*
  • Increased transferrin (total iron binding capacity)
  • Reduced % transferrin saturation

*Caution: ferritin can be elevated in infection and other stressful condition - It is one of the acute phase reactants. Severe depletion may require transfusion of PRBCs (packed red blood cells). Mildly symptomatic patients may increase meat in their diets, or take an iron supplement. Vitamin C enhances iron uptake.

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