This document discusses iron deficiency anemia, including its morphological classification, red blood cell indices, causes, pathogenesis, physical findings, and management. It notes that iron deficiency anemia results in microcytic hypochromic anemia with a low MCV and MCHC. The progression involves depletion of iron stores, decreased ferritin and iron, and increased TIBC, eventually resulting in microcytic hypochromic anemia seen on peripheral smear. Common physical findings include angular stomatitis, glossitis, koilonychia, and atrophic gastritis. Treatment involves iron supplementation orally or intravenously, with blood transfusion for severe anemia.

1. IRON DEFICIENCY ANEMIA

2. MORPHOLOGICAL CLASSIFICATION
OF ANEMIA

3. RED CELL INDICES
• Microcytic anemia have MCV < 80 fL and macrocytic anemia have MCV> 100
fL.
• MCH < 26 pg is seen in microcytic anemia and MCH > 33 pg is seen in
macrocytic anemia. It is of limited value in differential diagnosis of anemias
• MCHC<31 g/dL is seen in hypochromic RBC such as IDA and thalassemia.
MCHC >36 g/dL is an indication of hyperchromic RBCs. It is a better indicator
of hypochromasia than MCH
4. Red Cell Distribution Width (RDW)
•• RDW is a quantitative measure of anisocytosis. •• Normal RDW is 11.5% to
14.5%.
•• A normal RDW indicates that RBCs are relatively uniform in size. A raised RDW
indicates that red cells are heterogeneous in size and/or shape. In early iron
deficiency anemia, RDW increases along with low MCV while in thalassemia
trait, RDW is normal with low MCV.

4. CAUSES OF IRON DEFICIENCY
ANEMIA

5. PATHOGENESIS OF IRON DEFICIENCY ANEMIA
Stages of IDA in sequence: absent of iron
stores→ decreased serum ferritin→ decreased
serum iron→ increased TIBC → decreased iron
saturation→ microcytic hypochromic anemia.

7. DIAGRAMMATIC APPEARANCE OF PERIPHERAL
BLOOD SMEAR
WITH MICROCYTIC HYPOCHROMIC RED BLOOD
CELLS

8. REDUCED: SERUM IRON,
FERRITIN, % TRANSFERRIN
SATURATION.
INCREASED: TIBC, TFR AND
RED CELL PROTOPORPHYRIN.

9. CLINICAL FEATURES OF IDA
• Nonspecific and related to both severity and the cause of the anemia (e.g.
gastrointestinal disease)
• •• Onset: insidious.
• •• Nonspecific symptoms: fatigue, palpitations, breathlessness, weakness and
irritability.
• •• Pharyngeal/esophageal webs formed cause dysphagia.
• •• Patterson-Kelly or Plummer-Vinson syndrome:
• –– Microcytic hypochromic anemia
• –– Atrophic glossitis
• –– Esophageal webs
• •• Congestive heart failure in severe anemia.
• •• Central nervous system: pica-unusual craving for substances with no
nutritional value like clay or chalk. Craving for ice (pagophagia) specific to iron
deficiency. Pica may be the cause rather than effect of IDA.

10. PHYSICAL FINDINGS
• Diminished tissue enzymes cause characteristic epithelial changes of iron deficiency
anemia.
• •• Angular stomatitis and glossitis
• •• Chronic atrophic gastritis
• •• Koilonychia (spoon nails)
• Koilonychia (spoon nails) is a physical finding seen in iron deficiency. First fingernails
become thin and flat-platonychia, then brittle and finally spoon shaped.

11. ADDITIONAL HX IN ANEMIA

12. HX IN ANEMIA

15. MANAGEMENT
• Treatment of the cause
• Oral Ferrous sulphate 200 mg – 1+1+1 B/M
• Check Hb after 4-8 weeks and then continue for 3-6 months
• IV Iron if Severe anemia/late stage of
pregnancy/intolerance/CRF/malabsorption : 500 mg Iron carboxymaltose
with DA or NS
• Blood transfusion if Hb less than 7 or
Angina
Heart failure
Evidence of cerebral hypoxia