tailieunhanh - Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias (Part 7)

The second condition is the anemia of chronic inflammation with inadequate iron supply to the erythroid marrow. The distinction between true irondeficiency anemia and the anemia associated with chronic inflammation is among the most common diagnostic problems encountered by clinicians (see below). Usually the anemia of chronic inflammation is normocytic and normochromic. The iron values usually make the differential diagnosis clear, as the ferritin level is normal or increased and the percent transferrin saturation and TIBC are typically below normal. Finally, the myelodysplastic syndromes represent the third and least common condition. . | Chapter 098. Iron Deficiency and Other Hypoproliferative Anemias Part 7 The second condition is the anemia of chronic inflammation with inadequate iron supply to the erythroid marrow. The distinction between true iron-deficiency anemia and the anemia associated with chronic inflammation is among the most common diagnostic problems encountered by clinicians see below . Usually the anemia of chronic inflammation is normocytic and normochromic. The iron values usually make the differential diagnosis clear as the ferritin level is normal or increased and the percent transferrin saturation and TIBC are typically below normal. Finally the myelodysplastic syndromes represent the third and least common condition. Occasionally patients with myelodysplasia have impaired hemoglobin synthesis with mitochondrial dysfunction resulting in impaired iron incorporation into heme. The iron values again reveal normal stores and more than an adequate supply to the marrow despite the microcytosis and hypochromia. Iron-Deficiency Anemia Treatment The severity and cause of iron-deficiency anemia will determine the appropriate approach to treatment. As an example symptomatic elderly patients with severe iron-deficiency anemia and cardiovascular instability may require red cell transfusions. Younger individuals who have compensated for their anemia can be treated more conservatively with iron replacement. The foremost issue for the latter patient is the precise identification of the cause of the iron deficiency. For the majority of cases of iron deficiency pregnant women growing children and adolescents patients with infrequent episodes of bleeding and those with inadequate dietary intake of iron oral iron therapy will suffice. For patients with unusual blood loss or malabsorption specific diagnostic tests and appropriate therapy take priority. Once the diagnosis of iron-deficiency anemia and its cause is made there are three major therapeutic approaches. Red Cell Transfusion Transfusion .