These are the most common signs
and symptoms of iron deficiency anemia.
The patient's going to look pale.
They may be irritable or fussy, and
they're gonna lack energy and tire easily.
Maybe this patient was previously active and now they're
laying around, they just don't want to go run and play.
Tachycardia or a fast heartbeat.
The heart rate is gonna increase
to try to distribute the oxygen around.
There are less red blood cells and
each has less oxygen carrying capacity
so the body's gonna compensate by increasing the heart
rate to deliver the blood and oxygen to the tissues.
A sore or swollen tongue,
this is called glossitis.
Low levels of iron are gonna lead to low levels
of myoglobin which is a substance in the blood
that plays a role in muscular
health including the tongue.
An enlarged spleen, and
something called PICA,
Now this is when a patient wants to eat items
without nutritional value such as dirt or ice
and the reason for this is unclear.
when a patient presents with these symptoms, they should be
evaluated for iron deficiency anemia as a possible cause.
So in most cases anemia is
diagnosed with pretty simple blood test.
Routine anemia screening by checking the hemoglobin level
is done because this condition is so common in children
and they're often asymptomatic.
The American Academy of Pediatrics
recommends anemia screening
with a hemoglobin blood test for all infants at 12
months of age in addition to performing a risk assessment.
The risk assessment questions try to identify
patients with risk factors for iron deficiency anemia
including children with feeding problems, poor
growth and children with special healthcare needs.
If the hemoglobin level is low in the initial
screening, then more follow-up tests are done.
This includes a CBC - a complete blood count, and
this is gonna check the red and white blood cells,
The blood clotting cells which are the platelets,
young red blood cells called reticulocytes,
the hemoglobin, hematocrit and
there will be a differential if indicated.
A peripheral smear - this is a small sample of
blood that's gonna be loked at under a microscope.
Blood cells arechecked to see if they
have a normal size, shape and color.
Iron studies - blood tests can be done to
measure the amount of iron in your child's body.
Here are the components to the
CBC or the complete blood count:
You'll see a total red blood cell count, a white blood
cell count including the differential, the platelet count,
the reticulocyte distribution width and that's gonna
measure the variation in the red blood cell size.
This is called the RDW and it's usually
elevated in patients with iron deficiency anemia
because their body is constantly
trying to churn out more cells.
You'll see the hematocrit and this is the ratio of
the volume of blood cells to the total volume of blood.
And finally the hemoglobin - this is the protein
responsible for transporting oxygen and iron.
Next you'll see the the calculation
of the red blood cell indices.
First it starts with the mean cell
volume and that's the cell size.
You also have the ratio of the mean cell hemoglobin
concentration and then the mean cell hemoglobin.
When we're looking at iron deficiency anemia, we're really
looking at the MCV - the size and the MCH which is the color.
Part of this includes the peripheral
smear and all these red blood cell indices.
Cells can be a normal size which is normocytic, too large
which is macrocytic or too small which is microcytic
and the cells can also have different levels of
hemoglobin so a normal cells gonna be normochromic
or they can have two little
hemoglobin which is hypochromic.
There is no such thing as a red
blood cell with too much hemoglobin.
So here on the left on the normal peripheral smear,
you're gonna see normal size - these are normocytic.
You're also gonna see a normal
color so these cells are normochromic.
On the right, you see a patient smear
with severe iron deficiency anemia.
Now there's different characteristics
when you look at these cells.
Remember they're going to be
smaller than normal so they're microcytic
and they're gonna be a pale cells because they
don't have enough hemoglobin, so they're hypochromic,
and there's also going to be a
change in the variation of the size
so anisocytosis means there's a huge
variation the size bigger than normal
and poikilocytosis means
they're variable in shape.
Next you're gonna do an iron panel.
And the iron level, the total iron levels gonna
tell you the amount of iron carried by transferrin.
Next you'll see the ferritin level and
and this is the amount of stored iron.
The patient can have an artificially
high ferritin in the setting of an infection,
late- stage cancer, severe
inflammation and alcoholism.
You'll also see the transferrin level and
remember transferrin is the transfer protein
and this is gonna be produced by the liver.
When patients have liver dysfunction,
they're going to make less transferrin.
And last we have the total iron binding capacity and this
is the measure of proteins available for binding iron.
If a patient has low iron levels, they're gonna have no
more proteins and docking sites available for binding.
Now let's compare the blood.
Here on the left, there's a normal patient they're
gonna have a normal total iron binding capacity or TIBC
and they're also gonna have normal levels of
their serum iron, serum ferritin and transferrin.
On the right, we see a patient
with iron deficiency anemia.
They're gonna have a high TIBC or total iron
binding capacity because these sites are open
and they're just ready to capture the iron.
They're gonna have a low serum iron, they're gonna have low
serum ferritin because they don't have any iron stored up
and a low transferrin saturation.
So these are the diagnostics,
remember we're gonna do a CBC
and the characteristics of iron
deficiency anemia are a low MCV.
So these are microcytic cells, they're small, they
have a small volume a low hemoglobin and a high RDW.
Next you'll do the blood smear and you're
gonna see this microcytic hypochromic anemia
and in severe cases,
you'll see the poikilocytosis.
And you're gonna look at biochemical
indices which is your iron panel
and these patients will have decreased serum iron, decreased
transferrin saturation, decreased iron stored which is thir ferritin
and an increased total iron binding
capacity waiting to capture more iron.