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  #1  
Old 05-25-2012
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Blood Iron Deficiency or Chronic Disease Anemia?

A 34-year-old woman is evaluated in the office for a 1-day history of fever, chills, and cough. She has a past history of iron deficiency anemia attributed to menorrhagia for which she has been treated effectively with ferrous gluconate daily for 1 year.

On physical examination, temperature is 38.6 C (101.5 F). Crackles and egophony are heard in the right posterior chest.


Laboratory Studies
Hemoglobin

11.3 g/dL
Mean corpuscular hemoglobin

27.6 pg
Mean corpuscular hemoglobin concentration

33.2 g/dL
Mean corpuscular volume

83 fL
Leukocyte count

11,000/μL (80% neutrophils, 7% band forms, 10% lymphocytes, 3% monocytes)
Platelet count

440,000/L
Ferritin

126 ng/mL
Iron

25 μg/dL
Total iron-binding capacity
Which of the following is most likely causing this patient's anemia?
A Anemia of inflammation (anemia of chronic disease)
B Combined iron deficiency anemia and anemia of inflammation
C Iron deficiency anemia
D Sideroblastic anemia
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  #2  
Old 05-25-2012
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D iron overload seen in sideroblastic anemia
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Old 05-25-2012
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Quote:
Originally Posted by bisho View Post
D iron overload seen in sideroblastic anemia
why u think so?
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Old 05-25-2012
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C
I guess its beginning of iron deficiency anemia
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Old 05-25-2012
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i would go with C too.

imo Ferritin is normal so ACD is not an option to choose.
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Old 05-25-2012
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Ooh myGod, why did i saw ferritin 440.000
sorry its Iron deficiency anemia
Remember Low Ferritin is Sp but Not Se, so if nl dosen't rule out Fe def. this pt have concurrent infection >> elevation of ferritin (acute phase protein).
pt could have an underling Alpha thalathemia that can hide Fe def anemia
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Quote:
Originally Posted by tyagee View Post
A 34-year-old woman is evaluated in the office for a 1-day history of fever, chills, and cough. She has a past history of iron deficiency anemia attributed to menorrhagia for which she has been treated effectively with ferrous gluconate daily for 1 year.

On physical examination, temperature is 38.6 C (101.5 F). Crackles and egophony are heard in the right posterior chest.


Laboratory Studies
Hemoglobin

11.3 g/dL
Mean corpuscular volume
Mean corpuscu

27.6 pg
lar hemoglobin
Mean corpuscular hemoglobin concentration

33.2 g/dL

83 fL
Leukocyte count

11,000/μL (80% neutrophils, 7% band forms, 10% lymphocytes, 3% monocytes)
Platelet count

440,000/L
Ferritin

126 ng/mL
Iron

25 μg/dL
Total iron-binding capacity
Which of the following is most likely causing this patient's anemia?
A Anemia of inflammation (anemia of chronic disease)
B Combined iron deficiency anemia and anemia of inflammation
C Iron deficiency anemia
D Sideroblastic anemia
-i't normocytic normochromic anemia,iron low .ithink this mosaic pic=B.
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Old 05-25-2012
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How much is the Total iron-binding capacity
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Old 05-25-2012
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Quote:
Originally Posted by Novobiocin View Post
How much is the Total iron-binding capacity
25. why? normal is 250-460 μg/dL...
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Old 05-25-2012
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Quote:
Originally Posted by tyagee View Post
25. why? normal is 250-460 μg/dL...
I thought 25 μg/dL was her Serum Iron ?
Can you please check the question posted since one of the values seems be missing.
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Old 05-26-2012
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Any way hx didn't mention any hx of chronic dz and labs is low borderline
Fe is low , MCV is low borderline and plt is elevated which all can go with either Fe def or ACD or both, TIBC is missing ? And also could be borderline. So i will base my ans according to hx which lack evidence of chronic illness
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Quote:
Originally Posted by tyagee View Post
A 34-year-old woman is evaluated in the office for a 1-day history of fever, chills, and cough. She has a past history of iron deficiency anemia attributed to menorrhagia for which she has been treated effectively with ferrous gluconate daily for 1 year.

On physical examination, temperature is 38.6 C (101.5 F). Crackles and egophony are heard in the right posterior chest.


Laboratory Studies
Hemoglobin

11.3 g/dL
Mean corpuscular hemoglobin

27.6 pg
Mean corpuscular hemoglobin concentration

33.2 g/dL
Mean corpuscular volume

83 fL
Leukocyte count

11,000/μL (80% neutrophils, 7% band forms, 10% lymphocytes, 3% monocytes)
Platelet count

440,000/L
Ferritin

126 ng/mL
Iron

25 μg/dL
Total iron-binding capacity
Which of the following is most likely causing this patient's anemia?
A Anemia of inflammation (anemia of chronic disease)
B Combined iron deficiency anemia and anemia of inflammation
C Iron deficiency anemia
D Sideroblastic anemia
-could u plz rewrite the lab value ,it alittel bit confuse
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  #13  
Old 05-26-2012
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i lost the question. m very sorry guys...searching but could not find it...apologies
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Old 05-26-2012
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Found it: The TIBC is 277 μg/dL
The answer is A Anemia of inflammation

Anemia of chronic disease is often a mild normalcy anemia, but can sometimes be more severe, and can sometimes be a microcytic anemia ; thus, it often closely resembles iron-deficiency anemia

While no single test is always reliable to distinguish the two causes of disease, there are sometimes some suggestive data:
In anemia of chronic disease without iron deficiency, ferritin levels should be normal or high, reflecting the fact that iron is stored within cells, and ferritin is being produced as an acute phase reactant but the cells are not releasing their iron. In iron deficiency anemia ferritin should be low.
TIBC should be high in genuine iron deficiency, reflecting efforts by the body to produce more transferrin and bind up as much iron as possible; TIBC should be low or normal in anemia of chronic disease.

Quote:
Pathophysiology

In response to inflammatory cytokines, increasingly IL-6,[3] the liver produces increased amounts of hepcidin. Hepcidin in turn stops ferroportin from releasing iron stores. Inflammatory cytokines also appear to affect other important elements of iron metabolism, including decreasing ferroportin expression, and probably directly blunting erythropoiesis by decreasing the ability of the bone marrow to respond to erythropoietin.
Before the recent discovery of hepcidin and its function in iron metabolism, anemia of chronic disease was seen as the result of a complex web of inflammatory changes. Over the last few years, however, many investigators have come to feel that hepcidin is the central actor in producing anemia of chronic inflammation.
Nonetheless, in addition to effects of iron sequestration, inflammatory cytokines promote the production of white blood cells. Bone marrow produces both white blood cells and red blood cells from the same precursor stem cells. Therefore, the upregulation of white blood cells causes fewer stem cells to differentiate into red blood cells. This effect may be an important additional cause for the decreased erythropoiesis and red blood cell production seen in anemia of inflammation, even when erythropoietin levels are normal, and even aside from the effects of hepcidin. Nonetheless, there are other mechanisms that also contribute to the lowering of hemoglobin levels during inflammation: (i) Inflammatory cytokines suppress the proliferation of erythroid precursors in the bone marrow; (ii) inflammatory cytokines inhibit the release of erythropoietin (EPO) from the kidney; and (iii) the survival of circulating red cells is shortened.
In the short term, the overall effect of these changes is likely positive: it allows the body to keep more iron away from bacterial pathogens in the body, while producing more immune cells to fight off infection. Bacteria, like most life forms, depend on iron to live and multiply. However, if inflammation continues, the effect of locking up iron stores is to reduce the ability of the bone marrow to produce red blood cells. These cells require iron for their massive amounts of hemoglobin which allow them to transport oxygen.
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