00:02
Okay.
00:02
So now, let’s walk through in order how to
then evaluate your iron studies, shall we?
Number one, and I’m going to walk
you through this slowly again.
00:13
And then as we go through more of
our type of microcytic anemias,
I am going to go a
heck a lot quicker.
00:17
So get it down now.
00:20
I introduced the normal in
the previous discussion.
00:23
I told you number one, pay
attention to serum iron.
00:25
Number two, you take a look at ferritin.
00:28
Ferritin has an inverse relationship with?
What are you going to use, laboratory?
Transferrin or TIBC?
TIBC.
00:37
Inverse relationship with TIBC.
00:38
And number four,
what’s that called?
Transferrin saturation.
00:42
Okay, so those are the four
that we looked in normal.
00:45
Let us now play around
with iron deficiency.
00:50
Serum iron, obviously, decreased.
00:53
Number two.
00:54
You see that ferritin box right there?
Wow!
Very little green shade.
01:00
That green shade represents iron.
01:04
So very little
ferritin, number two.
01:06
What kind of relationship
does ferritin have with TIBC?
Inverse relationship.
01:11
So therefore,
a decrease in ferritin
means an increase in TIBC.
01:16
Number three,
your next question that
you’re asking yourself is
what is it that fills up this transferrin,
this column that you see here on your left.
01:29
Now, it’s moved up because
TIBC’s increased up to 500.
01:33
Total iron binding
capacity’s increased.
01:36
So if your binding capacity’s
increased, but you’re iron deficient,
well, what is the
body trying to do?
It’s trying to bind as
much iron that it can.
01:43
But it can’t find any, huh?
Because you’re iron deficient.
01:48
Why?
Maybe your female had menorrhagia,
you get my point.
01:50
So the binding
capacity’s increased.
01:54
But you can’t bind to any.
01:56
So therefore, what’s your
saturation percentage?
Decreased.
02:00
Clear?
Now, tell about how the
transferrin’s being saturated.
02:07
What does that mean?
Does this mean that transferrin
is delivering iron to itself?
That makes no sense.
02:13
The transferrin is transporting
the iron, Fe, to the bone marrow.
02:22
Why?
Oh, I think that’s where RBC
production is taking place?
Yeah, that’s exactly what’s happening.
02:26
Okay.
02:28
So then, what is it that’s
filling up this transferrin.
02:31
You won’t think of this as being --
ferritin kind of regulates that, okay?
So if your ferritin’s decreased,
then how in the world
can you then release enough iron
to saturate this big block.
02:40
You'd find it completely empty.
02:43
See this column here, and
that whole thing is TIBC.
02:46
Welcome to iron deficiency.
02:49
Number one, serum iron decreased.
02:49
Number two, decreased ferritin.
02:50
Number three, increased TIBC.
02:53
And number four, you’d find a
decrease in percentage saturation.
02:57
Let’s continue.
02:59
Laboratory values, in words,
is what we just talked about.
03:01
A decreased hemoglobin,
hematocrit, RBC count.
03:06
Well, that’s pretty nonspecific.
03:07
MCV, decreased, definitely puts
you into the realm of microcytic.
03:12
What’s your magic number?
Good.
03:16
Less than 80.
03:17
Next,
stop.
03:18
If you have iron deficiency –
I can’t even from proper
heme or globin, which one?
Heme.
03:25
Okay?
So what is that iron gives --
What kind of color does
iron give your heme?
Red.
03:35
Red.
03:35
So if you’re iron deficient and you can’t
form proper heme, what color is your RBC?
Rather pale.
03:41
What do you call that?
Pallor.
03:44
What about that central pallor?
Should you have a little bit of
central pallor in a normal RBC?
Sure.
03:49
But what about in iron deficiency?
That pallor, pallor,
pallor increases.
03:53
So increased central pallor.
03:55
What do you call this clinically?
Oh, yeah.
03:59
Hypochromic, there you go.
04:00
So what lab tells you that
the RBC is hypochromic?
Take a look.
04:08
MC -- you pay attention -- HC.
04:11
Hemoglobin concentration.
04:12
So once again, if you don’t have iron,
I don’t have proper
production of heme.
04:18
I don’t have proper amounts of
hemoglobin concentration in my RBC.
04:24
What color is your RBC?
Hypochromic.
04:25
Look at that. It makes perfect sense.
04:27
You have a decreased
MCV and you had MCHC,
what do you call
this clinically?
You call this
hypochromic microcytic.
04:34
That you’ve memorized so
many different times.
04:37
But to actually see in laboratory,
isn’t that fascinating?
I’m a dork.
04:42
I love this stuff because the
labs actually speak to you.
04:44
Anything that laboratory
was, EKG, ultrasounds,
all these give you vital information.
04:51
Next, well, tell me about the RBCs
in a peripheral blood smear.
04:55
Peripheral blood smear.
04:56
They’re microcytic, correct.
And they’re hypochromic.
05:00
All at the same time?
Could it be possible that you might
have some RBCs that are bigger?
Some are smaller.
05:06
So bigger, smaller, bigger –
Can I be any more dramatic?
So in a peripheral blood smear,
you have big RBCs, little RBCs,
big RBCs, little RBCs,
and you then call this red
blood cell distribution width.
05:21
Because you don’t have uniformity of
your RBCs on a peripheral blood smear,
guess what your RDW is.
05:30
Increased.
05:30
So what does that mean?
Uniformity is what should come
to mind when we think RDW.
05:36
You don’t have it usually with an
iron deficiency type of picture.
05:41
Let’s move on.
05:42
That’s huge, huge.
05:44
That second and third bullet point are
huge, aren’t they? For iron deficiency.
05:49
Now, what about your iron studies?
Well, you tell me.
05:50
Close your eyes.
05:51
Serum iron, decreased.
05:54
Number two, ferritin, decreased.
05:55
Ferritin, decreased.
TIBC, increased.
05:57
Transferrin saturation,
decreased.
05:59
You see how easy that was?
You spend time with that normal graph
first in the previous discussion.
06:05
You go through this cycle
that I’m giving you.
06:08
Every single time, you
can’t miss a question.
06:12
Increased TIBC.
06:14
What does BC mean?
Binding capacity.
06:18
but the problem is, you can’t bind to
anything because you’re iron deficient.
06:24
On your left is going
to be your pathology.
06:27
Let’s take a look at
that central region.
06:28
See that increased pallor?
“Compared to what, Dr. Raj?”
Take a look at the
right, that’s normal.
06:35
You see the central
pallor in the right.
06:37
The pallor?
Yeah, it’s there.
06:39
But not much.
06:39
On the left, oh, it’s too much.
06:41
There you go.
06:44
What lab gives you increased
central pallor or lack of color?
What gives you hypochromicity?
MCHC.
06:53
Are we clear?
So hemoglobin concentration
is decreased on the left.
06:56
Therefore giving you hypochromic and to be
technical, you know that MCV is decreased.
07:03
So microcytic hypochromic
anemia, iron deficiency.