hey everybody let's talk about iron deficiency anemia so in previous videos we have talked about anemia what's anemia also microcytic anemia iron studies so if you need anything from previous subjects please go ahead and watch previous videos first so this one can make sense let's talk about iron deficiency anemia tired and pale pale and tired some quick facts are about iron deficiency anemia it's the most common cause of anemia worldwide in the developing world it's usually nutritional like nutritional deficiency in the developed world it's usually a cube blood loss from GI bleeding or peptic allor specially peptic ulcer disease it's the most common cause of nutritional deficiency world wide there is population includes females why menstruation children why decrease intake high demand because they are growing what are the causes imagine that you are a businessman so when you have problem it's either decrease supply or increase demand or loss decrease apply is jazz nutritional deficiency or malabsorption I'm not getting enough iron or I'm getting enough iron but I cannot absorb it what's the difference it's basically the same increase demand such as increase utilization I need more iron now I need more and more or loss such as blood loss or hemolysis the RBC's are being destroyed so the causes of iron deficiency anemia or decrease supply increase demand or loss decrease supply we said nutritional deficiency or mal observe the traditional deficiency it says prematurity premature babies are more risk from getting our deficient singing poverty and nutritional deficiency are not getting enough food or enough minerals also old age the same problem as the kids diet some people who are strict vague ends they are not getting enough heme iron so as we have said before there are two types while the heme that we get from meat products and the non heme from the vegetables the heme iron is better absorbed than the none heme so people who are strict bagans they eat only vegetables there increased risk of getting iron deficiency anemia male absorption such as celiac disease or post gastric surgery have a increased demand increase utilization such as pregnancy so the lady is not only feeding her body she's feeding to body issues she needs more are also lactation same concept growth I'm needing more iron because I'm building new cells loss such as blood loss or intravascular hemolysis blood loss such as peptic ulcer disease meckel's diverticulum peptic ulcers usually in adults Michaels and kids because Michaels has some gastric tissue and them sometimes so they can bleed hookworm infection hookworm such as ancylostoma or Nicator americans and so lost my dog Nellie or Nicator Americans colon polyps can bleed colon cancer of course can't believe they relate to blood loss which will lead to our deficiency ending intravascular hemolysis has to be intravascular so the blood will get broken down then eventually they will go through the kidney and they will lose a lot of iron there so we have microangiopathic hemolytic anemia and a condition called paroxysmal nocturnal hemoglobinuria these are the causes of our deficiency anemia decrease supply increased demand or blood loss let's review so hemoglobin consists of heme and globin him consists of iron and protoporphyrin so when I have iron deficiency anemia iron will be decreased him decreased hemoglobin decreased that's why it's anemia anemia low hemoglobin and hematocrit by definition hello Ben will be normal okay since proto poor friend will not have enough iron to bind with form him proto poor friend also to pile up okay okay I'm at two pieces we have pro-arab last all the way down to the mature erythrocyte cells start up big then they get smaller and smaller and smaller so here is the mature red blood cell the cells are waiting for cell division and they're waiting for iron so if iron is not coming they will keep decreasing in size like this like this we end up with small cells that why that's why it's called microcytic anemia they are stopped waiting for iron by the same token them being so small we'll get the hemoglobin inside them to look relatively bigger so they are trying to mitigate the problem clinically our deficiency anemia such as any like any other anemia turning pale pale and tired sometimes I have angina sometimes I have weak irritable exercise intolerance we have sometimes other associations such as plumber Vincent syndrome with esophageal whips glossitis colitis inflammation of that tongue and the lips restless leg syndrome for an unknown reason restless leg syndrome is associated with iron deficiency anemia this is high-yield a claw Hydra we have talked about iron absorption we have mentioned that HCl is necessary to convert the ferric are into the for us which is more readily absorbed also there is an association with celiac disease as we have mentioned it's a mail absorption problem we have spoon-shaped nails called coil Oh Nakia coil Oh Nakia coiled nail be Turia you know ten percent of the general population when they ate beads they get red urine in art efficiency anemia almost all of them will get the beat turian Hika Hika is craving for ice not just ice but any ice containing drink such as ice coffee they just create they just want the ice why I don't know so remember these associations also the pica or pica is also known as pack go Faiza hematology is all about lab results the story of iron that we have iron the serum gets on transferring the bounding protein then gets stored in the tissue as ferritin so as an anemia what will happen to him or globin and hematocrit they'll both be too Christ that's a given MCV since it's a microcytic MCB is below MCH and MCHC they'll be hello it's an iron deficiency anemia it's an enum reticulocytes will be low why is that I don't have enough iron to make match your RBC's or even immature abuse you don't have enough iron period white blood cells are usually normal except there is one exception I'll mention it later platelets platelets may get slight increase why is that because sometimes the erythropoietin is very similar to thrombopoietin okay that's a theory other theory is that the now anemia the blood is very thin let's try to make it thicker and more dense by producing more cells i cannot produce RBC's at least i can produce more platelets what about the iron studies that's crucial serum are definitely decreased okay it's iron deficiency how about firt in the store dire the store comes from work from the serum so they're decreased how about TI BC the liver recognizes the problem says hey we're not having iron let's get more carriers to try to catch the last iron molecule left let's try our best so TI BC is increase and as we have said before 13 + TI BC are always inversely related to each other percent saturation of course is decreased because percent saturation is the iron on the transferrin and since iron is decreased and gob sees increased the ratio of course will be decreased how about this one the soluble transferrin receptor as say this one we'll be increased in our deficiency anemia but normal in an emu of chronic disease as we've said before rtw rtw is the variation in the sizes of red blood cells and if you go back to our video when I've talked about our RDW rome did not fall in a day and neither did the bone marrow so it happens gradually there is a wide variation so the early W is high but wait there is an important piece of information here firuzan is an acute phase reactants data influenced by interleukin 6 so if I have a patient with iron deficiency anemia I expect dry ferritin below however if he has concurrent information maybe further will be high oh how can I know it will be not be anchored it will not be helpful that's why the soluble transferrin receptor s say his actor is not influenced by interleukin 6 so you'll have this one will be high okay so that's how you know the difference so long story short do not rely in ferritin if you have ongoing inflammation we're all did not fall in a day neither did the bone marrow start as normal setting then become micro setting microcytic cells have increased central pallor and since protoporphyrin is left alone start to pile up so we have increased free erythrocyte protoporphyrin there is no iron to join it poor protoporphyrin you'll be left alone once the most accurate tests diagnose our deficiency anemia is bone marrow biopsy and by the way it's very painful the various teams very sensitive to pain so do we usually do bone marrow biopsy just to diagnose deficiency anemia no there is an easier way to diagnose it what give the patient iron if they improve its art efficiency anemia bingo okay what will happen if we did a bone marrow biopsy in a patient with iron deficiency we will have depleted iron stores evident on the biopsy okay we've mentioned that iron deficiency anemia usually have normal white blood count but there is one exception you know what's that yes when there is a hook warm infection poke warmth such as and Celeste ma Duat Nellie and Nicator Americans what's the treatment of our deficiency anemia we start with oral for a sulfate and has side effects yes sometimes dairy or constipation black stool since iron will come in the store however this is guaiac negative stool why because it's just iron there is no blood remember guaiac stool test detects RBC's haemoglobin myoglobin since we have only our install will be guaiac negative failure of treatment sometimes because patients are not compliant with the treatment okay also blood loss if it's going on it will not fix it just to give him iron absorption problem this is very important the resistant cases to treatment usually have celiac diseases okay what if first one failed let's start inner muscular intramuscular intravenous iron what's the biggest side effect anaphylaxis especially if it contains dick strain that's it that's iron deficiency please subscribe there are new videos coming every week thank you for your support I'll see you in the next video to continue talking about microcytic anemia