Let’s begin with iron deficiency anemia,
extremely common in our society.
Let’s take a look at all the different
causes as to why you are iron deficient.
Maybe you’re losing blood.
On a monthly basis,
a female who is in her
is always going to
have her menses.
She’s always going to
have her menstrual cycle.
Maybe perhaps during her menses,
she might be losing a
little bit of blood.
So therefore, she might then, over a
period of time, become iron deficient.
Is that common?
what if you have a patient
that has arthritis
and has been taking
for ten, fifteen, twenty years.
How common is arthritis in the world?
You can’t help it sometimes, right?
So it’s a wear and tear
type if arthritis.
Your joints can become weak.
Patient is in pain, inflammation, so
therefore, takes NSAIDs, correct?
“What does that mean, Dr. Raj?”
Meaning to say with NSAID, you’re trying to
relieve your anti-inflammatory type of –
You’re trying to relieve
some of that inflammation.
But in the process, you’re also knocking
out the prostaglandin, aren’t you?
You knock out the prostaglandin, then
don’t you need your prostaglandin
to properly protect the
lining of the stomach?
Of course, you do.
So over ten, fifteen,
you take NSAIDs or aspirin even,
and you knock out the prostaglandin,
your patient is now at risk for?
A gastric peptic ulcer disease, correct?
What’s one of the most common causes of
painless rectal bleeding in the United States?
Give me another one.
Do you see how common
iron deficiency would be?
Is it possible that you actually
have one type of anemia
in which you’re peeing or
urinating and you see red urine.
Oh, my goodness! Red urine.
And maybe this is in the
morning or after you exercise.
With that type of history,
paroxysmal nocturnal hemoglobinuria,
high in the differential.
And the point is, as you continue
having one type of anemia, such as PNH,
and you’re releasing red urine,
what does that red mean?
Oh, yeah, this is hemoglobinuria.
What’s in hemoglobin?
Oh, yeah, iron.
So you have iron deficiency
and a normocytic
and a microcytic anemia at the same time?
Do you see where I’m getting at?
Iron deficiency, extremely common.
Ulcers, diverticulosis, colon cancers,
especially right side is big.
This is as I said a female
who has menorrhagia,
and that’s quite a bit of menses
taking place every single month.
Maybe, maybe this is a female that
has von Willebrand disease, huh?
Von Willebrand disease.
well very young, very old.
In the nursing home, maybe they’re not
being fed properly, malnourished.
Very young, once again, maybe
iron deficient because
your child might just be on a McDonald’s
diet, do you see where I’m getting at?
Well, that might actually
have enough iron in it
because of the meat, but you get my point.
So malnourishment is
very young, very old.
Malabsorption is always
an issue as well.
Remember the type of iron that
you’re taking in is ferric.
But that is not at
all usable for us.
So what do you want to
do with that ferric?
You remove the one valent,
and now you get what?
Give me a couple of things that will then
help you convert that ferric into ferrous?
In other words, convert the
methemoglobin into ferrous.
I need some acid.
Where do you have acid?
In the esophagus?
Are you kidding me?
Physiologically, you should never
have acid in the esophagus.
In the stomach.
And this acid’s going to do what?
It will help you convert
the ferric into ferrous.
What else might you require?
A lot of times, you might
find a treatment modality
and this could be ascorbic acid.
Well, there you go.
In a form of vitamin C, helps
to convert ferric into ferrous.
My point is this, any point in time
that you knock out your gastric acid,
you might then be rendered iron
deficient because you cannot convert
your ferric into ferrous.
Are we clear about this?
I hope so.
And the point is, say that you have a –
Give me an autoimmune type of anemia
that then knocks out the parietal cells.
"Oh, I know that one."
Of course, you do.
anemia, isn’t it?
And so there are two anemias,
two different types.
So one is going to be your
microcytic, megaloblastic anemia
known as vitamin B12
deficiency secondary to?
I don’t have the acid, and so
therefore I’m also iron deficient.
Use common sense.
Small bowel resection.
Okay, that is always
Say that you have patient
who has increased heart rate at
200 maybe, 300 beats per minute,
and on your EKG, you find ---
Well, you can’t even find the P
waves because they’re all wavy.
atrial fibrillation, good.
Why am I bringing this up?
You have you possibility with atrial
fibrillation that you might then form a thrombi.
that’s why you use a drug called
Coumadin for prophylaxis, right?
But I’d say that then take place
and you ended up embolizing.
Ischemic type of issue.
Ischemic bowel disease.
You might end up in the superior mesenteric artery.
So remove the small bowel, your
patient might become iron deficient.