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Physician Assistant (PA)
Iron Deficiency Anemia

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Iron Deficiency Anemia

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Iron Deficiency Anemia

Broken Iron and Anemone
Iron deficiency anemia accounts for more than half of anemia cases worldwide. It is typically caused by malnutrition (decreased ingestion of meat, eggs, iron-fortified foods and leafy greens), as well as malabsorption (IBD, parasitism, celiac disease). Hemorrhage is another reason for this type of anemia, which may be caused by heavy menstruation, parasitism, malignancy or ulceration. This is a microcytic, hypochromic anemia which is caused by decreased heme synthesis. Labs typically show decreased reticulocytes, and decreased ferritin, which is an iron-storing protein. There is also an increased red cell distribution width, which helps distinguish iron deficiency anemia from thalassemia.

The most common global cause of iron deficiency anemia is malnutrition or malabsorption. Meat, eggs and leafy-greens describe the types of foods containing iron, which are necessary to prevent anemia. Malabsorption due to parasitism, celiac disease or inflammatory bowel disease may lead to decreased iron absorption. Because dietary iron requires gastric acid to be absorbed, certain bariatric surgeries that reduce available acid may cause an iron deficiency anemia.


Hemorrhage is a cause of iron-deficient anemia, due to the amount of iron contained in the blood. Menorrhagia (increased blood loss during menstruation), colorectal cancers, and ulcers are other common causes of blood loss that may lead to iron deficiency anemia. Intestinal parasites may also contribute to hemorrhage. Patients IDE stemming from hemorrhage actually have an increased reticulocyte count.

Microcytic, Hypochromic Anemia
Small-cells with Hippo-chrome and Anemone

Lab results in patient with iron deficiency anemia show a microcytic, hypochromic anemia. This means that the mean corpuscular volume is less than 80 (MCV <80) and that the cells are paler than usual. Typically the cells have central pallor.

Decreased Heme Synthesis
Down-arrow He-man

As the body's stores of iron are depleted, a CBC blood test will show a decreased RBC count. This occurs because there is not enough iron to properly complete the final step in heme synthesis.

Decreased Reticulocytes
Down-arrow Rattle with Baby-cell

Reticulocytes are immature blood cells, which are a small component of the blood cells that develop and mature in the bone marrow. The reticulocyte count is decreased in iron-deficient anemia as hematopoiesis is interrupted. It should be noted that with hemorrhage, reticulocyte count is actually increased.

Decreased Ferritin
Down-arrow Ferret-tin

Ferritin is a protein which stores iron. For lab purposes, it is an important indicator for how much stored iron is present. Thus in iron deficient anemia, ferritin levels are decreased.

Increased Red Cell Distribution Width (RDW)
Up-arrow Red Cell Projectile Width

The red cell distribution width (RDW) measures the variation of blood cell volume in an obtained sample. Varying sizes of blood cells is a hallmark of iron deficiency anemia and helps distinguish between this disease and thalassemia (as both are hypochromic and microcytic).

Pokiball-side-toe cell

Blood smears in these patients show a variation in blood cell shape (poikilocytosis).

N-ice-side-toe cell

Patients with iron deficiency anemia show blood cells of differing sizes (anisocytosis).

Increased Central Pallor
Up-arrow Pail with Central Pallor

Red blood cells in iron deficiency anemia show pallor on the inside of cells.


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