Urgent Care facility in Orlando services large area. A 50 year old female patient was seen in the Walk in Clinic in Orlando for feeling tired and weak. Patient denied any cold, congestion and cough.
Dr. Jain is the medical director of the walk in clinic and examined the patient. Blood tests were ordered which revealed low Hgb of 9.0. The patient had further test ordered to work up an anemia. Anemia could be from
1. Iron deficiency anemia,
2. Anemia from chronic inflammation
3. Acute blood loss anemia
The patient had further test ordered to work up an anemia.Test ordered to evaluate anemia
3. Iron and Iron binding capacity
7. Vitamin B12 and Folic acid
Patient loses 1 to 2 mg per day.
Iron deficiency anemia from chronic inflammation happens because of the poor absorption of Iron from the intestine in to the blood. chronic inflammation causes increase in hepcidin which is the regulator of Iron metabolism. Enterocyte gets the Iron from the intestine and traps the iron and it is not released in the blood which causes the low Iron. Increased hepacidin inhibits Iron release of enterocytes and also reduction of ferroportin to release the Iron in circulation.
Iron gets absorbed in duodenum and procimal intestine.In iron deficiency anemia from low iron:
1 Low hgb
2. Low Ferritin
3. Increase in transferrin
4. Iron saturation would be low.
6. Normal hepcidin levels
Treatment of the Iron deficiency anemia from chronic inflammation is to treat by intravenous Iron as oral is not absorbed in the circulation.
The patient received the intramuscular injection of Iron dextran and improved. The Hgb was checked in 2 weeks which showed an improvement. Other Iron preparation would be Iron sucrose and Ferric carboxymaltose.
Iron supplements can cause abdominal pain, diarrhea and lethrgy.