11 Microcytic Anemia
![](https://photos.thisispiggy.com/file/wikiFiles/CDBTWtf.jpg)
- liquid plasma at top of tube
- % occupied by red cells compared to whole = hematocrit
![](https://photos.thisispiggy.com/file/wikiFiles/vep3Agz.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/GoNUzMA.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/JBaEbSY.jpg)
- MCV: mean amount of volume in RBC, not total volume
- MCHC: ratio of MCH/MCV
![](https://photos.thisispiggy.com/file/wikiFiles/K5b0kTT.jpg)
- MCV most important
- iron deficiency/anemia of chronic disease: both microcytic and normocytic
Microcytic Anemia
![](https://photos.thisispiggy.com/file/wikiFiles/w4HY50Z.jpg)
- when not enough hemoglobin, RBC precursor undergoes extra devision, smaller RBC
- histology: larger pale areas
![](https://photos.thisispiggy.com/file/wikiFiles/xpTLMN8.jpg)
- if any of the 3 main components deficient, anemia
- protoporphyrin: surrounds iron in heme
- loss of heme: lead poisoning, sideroblastic anemia
![](https://photos.thisispiggy.com/file/wikiFiles/qRJWpUD.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/K5b0kTT.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/aySrJmE.jpg)
Iron Deficiency
![](https://photos.thisispiggy.com/file/wikiFiles/nSbZOfo.jpg)
- absorbed in 2 forms
- heme: iron in center of heme, found in flesh of other animals
- absorbed in duodenum
![](https://photos.thisispiggy.com/file/wikiFiles/dwlFYb3.jpg)
- enterocyte uptake main way of regulation
- ferroportin controls amt of iron released from duodenal cells into body
![](https://photos.thisispiggy.com/file/wikiFiles/JtHUnMp.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/DLqsqqZ.jpg)
Cause
![](https://photos.thisispiggy.com/file/wikiFiles/rvJbt6q.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/oxq5C5p.jpg)
- new born babies deplete iron store from mother in 6 months of age
![](https://photos.thisispiggy.com/file/wikiFiles/QGpvri2.jpg)
- loss of acid: gastrectomy/PPI
![](https://photos.thisispiggy.com/file/wikiFiles/wTITGhx.jpg)
- loss most common cause
- colon cancer: very important/dangerous. Initial presentation
- unexplained iron deficiency anemia: colon cancer workup
![](https://photos.thisispiggy.com/file/wikiFiles/rFcgSpr.jpg)
- losing more iron than taking in
![](https://photos.thisispiggy.com/file/wikiFiles/GEL9Og4.jpg)
- % sat low under pregnancy/OCP use, misleading for iron deficiency anemia
- use ferritin for diagnosis in pregnancy/OCP
![](https://photos.thisispiggy.com/file/wikiFiles/Nm0zFry.jpg)
Pathogenesis
![](https://photos.thisispiggy.com/file/wikiFiles/q8ioMAk.jpg)
- 1st thing: deplete body storage
- eventually ferritin storage depleted, and serum iron begin to drop
Diagnosis
![](https://photos.thisispiggy.com/file/wikiFiles/zQz4kTN.jpg)
- fewer RBC produced
- everything is low
- initially make fewer RBC but maintain size
![](https://photos.thisispiggy.com/file/wikiFiles/WhSDwEM.jpg)
- some cells find iron to form normal amount of hemoglobin = normal in size
- other cells deficient in iron = small
- can be seen in any nutritionally caused anemia
- thalassemia: normal, deficient production of globin chain, all RBC same problem
![](https://photos.thisispiggy.com/file/wikiFiles/dxW87IL.jpg)
- not enough iron around: elevated protoporphyrin levels
![](https://photos.thisispiggy.com/file/wikiFiles/ZyZ2dFm.jpg)
- hemochromatosis: iron overload
Treatment
![](https://photos.thisispiggy.com/file/wikiFiles/tv829Hs.jpg)
Anemia of Chronic Diseases
![](https://photos.thisispiggy.com/file/wikiFiles/Dn9duoO.jpg)
- mild anemia
- severe anemia: unlikely microcytic
![](https://photos.thisispiggy.com/file/wikiFiles/kwWTms4.jpg)
- rising cytokines
- RBC don't live as long
- EPO rise higher in iron deficiency anemia compared to rise in chronic disease anemia
![](https://photos.thisispiggy.com/file/wikiFiles/okGPqLT.jpg)
- ferroportin lets iron out in enterocytes and macrophages
- rise in ferritin: opposite of iron deficiency
![](https://photos.thisispiggy.com/file/wikiFiles/WaoM3wV.jpg)
Diagnosis
![](https://photos.thisispiggy.com/file/wikiFiles/I8ItZGY.jpg)
- in real life: ferritin is acute phase reactant, increase not representative. Step 1, ferritin is chronic disease
- TIBC: low, total body storage is high
![](https://photos.thisispiggy.com/file/wikiFiles/ZyZ2dFm.jpg)
- hemochromatosis: iron overload
Lead Poisoning
![](https://photos.thisispiggy.com/file/wikiFiles/maO6q7Y.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/eXRICfn.jpg)
- heme derived from succinyl coa and glycine
- inhibition of D-ala dehydratase and ferrochelatase: low Heme
- increased activity of ALA synthase: build up of D-ALA
![](https://photos.thisispiggy.com/file/wikiFiles/MQaNUdl.jpg)
- protoporphyrin: also used to screen iron deficiency
![](https://photos.thisispiggy.com/file/wikiFiles/JBYRemk.jpg)
Symptoms
![](https://photos.thisispiggy.com/file/wikiFiles/XBmOfca.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/iccuGpS.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/UUCowT1.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/Osduvxp.jpg)
Sideroblastic anemia
![](https://photos.thisispiggy.com/file/wikiFiles/GsVLQuV.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/L2U9TNH.jpg)
![](https://photos.thisispiggy.com/file/wikiFiles/JTN8fgt.jpg)
- B6 co factor
- lead poisoning: underproduction of protoporphyrin
![](https://photos.thisispiggy.com/file/wikiFiles/sHr1QH7.jpg)
- B6 activates available ALA synthase
Diagnosis
![](https://photos.thisispiggy.com/file/wikiFiles/lfbeWu9.jpg)
- lead poisoning sideroblastic: can have high protoporphyrin
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