철분 결핍 빈혈: 철분 결핍 빈혈: 원인, 증상 및 진단

철분 결핍성 빈혈은 공급 감소, 수요 증가 또는 출혈로 인해 전 세계적으로 가장 흔하게 발생하는 질환입니다.

### 철분 결핍 빈혈: 원인, 임상적 특징, 검사 결과 및 치료법
* 🌍 철분 결핍성 빈혈은 전 세계적으로 가장 흔한 빈혈로, 개발도상국에서는 영양 결핍이 주요 원인이며 **선진국에서는 소화성 궤양과 같은 위장관 출혈**로 인한 급성 출혈이 주요 원인으로 꼽힙니다.
* 👩 철분 결핍 빈혈의 고위험군에는 **월경으로 인한 여성, 성장기 철분 섭취량 감소와 높은 수요**로 인한 어린이, 철분 수요 증가 또는 손실이 있는 개인이 포함됩니다.
* 💊 철분 결핍성 빈혈의 원인은 **공급 감소(영양 결핍, 흡수 장애), 수요 증가(예: 임신, 성장) 또는 손실(예: 출혈, 혈관 내 용혈)**로 분류할 수 있습니다.
* 철분 결핍 빈혈에서는 **헤모글로빈, 헴, 철분이 감소**하여 적혈구가 작은 소적혈구 빈혈이 생깁니다.
* 철분 결핍 빈혈의 실험실 소견으로는 **낮은 혈청 철분, 페리틴 및 철분 포화도, 높은 TIBC, 가용성 트랜스페린 수용체 분석 증가, 높은 RDW** 등이 있습니다.
* 철분 결핍성 빈혈을 진단하는 가장 정확한 검사는 **골수 생검**으로, 철분 저장량이 고갈된 것을 확인할 수 있습니다.
* 💊 철분 결핍 빈혈의 치료는 일반적으로 **경구용 황산철**로 시작하며, 경구용 철분이 실패하면 근육 또는 정맥 철분을 사용할 수 있으며, 주요 부작용은 **아나필락시스**이며 특히 덱스트란 함유 제제의 경우 아나필락시스가 발생할 수 있습니다.

Hey everybody. Let's talk about iron deficiency anemia. So, in previous videos, we have talked about anemia, what's anemia. Also, microcytic anemia (low MCV), Iron studies. So, if you need anything from previous subjects, please go ahead and watch my previous videos first. The playlist is called: hematology. So that this one can make sense. Iron deficiency anemia. Tired and pale. Pale and tired. Some quick facts about iron deficiency anemia: It's the most common anemia worldwide. The cause of iron deficiency anemia in the developing word is usually nutritional. Like nutritional deficiency. In the developed world, it's usually acute blood loss from GI bleeding especially peptic ulcer disease (PUD). It's the most common nutritional deficiency worldwide. At risk population include females. Why? - Menstruation. Children. Why? - Decreased intake. High demand because they are growing. What are the causes? Imagine that you are a businessman.

So, when you have a problem (i.e. shortage), it's either decreased supply or increased demand... or loss. Decreased supply, such as nutritional deficiency or malabsorption. I am not getting enough iron, or I am getting enough iron but I cannot absorb it (malabsorption). What's the difference?
It's basically the same. Increased demand, such as increased utilization... I need more iron now... I need more. Or loss, such as blood loss (hemorrhage) or hemolysis... The RBCs are being destroyed. So, the causes of iron deficiency anemia are decreased supply, increased demand, or loss. Decreased supply, we said: nutritional deficiency or malabsorption. Nutritional deficiency, such as prematurity; premature babies are at higher risk of getting iron deficiency anemia. Poverty; they are not getting enough food, or enough minerals. Also, old age, the same problem as the kids. Diet... Some people who are strict vegans, they are not getting enough

heme iron. I've said before that there are 2 types of iron: the heme that we get from meat, and the non-heme (from the vegetables). The heme iron is better absorbed than the non-heme. So, people who are strict vegans, they eat vegetables only, and they are at higher risk of getting iron deficiency anemia. Malabsorption such as celiac disease or post-gastric surgery. How about increased demand? Increased utilization such as pregnancy. So, the lady is not only feeding her body. She is feeding 2 bodies, she needs more iron., also lactation, same concept... Growth, I am needing more iron because I'm building new cells. Loss such as blood loss or intravascular hemolysis. Blood loss such as peptic ulcer disease (PUD) Meckel's diverticulum... Peptic ulcer disease is usually in adults... Meckel's in kids. Meckel's has some gastric tissue in them, sometimes...

so, they can bleed. Hookworm infection such as ancylostoma duodenale and necator americans. Colon polyps can bleed. Colon cancer, of course, can bleed. will lead to blood loss which will lead to iron deficiency anemia. Intravascular hemolysis, has to be intravascular, so the blood will get broken down. Then eventually will go to the kidney, and they will lose a lot of iron there. So we have microangiopathic hemolytic anemia, and a condition called paroxysmal nocturnal hemoglobinuria (PNH). These are the causes of iron deficiency anemia: decreased supply, increased demand, or blood loss. Let's review, so hemoglobin is made of heme and globin. Heme consists of iron and protoporphyrin. So, when I have iron deficiency anemia, iron will be decreased, heme will be decreased, and hemoglobin (Hb) will be decreased. That's why, it's anemia.

Anemia is low hemoglobin (Hb) and hematocrit (HCT) by definition. Globin will be normal. Since protoporphyrin - now - doesn't have any iron to bind to, protoporphyrin will start to pile up. Ok.. Ok... Hematopoiesis, we have proerythroblasts, normoblasts all the way down to the mature erythrocyte. Cells start big, then they become smaller, and smaller, and smaller. So, down here is the mature red blood cell. The cells are waiting for cell division, and they are waiting for iron. So, if iron is not coming, they will keep decreasing in size, like this, like this, until we end up with small cells, that's why it's called microcytic anemia. They are still waiting for iron :( By the same token, them getting smaller will make the hemoglobin inside them look relatively bigger. So, they are trying to mitigate the problem.

Iron deficiency anemia, like any other anemia, tired and pale, pale and tired. Sometimes I have angina, sometimes, I have murmur. Weak, irritable, exercise intolerance. can have- sometimes- other associations such as: Plummer-Vinson syndrome with esophageal webs... Glossitis, chelitis, inflammation of the tongue, inflammation of the lips [respectively]. Restless leg syndrome for an unknown reason. Restless leg syndrome is associated with iron deficiency anemia (this is high yield). Achlorhydria... When we have talked about iron absorption [previous video], we have mentioned that Hydrochloric acid (HCl) is essential to convert the ferric iron (Fe3+) into the ferrous (Fe2+) which is more readily absorbed. Also, there is an association with celiac disease, as we have mentioned, it's a malabsorption problem. We have spoon-shaped nails called koilonychia coiled nail.

Beeturia... You know, 10% of the general population, when they eat beet, they get red urine. In iron deficiency anemia, almost all of them will get the beeturia. Pica... Pica is craving for ice [and others], but also any ice-containing drink, such as ice-coffee. They just want the ice. Why? - I don't know. So, remember these associations (with iron deficiency)... Also, the pica is known as pagophagia. Hematology is all about lab results... The story of iron is that we have iron in the serum... Gets on transferrin (the binding protein). Then gets to the tissue as ferritin. So, in anemia... What will happen to hemoglobin and hematocrit? They'll both be decreased... It's a given.

MCV: since it's microcytic, MCV will be low. MCH and MCHC will be low, it's an iron deficiency anemia.

Reticulocytes will be low. Why? - I don't have enough iron to make mature RBCs, or immature RBCs (reticulocytes)... I don't have iron period. White blood cells are usually normal, EXCEPT... There is one exception, and I will mention it later. Platelets might be slightly increased... Why is that? - because sometimes, the erythropoietin (EPO) is very similar to thrombopoietin (TPO), that's a theory. Other theory is that, now, in anemia, the blood is very thin, let's try to make it thicker by producing more cells. I cannot produce more RBCs, at least, I can produce more platelets. What about iron studies?... That's crucial... Serum iron is definitely decreased... It's iron deficiency. How about ferritin? the stored iron? since the stored iron comes from the serum iron, and the serum is decreased, therefore the stored ferritin is decreased.

How about TIBC? - The liver recognizes the problem and says: Hey, we are not having any iron, let's get more carriers (TIBC) to try to get the last drop (molecule) of iron left in the serum. Let's do our best. So, TIBC is high... and as we've said before, Ferritin and TIBC are always inversely related to each other. Iron percent saturation is decreased. Iron % saturation is the serum iron over the transferrin, and since the iron is decreased, and the TIBC is increased, the ratio, of course, is decreased. How about the soluble transferrin factor receptor assay? This is gonna be increased in iron deficiency anemia (IDA), but normal in anemia of chronic disease (ACD). RDW is the variation of the sizes of the red blood cells, and if you go back to our video where we discussed RDW... Rome did not fall in a day, and neither did the bone marrow.

It happens gradually. There's a wide variation, so the RDW is high. But wait, there is an important piece of information there. Ferritin is an acute phase reactant due to the influence by interleukin 6 (IL-6). So, if I have a patient with iron deficiency anemia, I expect the ferritin to be low. However, if he has concurrent inflammation, maybe ferritin is gonna be high. How can I know? That's why the soluble transferrin factor receptor assay is accurate because it's not influenced by IL-6 (it's not an acute phase reactant). So, you will have this one (STFR) be high. That's how you know the difference. Long story short, don't rely on ferritin if you have ongoing inflammation. Rome did not fall in a day, and neither did the bone marrow. Starts as normocytic (normal MCV), then becomes microcytic (low MCV).

microcytic cells have increased central pallor, and since protoporphyrin is left alone, it will start to accumulate and pile up. So, we have increased free erythrocyte protoporphyrin (FEP) there is no iron to join it. Poor protoporphyrin, you'll be left alone :( What's the most accurate test to diagnose iron deficiency anemia? - bone marrow biopsy. And by the way, it's very painful, the periosteum is very sensitive to pain. Do we usually use bone marrow biopsy just to diagnose iron deficiency anemia? - No. There is an easier way to do it... Give the patient iron, if they improve, it's iron deficiency anemia... Bingo. What will happen if we did a bone marrow biopsy in a patient with iron deficiency? We will have depleted iron store evident on the biopsy. Ok, we've mentioned that iron deficiency usually has a normal WBC count. There is one exception, do you know what's that?

Hookworm infections, such as Ancylostoma duodenale and Necator americanus. What's the treatment of iron deficiency anemia? We start with oral ferrous sulfate. Does it have side effects? -Yes, sometimes diarrhea or constipation, black stool since iron will come in the stool. However, this is guaiac-negative stool. Why? Because it's just iron, there is no blood. Remember, guaiac stool test detects RBCs, hemoglobin, myoglobin. Since we only have iron in stool, it's guaiac negative. Failure of treatment, sometimes because patients are not compliant with the treatment, blood loss if it's going on, giving iron will not fix it. Absorption problem, this is very important. Cases resistant to treatment usually have celiac disease. What if oral iron failed? Let's start intramuscular (IM) or intravenous (IV) iron. What's the biggest side effect? -Anaphylaxis, especially if it contains Dextran.

That's iron deficiency. Please subscribe. There are new videos coming every week. Thanks. [Please consider supporting my work]. I will see you in the next video to continue talking about microcytic anemia. Peace.

Iron Deficiency Anemia - All you need to know - Causes, Symptoms, Diagnosis, Treatment

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Medicosis Perfectionalis

철분 결핍성 빈혈은 전 세계적으로 가장 흔한 유형으로, 선진국과 개발도상국 사이에 원인이 다양합니다.

개발도상국에서는 주로 영양 결핍으로 인해 발생하며, 선진국에서는 특히 위장관 출혈로 인한 급성 출혈로 인해 발생하는 경우가 많습니다.

이 질환은 월경으로 인한 여성, 성장과 섭취량 감소로 인한 어린이, 임산부 및 출혈을 경험하는 사람과 같이 철분 수요가 증가하는 사람과 같은 고위험군에서 흔히 발견됩니다.

구충 감염, 대장 문제, 출혈은 철분 결핍성 빈혈의 흔한 원인입니다.

철분 결핍성 빈혈은 헤모글로빈과 적혈구 감소로 이어지며 피로감, 창백한 피부, 경우에 따라 관련 건강 문제와 같은 증상을 유발할 수 있습니다.

철분 결핍성 빈혈은 하지 불안 증후군, 무탈수증, 숟가락 모양의 손톱을 유발하는 플러머-빈슨 증후군 및 셀리악병과 같은 질환과도 관련이 있습니다.

철분 결핍성 빈혈과 혈액학적 영향에 대한 이해

철분 결핍 빈혈은 혈색소 및 헤마토크릿 저하뿐만 아니라 비투리아 및 피카(구토)와도 관련이 있습니다.

또한 철분 결핍 빈혈은 혈소판 수치를 약간 증가시킬 수 있는 반면, MCV, MCH, MCHC 및 망상 적혈구 수치를 낮춥니다.

철분 연구에서는 혈청 철분 및 페리틴 감소, 높은 TIBC, 철분 포화도 감소, 가용성 트랜스페린 수용체 분석 증가가 나타납니다.

또한 철분 결핍성 빈혈의 영향을 받아 적혈구 크기가 변화하는 것으로 나타났습니다.

철 결핍성 빈혈은 페리틴 수치가 염증의 영향을 받을 수 있어 진단이 어려울 수 있으며, 이로 인해 잘못된 해석이 나올 수 있습니다.

가용성 트랜스페린 수용체 분석은 IL-6의 영향을 받지 않기 때문에 염증이 있는 경우 더 정확한 지표입니다.

질환이 진행되면 적혈구가 정상 세포에서 미세 세포로 전환되며 철분 부족으로 인해 유리 적혈구 프로토 포르피린이 증가합니다.

골수 생검은 진단을 위한 가장 정확한 검사이지만, 철분 보충제에 대한 반응이 더 간단한 대안이기 때문에 일반적으로 사용되지는 않습니다.

철분 결핍 빈혈의 골수 생검은 철분 저장량이 고갈된 것을 보여줍니다.

이 상태는 일반적으로 염증이 동반된 경우를 제외하고는 백혈구 수가 정상으로 나타납니다.

철분 결핍성 빈혈 치료 및 부작용 관리하기

경구용 황산철은 철 결핍성 빈혈의 1차 치료제로 사용되지만 설사, 변비, 흑색변(혈액이 없어 과악 음성) 등의 부작용을 일으킬 수 있습니다.

치료 불순응, 지속적인 출혈 또는 흡수 문제로 인해 치료 실패가 발생할 수 있으며, 셀리악병이 내성의 흔한 원인입니다.

경구 철분 치료가 실패하면 근육 내 또는 정맥 내 철분제를 사용할 수 있으며, 특히 덱스트란 함유 제품의 경우 아나필락시스가 가장 큰 위험입니다.