#Hematology_11 #Anemia #IDA_6 Diagnosis of Iron Deficiency an | "لعلي أفيدك" Clinical discussion

#Hematology_11 #Anemia #IDA_6
Diagnosis of Iron Deficiency anemia part 2
اهم tests لتشخيص ال IDA هم ال ferritin وال TSAT
هنضيف على البوست السابق ملاحظتين عن ال TSAT وال ferritin

ال TSAT بيتأثر بال Iron Supplement
يعني لو فرضا المريض ماشي ع Oral or I.V Iron وبنتابعه وسحبناله ال TSAT ممكن يكون Falsely Increased

Therefore, TSAT should not be drawn immediately after a morning dose of oral iron.

After a dose of intravenous iron, we typically wait and retest iron studies at the time of repeat CBC (eg, after approximately four weeks).

لو المريض عنده inflammatory condition مثلا RA او IBD وماشي عأدويه ال TNF inhibitor زي ال infliximab, adalimumab
بهلحاله ال ferritnهيكون low ويعبر عن ال Normal Iron stores
رغم ال Inflammation condition

Pateint on TNF appears to reduce the ferritin level (perhaps to a more accurate representation of iron stores) and increase the TSAT

the serum ferritin is likely to be most representative of the level of iron stores despite its acute phase reactivity in such patients

نكمل بباقي تيستات ال Iron study

Serum iron

في حالات ال IDA ال serum Iron بيكون Low
بس مش specific ، يعني ممكن نلاقيه بردو low في حالات
ال anemia of chronic disease وال anemia of inflammation

serum iron cannot be used to diagnose or exclude iron deficiency.

تحليل ال serum iron بتأثر بال Diet ولو المريض ماشي ع Iron supplement بردو بيأثر ع نتيجه التحليل

It is recommended that the sample be drawn after an overnight fast.

By itself, low serum iron is not diagnostic of any condition but must be evaluated in light of other tests such as transferrin saturation and ferritin.

Serum transferrin
بيزيد في حالات ال IDA وبيقل بال Anemia of chronic disease
ممكن عن طريق ال Serum transferrin نحسب ال TIBC
TIBC (Total iron-binding capacity)

TIBC = Serum transferrin * 1.389

Soluble transferrin receptor (sTfR) and sTfR-ferritin index
ال (sTfR) بيزيد في حالات ال IDA وبيكون طبيعي في حالات ال
Anemia of Chronic Disease ( ACD) Or Anemia of inflammation ( AI)

sTfR is a circulating protein derived from cleavage of the membrane transferrin receptor on bone marrow erythroid precursor cells. Its concentration in serum is directly proportional to erythropoietic rate and inversely proportional to tissue iron availability, similar to serum transferrin

The major advantage of sTfR is that it reflects overall erythropoiesis, which is increased in iron deficiency. However, sTfR can be elevated in patients with hemolysis or with administration of erythropoiesis-stimulating agents (ESAs).

Patients with ACD/AI are likely to have an sTfR-ferritin index <1, whereas those with isolated iron deficiency or iron deficiency plus ACD/AI are likely to have an sTfR-ferritin index >2

RBC protoporphyrin and RBC zinc protoporphyrin
في حالات ال IDA بيزيد ال Intestinal Zinc absorption
وال Zinc بيصيرله incorporated into protoporphyrin زبيدخل في تصنيع ال RBCs
Thus, elevated erythrocyte (RBC) zinc protoporphyrin (eg, >80 mcg/dL) is consistent with iron deficiency.

ولكنه مش Specific لانه بردو بيزيد في حالات ال Inflammation
وال Hemodialysis وال lead poisoning

Reticulocyte hemoglobin content (CHr)

بيكون Low في حالات ال IDA وما بتأثر لال Inflammation

individuals with thalassemia have reduced RBC hemoglobin content due to decreased globin chain synthesis; in these individuals, a low CHr is unreliable for diagnosing iron deficiency, although an elevated CHr can exclude iron deficiency.

Bone marrow iron stain
Staining of the bone marrow aspirate smear for iron provides a qualitative assessment of iron in bone marrow cells (eg, macrophages, red blood cell precursors). Stainable bone marrow iron is considered the gold standard for assessing iron stores but is rarely required for diagnosis.
البوست القادم ان شاء الله هنبدأ بال Management

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