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.
The lecture Iron Deficiency Anemia: Iron Studies by Carlo Raj, MD is from the course Microcytic Anemia – Red Blood Cell Pathology (RBC).
Which of the following best corresponds to laboratory values in iron deficiency anemia?
Which of the following laboratory tests indicates hypochromia?
The production of which of the following is mainly defective in iron deficiency anemia?
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i love every dr. gaj lecture he gets into details - repeat many times - joyful
I like your lectures Dr, they are all very well explained thus allows us to pick up the concept quite easily! Thanks
Dr. Raj is really funny and makes the lecture engaging. His thought process is very logical, and it helps me really remember some of these more complicated concepts.