Iron Deficiency

Ans. is ‘b’ i.e., Serum ferritin

“The single most sensitive tool for evaluating the iron status is by measurement of serum jerritin” – Park

“It is the most usefill indicator of iron status in a population where the Prevalence” of iron deficiency is not high.

Answer is B &  C  (↓TIBC;↑Ferritin)

Anemia of chronic disease is associated with decreased TIBC and increased serum Ferritin while Iron deficiency anemia is associated with Increased TIBC and reduced serum Ferritin

Differential diagnosis of Microcytic Hypochromic Anemia

Ans. D: Excess of meat in the diet

Causes of iron deficiency anemia:

• Diet

– The prevalence of iron deficiency anemia is low in geographic areas where meat is an important constituent of the diet.

Substances that diminish the absorption of ferrous and ferric iron are phytates, oxalates, phosphates, carbonates, and tannates. Ascorbic acid increases the absorption of ferric and ferrous iron.

• Hemorrhage

–  Bleeding for any reason produces iron depletion. If sufficient blood loss occurs chronically, iron deficiency anemia ensues.

• Malabsorption of iron

– Prolonged achlorhydria may produce iron deficiency because acidic conditions are required to release ferric iron from food.

– Extensive surgical removal of the proximal small bowel or chronic diseases, such as untreated sprue or celiac syndrome, can diminish iron absorption.

• Increased demand: pregnancy, lactation and growth periods.

Ans. D: Reduced ferritin

Ans. C: Ancylostoma duodenale

An adult Ancylostome (hookworm) can suck about 0.2 ml blood a day, while the smaller necator sucks in about 0.03 ml per day. These worms frequently leave one site and attach themselves to other site. As the secretions of the worm contain anticoagulant activity, bleeding from the site may continue for several days adding to the blood loss.

This chronic blood loss over a period of time leads to a microcytic hypochromic anemia. Pinworm (Enterobius vermicularis) causes irritation and pruritis in the perianal and perineal area. It may cause symptoms of chronic salpingitis and appendicitis.

Taenia solium causes cysticercus cellulosae commonly in the subcutaneous tissues and muscles. It may also affect eye, brain, heart, lung or liver.

Ans. is ‘c’ i.e., Hypochromic microcytic

Ans. is ‘c’ i.e., It binds to trnasferrin

Ans. is ‘b’ i.e., Iron dextran

Ans. is ‘D’ i.e., Bone marrow iron is decreased earlier than serum iron

“In iron deficiency anemia the first change is decrease in iron stores “

The decrease in iron stores is demonstrated by decreased serum ferritin level.

Remember,

Serum ferritin reflects the amount of storage iron in the body.

As the total body iron level begins to fall a characteristic, sequence of events ensue :

• First Stage or Prelatent Stage of Iron Depletion
• When iron loss exceeds absorption, a negative iron balance exists.
• Stored iron begins to be, mobilized from stores. The iron present in the macrophages of liver, spleen and bone marrow are depleted
• Decrease in stored iron is reflected by decrease in serum ferritin.
• At this stage all other parameters of iron status are normal.

Second Stage or Stage of Latent Iron Deficiency :

• Iron stores are exhausted but the blood hemoglobin level remains higher than the lower limit of normal. o After the exhaustion of iron stores :
• The plasma iron concentration fallsQ.
• Plasma iron binding capacity increases2.
• Percentage saturation falls below 15%Q.
• The percentage of sideroblast decreases in the bone marrowQ.

Third Stage or Stage of Apparent Iron Deficiency Anemia

• Supply of iron to marrow becomes inadequate for normal hemoglobin production,
• So the blood hemoglobin concentration falls^Q below the lower limit of normal and iron deficiency anemia is apparent.

Ans. is ‘b’ i.e., Microcytic hypochromic anemia