Normal (Pernicious Anemia) Iron Deficiency Thalassemia Anemia of Chronic Folate Deficiency Vitamin B12 Anemia Disease Deficiency Laboratory Laboratory Laboratory Laboratory Laboratory Hgb<12g/dL ↓ Hgb<12g/dL ↓ Hgb<12g/dL ↓ Hgb<12g/dL ↓ Hgb<12g/dL ↓ Hct<35% ↓ Hct- 28-40% ↓ Hct<35% ↓ Hct<35% ↓ Hct<35% ↓ Serum Iron<50mg/ml ↓ Serum Iron ↔/↑ Serum Iron<50mg/ml ↓ Serum Iron ↑ Serum Iron ↑ Ferritin<12ug/L ↓ Ferritin<12ug/L ↔ Ferritin<12ug/L ↔/↑ Ferritin<12ug/L ↑ Ferritin ↑ MCV(nl 80-100) ↓ MCV ↓ MCV ↔ MCV ↑ MCV ↑ MCHC(nl27.5-33.2) ↓ MCHC ↓ MCHC(nl27.5-33.2) ↔ MCHC ↔ MCHC ↓ Retic Count ↓ Retic Count ↔/↑ Retic Count ↔/↓ Retic Count ↓ Retic Count ↓ TIBC<250ug/dL ↑ TIBC(nl 250-450ug/dL) ↔ TIBC<250ug/dL ↓ TIBC250-450ug/dL ↔ TIBC250-450ug/dL ↔ RDW ↑ RDW ↔ RDW ↑ RDW ↑ RDW ↑ Bilirubin ↔ Bilirubin ↑ Bilirubin ↔ Bilirubin ↔/↑ Bilirubin ↔/↑ Serum Folate ↓ B12 ↓ High Risk High Risk High Risk High Risk High Risk Infants, adolescence, Chinese, Vietnamese, Chronic infection, Poor dietary intake, Partial or complete pregnancy, vegetarians, African Americans, cancer, inflammation, rapid growth gastrectomy, strict poor, elderly, GI tract Mediterranean descent renal or liver failure (adolescence, vegetarian, severe disturbances or surgery, pregnancy) Alcoholics, Crohn’s disease, fish excessive menstrual chronically tapeworm ingestion, flow, lead poisoning malnourished age 60+ Symptoms Symptoms Symptoms Symptoms Symptoms Mucous membrane Pallor, splenomegaly, Milder forms of: Glossitis, angular Weak, fatigue, sore pallor, pale palmar bronzing of skin, Hypoxia, rapid fatigue, cheilitis, anorexia, tongue, glossitis, creases (Hgb<7) Thalassemia major tachycardia, palpitations, diarrhea, pale or icteric, angular cheilitis, hypoxia, rapid fatigue, presents with more tachypnea with exertion, fine brittle hair, Pica anorexia, diarrhea, irritability, tachycardia, severe anemia chest pain, glossitis, premature aging *mid-systolic or pan- angular stomatitis, Neurologic signs: systolic murmur, (*reversible with two Peripheral palpitations, tachypnea weeks of tx) Ice Pica, paresthesia’s, difficulty with exertion, chest pain, brittle fine hair, with balance, dementia, glossitis, angular koilonychia (spoon positive Babinski’s and stomatitis, (*reversible shaped nails) Romberg signs. with two weeks of tx) Ice Hepatosplenomegaly Pica, brittle fine hair, koilonychia (spoon shaped nails) Treatment Treatment Treatment Treatment Treatment Treat underlying cause! No Iron supplements! Treat underlying cause! Supplement with folic Supplement with B12 Ferrous sulfate 325mg If asymptomatic, no tx Provide with iron-rich acid 1mg QD PO. 1000ug QDx1wk; TID before meals. Take needed. Patient food list, and iron Recheck folate levels in 1000ug Qweek x with VitC or citrus identification is needed supplements if needed. 2 months, adjust dose if 1month then 1000ug juices. Continue to prevent treatment High Iron foods: organ needed. Dietary per month for life. treatment for 6mos after with iron* Thalassemia and lean red meats, egg sources: asparagus, Consider iron Hgb is normal. If iron major is usually yolks, apricots, raisins, green leafy vegetables, replacement for 1 absorption is a problem referred for transfusion, grapes, shellfish, green red beans, black beans, month because of use iron dextran and chelating agent leafy vegetables. bananas, fish, liver increased need, recheck 100mg/wk IM. Check prescription. peanut butter, oatmeal levels in 2 months. retic count @ 1wk; and wheat bran. PT-motor, OT- check Hgb @ 2wks neuropathy