Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Elisabeth A. Fandrich
May 2, 2008
Anemia is the condition of having too few circulating red blood cells or components of the
red blood cells. Red blood cells usually make up 40-45% of the total blood volume. This
percentage is called hematocrit. The most important function of red blood cells is to carry oxygen
from the lungs to the tissues of the body. Hemoglobin is a molecule contained within red blood
cells. Each molecule of hemoglobin contains iron which binds with oxygen in areas of high
oxygen concentration (the lungs), and releases oxygen in areas of low oxygen concentration (the
capillaries). This iron contained within the hemoglobin is what gives blood its red color.
Hemoglobin also helps remove carbon dioxide from the body. An enzyme called carbonic
anhydrase is contained within the hemoglobin. This enzyme is the catalyst which speeds up the
molecular breakdown of carbon dioxide into hydrogen ions and bicarbonate ions. The hydrogen
ions bind with the hemoglobin, and the bicarbonate ions enter the blood plasma. The majority of
carbon dioxide is removed through the blood in this way. The remaining amount of carbon
dioxide is carried intact by the hemoglobin to the lungs where it is expelled from the body.
Anemias are classified in two ways. The first is by size and hemoglobin content of the red
blood cells. The second is by mechanism or cause. Iron deficiency anemia is classified as
microcytic hypochromic. To further classify iron deficiency anemia, the cause must be known.
There are several potential causes of iron deficiency anemia. The most obvious reason for
being iron deficient is inadequate dietary intake of iron. Other reasons are poor absorption of iron
by the body, blood loss (including heavy menstrual bleeding and gastrointestinal bleeding) and loss
of iron through the urine (hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis). This
type of anemia is also associated with use of aspirin and NSAIDs, celiac disease, lead poisoning,
and certain types of cancers. At the time I assessed 3512,W,E, the cause of her anemia was
unknown. Gastrointestinal bleeding was suspected in this patient after a hemooccult stool sample
Anemia 3
came back positive for blood. A diagnostic procedure was planned, but I was unable to obtain the
results.
Common symptoms of iron deficiency anemia include pallor, fatigue, irritability, weakness,
shortness of breath, brittle nails, pain of the tongue, pica, frontal headache, anorexia, and bluish
sclerae. If the condition is mild, the patient may be asymptomatic. 3512,W,E presented to the
emergency department at 2330 April 27, 2008 complaining of abrupt onset of “heartburn”,
substernal chest pressure and headache. She described that it came on at approximately 2030 that
evening. It persisted until arrival at the emergency department. She described the pain and
pressure as moderate intensity and that it did not radiate. There was associated nausea, shortness
A complete assessment including history and physical along with laboratory studies of
blood, stool and urine are used to diagnose this condition. Common lab studies ordered are CBC,
peripheral smear, serum iron, total iron-binding capacity (TIBC), serum ferritin, MCV, MCHC,
stool occult blood, testing for hemoglobin in the urine without the presence of red blood cells and
hemoglobin electrophoresis. Other procedures used diagnostically are bone marrow aspiration
and measurements of tissue lead concentrations. Pertinent lab results for 3512,W,E were as
follows on admission: WBC 11.63 ↑ (normal:3.5-10 K/uL ), RBC 4.13 ↓ (normal: 4.2-5.40
M/uL), Hgb 10.5 ↓ (normal: women 12-16 g/100 mL), Hct 31.5 ↓ (normal: women 36-46%),
serum glucose 170 ↑ (normal: 65-110), CK 253 ↑ (normal: 22-235 u/L), CKMB 1.6 normal
(normal: 0-6 ng/mL), Toponin I <0.02 normal (normal: 0.0-0.40 ng/mL), MCV 76.3 ↓ (normal:
82-98 fl), MCH 25.5 ↓ (normal: 27.0-33.0 pg), MCHC 33.4 normal (normal: 32.0-36.0 gm/dL),
and RDW 16.6 ↑ (normal: 11.5-14.5%). Further tests were ordered the next day after the results
of the initial lab tests were known. Stool occult blood tested positive (normal: negative), ionized
calcium 4.49 ↓ (normal: 4.75-5.63 mg/dL), serum iron 13 ↓ (normal: 25-165 uf/dL), ferritin 5 ↓
Anemia 4
(normal: 10-120 ng/mL), total iron-binding capacity 366 normal (normal: 250-450 ug/mL), and
reticulocyte count 1.5 normal (normal: 0.5-1.5% of all RBCs). A definitive diagnosis was not
made before I reported to the nurse at the end of my shift. However, the lab tests indicate that the
chest pain and pressure was not related to a heart attack as was initially suspected, but rather, it
was a symptom of iron deficiency anemia related to loss of blood in the gastrointestinal tract.
Treatment of iron deficiency anemia varies with the cause of the anemia. Underlying
etiology should be resolved to prevent future episodes of iron deficiency anemia. Because most
patients with iron deficiency anemia have a lack of iron in the diet, supplements and food
recommendations (iron fortified foods, red meats, green leafy vegetables) are all that is needed. If
the cause of the anemia is hemorrhage, surgery may be indicated. Activity restrictions may be
indicated until the deficiency resolves with the use of oral iron supplements. If the anemia
surgery may be indicated to repair the damage. Medications and other treatments associated with
Patients taking oral iron supplements should be advised to take the medication as ordered,
to follow a diet high in iron, and take the medication on an empty stomach unless gastrointestinal
upset occurs. Patients should also be informed that oral iron supplements may cause their stools
to become black or dark green and “tarry”. This change is harmless and expected. Patients
taking liquid forms of iron supplementation should be advised to mix the liquid with a beverage
(preferably high in vitamin C, not milk), and consumed via a straw to prevent discoloration of the
teeth.
3512,W,E is a 38 year old female who is obese, has a history of diabetes, hypertension,
hypercholesterolemia, previous heart attack and TIA. This patient has a history of illicit drug use
which ceased in 2004. The prognosis for this patient depends greatly on her commitment to make
Anemia 5
lifestyle changes in order to improve her general well-being. The iron deficiency anemia may be
corrected with surgery or supplementation. The patient’s weight, diabetes mellitus, hypertension
and hypercholesterolemia are concerning, especially considering her history of heart attack and
TIA at a relatively young age. It is difficult to determine a specific prognosis regarding the iron
References
(2008, January 30). IronDeficiency Anemia. Retrieved April 29, 2008, from University of Maryland Medical
Center
Web site: http://www.umm.edu/blood/aneiron.htm
Bianco MD, C. (2007). How Blood Works. Retrieved April 29, 2008, from Howstuffworks Web site:
http://health.howstuffworks.com/blood1.htm
Anemia 6
(2007). Anemia Classification. Retrieved April 29, 2008, from University of Texas at Brownsville Web site:
http://blue.utb.edu/medlabtech/hematology%201415/anemia5.html
Conrad MD, BS, Marcel E. (2006). Iron Deficiency Anemia. In eMedicine [Web]. New York, NY: WebMD.
Retrieved April 29, 2008, from http://www.emedicine.com/med/TOPIC1188.HTM#section~AuthorsandEditors