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Edwin Trinidad
Topic Conference 1: Anemias Exam 1
mortality and morbidity associated with IDA. It is common reticuloendothelial system) and the body recycles the
in toddlers, adolescent girls and women of childbearing released iron.
age.
The National Nutrition Survey (1998) conducted There is no excretory pathway for iron. The only
by the Food and Nutrition Research Institute, Department mechanisms by which iron is lost from the body are blood
of Science and Technology revealed that the following
loss and the turnover of epidermal cells from the skin and
groups were anemic or suffering from IDA:
gut. The amount of dietary iron required to replace
5-6 out of 10 infants aged 6 months to less ongoing losses averages about 1.0 mg among men and
than 1 year 1.4 mg among women of childbearing age, equivalent to
3 out of 10 children aged 1 to 5 years the amount absorbed in the diet. The following figure
3 out of 10 young children aged 6 to 12 summarizes the process or iron absorption, usage, and
years
storage.
3 out of 10 teenagers aged 13 to 19 years
2-3 out of 10 adults aged 20 to 59
3-4 out of 10 older persons aged 60 years Figure 1.
and over
5 out of 10 pregnant women
4-5 out of 10 lactating women
stores are absent and serum ferritin levels are below 15 Anemia develops slowly after the normal stores
μg/L. Hemoglobin synthesis is impaired when transferrin of iron have been depleted in the body and in the bone
saturation drops to 15-20%. marrow. Women of child-bearing age, in general, have
smaller stores of iron than men and have increased loss
In iron-deficiency anemia, iron stores are through menstruation, placing them at higher risk for
already inadequate to maintain hemoglobin production. anemia than men. Other high-risk groups include pregnant
This stage is reflected by low hemoglobin and hematocrit or lactating women who have an increased requirement
levels. Microcytic red cells and hypochromic reticulocytes for iron, infants, children, and adolescents in rapid growth
begin to appear. Transferrin saturation is now at 10-15%. phases and those with a poor dietary intake of iron.
When there is moderate anemia (hemoglobin of 10-13
g/dL), the bone marrow remains hypoproliferative. With IDA during infancy
severe anemia (hemoglobin of 7-8 g/dL), there is
prominent hypochromia and microcytosis. Target cells
Iron deficiency anemia is a common
and poikilocytes also appear on the blood smear. The
nutritional deficiency that affects children, especially
erythroid marrow also becomes more inefficient. Erythroid
during the first two years of life (around 6-20 months).
hyperplasia of the marrow, instead of hypoproliferation,
There are several factors affecting the development of
occurs with prolonged IDA.
IDA in infants, such as sex (more common in males),
Figure 2. Comparison the 3 stages of iron rate of weight gain (faster gain associated with IDA),
deficiency term, iron stores of the mother, and episodes of intra-
and/or extrauterine bleeding.
ensure an adequate intake of iron in their diet. Iron is the signs and symptoms of iron-deficiency anemia are true
necessary for the formation of maternal and fetal for all kinds of anemia.
hemoglobin, the oxygen-carrying component of blood.
Normally during pregnancy, erythroid hyperplasia of The main manifestations in EM’s case were the
the marrow occurs, and RBC mass increases. following: fainting, dizziness, exertional dyspnea, pale
However, a disproportionate increase in plasma
conjunctiva, pale nail beds and a soft systolic murmur.
volume results in hemodilution (hydremia of
pregnancy). Since a woman's blood volume
increases by 25 to 50 percent during pregnancy, and The major symptom of all types of anemia,
the baby is manufacturing blood cells too, more iron is including iron-deficiency anemia, is fatigue (feeling tired).
needed to make more hemoglobin for all that Fatigue is caused by having too few red blood cells to
additional blood. The increased need for iron puts the carry oxygen to the body. This lack of oxygen in the body
mother at risk for anemia. Furthermore, during the last can cause people to feel weak or dizzy, have a headache,
trimester, the baby draws from the mother some of or even pass out when changing position (for example,
the iron reserves that it will need during the first four
to six months of life. Thus, it is really essential that the standing up).
mother has sufficient iron stores all throughout the
pregnancy. The increased blood volume and iron Since the heart must work harder to move the
stores will also help the mother’s body adjust, to some reduced amount of oxygen, signs and symptoms may
degree, to the blood loss that occurs during childbirth. include shortness of breath and chest pain. This can lead
to a fast or irregular heartbeat or a heart murmur.
The causes of IDA during pregnancy may be
poor intake of iron, loss of blood from bleeding In anemia, the red blood cells don't have enough
hemorrhoids or gastrointestinal bleeding. Maternal hemoglobin. Common signs of lack of hemoglobin include
iron deficiency anemia is associated with an pale skin, tongue, gums, and nail beds. Pallor of the skin
increased incidence of anemia in the baby during the may be difficult to appreciate in dark skinned individuals,
first year of life. Pregnant women with iron deficiency
therefore scleral or palmar pallor may be more reliable as
anemia, particularly in the first and second trimesters,
have an increased risk for premature delivery and for a finding.
delivering a low-birth weight infant.
Other Signs and Symptoms of Anemia
IDA during lactation
Other signs and symptoms of anemia can include:
Studies have shown that anemia is common Cold hands and feet as well as brittle nails
among lactating women. Ensuring adequate intake of Swelling or soreness of the tongue and cracks in the sides
all hemopoietic nutrients during lactation is also of the mouth
critical. The benefits of iron supplementation during An enlarged spleen
Frequent infections
pregnancy to reduce the risk of anemia during
Additional findings include blue sclera, koilonychias,
pregnancy and improve iron stores beyond 6 months
angular stomatitis, and functional gastrointestinal tract
postpartum are well established. Although providing
abnormalities.
supplements during lactation is not contraindicated,
the efficiency of absorption is much higher during
pregnancy. In contrast to iron, the requirements for Signs and Symptoms of Iron-Deficiency Anemia
folate and vitamin B12 are increased during lactation.
Symptoms of iron-deficiency anemia include
The iron content of breastmilk is relatively unusual cravings for nonfood items such as ice, dirt, paint,
protected and not influenced by maternal nutritional or starch. This craving for nonfood items is called pica.
status, but depletion of maternal stores can result
among poorly nourished women who are already Another symptom of iron-deficiency anemia is
anemic prior to lactation. A randomized clinical trial of developing restless legs syndrome (RLS). RLS is a
pregnant women showed that iron supplementation disorder that causes an uncomfortable feeling in the legs
during the last trimester of pregnancy did not alter the that can only be relieved by movement. Sleep is difficult
concentrations of iron, copper, selenium and zinc in for people with RLS.
breast milk. In contrast, there is evidence that the
Age of onset of anemia is an important clue, as
breast milk level of other hemopoietic nutrients such
iron deficiency is uncommon before 4 to 6 months of age
as folic acid, vitamin A and vitamin B12 are affected
in the absence of prematurity. In infants and young
by maternal status.
children, signs and symptoms include a poor appetite,
being irritable, and a slower rate of growth and
* See Appendix 2 for Pathologic Correlation for EM’s development.
Case
Some of the signs and symptoms of iron-
V. Clinical Manifestations
deficiency anemia are related to its causes, such as blood
Signs and symptoms of anemia depend on the loss. Blood loss is most often seen with very heavy or long
severity of the condition. People with mild anemia or lasting menstrual bleeding or vaginal bleeding in women
anemia that has come on very slowly may have no after menopause. Other signs of internal bleeding are
symptoms at all. However, if the anemia is severe, the bright red blood in the stool or black, tarry-looking stools.
symptoms increase and become more serious. Many of
Diagnostic Work-Up
I. CBC count
For EM’s case, the main cause of IDA is blood loss due to prolonged menstruation, a result of irritation to the
intrauterine lining from the inserted IUD. The following figure summarizes the pathogenesis of EM’s condition.
Menorrhagia
Menses prolonged for 7 days;
(6 napkins/day) fully soaked decreased hematocrit; increased turbulence
w/ blood for first 4 days decreased blood viscosity
Fainting
Appendix 3.