Iron Deficiency

Microcytic Anemia (MCV <80)
  • Occasionally Normocytic, with MCV <85
Diagnosis:
  • Low serum Ferriten (<30 ng/mL; esp. <15)
  • Low Transferrin Saturation % (calculated from low Iron & high TIBC)
  • High Zinc Protoporphyrin (aka Free Erythrocyte Protoporphyrin)

Seek Causes:

** G-I Blood Loss (ulcer, cancer, etc).  Send for Endoscopy if
  •  >50 y.o.;
  • melena;   OR
  •  no other cause found
** Menstrual Loss  –  If Hx very heavy/prolonged menses:
   > Check Platelets
   > R/O von Willebrand Disease.  Order “von Willebrand Panel”
  • Plasma VW Factor Antigen
  • Plasma VW Factor Activity (aka ristocetin cofactor activity)
  • Plasma Factor VIII activity
  • If any of above abnormal, send to Hematology for Dx & Tx
** Celiac Disease  –  Common.  Order:
  • Anti-tissue Transglutaminase IgA Antibody
  • Rare in persons of pure Chinese, Japanese, Sub-Saharan descent
** Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu) — Rare
  • Examine for oral / mucosal telangiectasias
  • If found, W/U for pulmonary / cerebral AVMs

** S/P Gastric Bypass

** Never blame diet unless truly faddish, or no access to food (e.g. housebound elderly).

See postings Anemia – 1 (general) and Anemia – 2 (microcytic anemia),