Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44

868 Iron Deficiency

➣complete blood count and mean corpuscular volume (CBC)

➣reticulocyte count

➣RDW (iron deficiency – elevated; thalassemia trait – normal)

➣serum iron

➣total iron-binding capacity (TIBC)

➣serum ferritin

➣erythrocyte sedimentation rate (ESR)

■Stool

➣guaiac

■Urine

➣hemosiderin

➣hemoglobin

Specific Diagnostic Tests

■Bone marrow aspirate with Perl’s Prussian blue iron stain (Zenker’s

fixative can wash iron out of biopsies).

■Red cell zinc protoporphyrin levels

Reticulocyte hemoglobin concentration

differential diagnosis

n/a

management

What to Do First

■Determine and interdict the source of blood loss.

General Measures

■Assess hemodynamic stability with acute bleeding superimposed on

chronic blood loss.

specific therapy

Indications for Treatment

■organ hypoxia due to decreased oxygen-carrying capacity

■fatigue, dyspnea

■glossitis, angular stomatitis

Treatment Options

■oral iron replacement. Preferred route on an empty stomach.

Vitamin C increases absorption. Delayed-release tablets primarily

release below the duodenum, missing the major site of iron absorp-

tion. Add meat to diet if meat intake is low.