Anemia in Women and Diagnosis

Anemia

• Anemia definition (women): Hemoglobin level below 12.8 g/dL
• Anemia definition (pregnant women): Below 11.8 g/dL in first and third trimesters, less than 10.58 g/dL in second trimester.
• Normal MCV: 80-100 fL
• Microcytic anemia MCV: <80 fL
• Macrocytic anemia MCV: >100 fL
• Electrophoresis ordered for: Diagnosis of thalassemia, especially if family history exists.
• Iron indices: Serum iron, transferrin, total iron-binding capacity (TIBC), unsaturated iron-binding capacity (UIBC), and transferrin saturation.
• Serum Iron: Measures iron level in the blood serum.
• Transferrin: Protein transporting iron throughout the body. Usually about 1/3 saturated with iron.
• TIBC: Total amount of iron that can bind to proteins in the blood, indirectly measuring transferrin levels.
• UIBC: Measures the portion of transferrin not yet saturated with iron, reflecting transferrin levels.
• Transferrin saturation: Percentage of transferrin saturated with iron.
• Serum Ferritin: Amount of stored iron in the body.

Differentiating B12 and Folate Deficiency

• Methylmalonic acid: Elevated in B12 deficiency
• Total homocysteine: Elevated in both deficiencies.

Iron-Deficiency Anemia

• Ferritin: Low
• Reticulocyte: Low
• TIBC: High
• MCV: <80 fL
• H&H: Low
• Serum Iron: Low
• MCHC: <27 g/dL

Anemia Types: Normocytic, Microcytic, Macrocytic

• Normocytic anemia: Associated with blood loss, chronic diseases (IBD, lupus), renal failure, or liver disease.
• Microcytic anemia: Most common type, associated with iron deficiency anemia, thalassemia.
• Macrocytic anemia: Typically associated with vitamin B12 deficiency, pernicious anemia, folate deficiency, alcohol abuse, or hypothyroidism.

Subjective Data for Anemia Types (Example)

• Normocytic: May be asymptomatic; fatigue, achiness, feeling cold, difficulty breathing with activity.
• Microcytic: Fatigue, weakness, tachycardia/palpitations, lightheadedness, dyspnea on exertion, use of antacids, 42-blockers, PPIs, NSAIDs, aspirin, zinc, menstrual history (heavy/lengthy), pica, melena in stools.
• Macrocytic: Fatigue, weakness, tachycardia/palpitations, lightheadedness, dyspnea on exertion, difficulty walking, diarrhea, peripheral neuropathy (pain and tingling), memory and cognitive issues, depression, irritability, use of antacids, H2 blockers, PPIs, and metformin.

Diagnostic Testing and Interpretation (Examples)

• Iron deficiency (IDA): Low ferritin, low reticulocyte count, high TIBC, low serum iron, low MCHC.
• Thalassemia: Low MCV, low hemoglobin and hematocrit, may have family history. Hemoglobin electrophoresis confirms diagnosis.
• Vitamin B12 deficiency: Elevated methylmalonic acid, low serum B12, megaloblastic anemia on smear, possible history of gastrectomy.
• Folate deficiency: Elevated homocysteine, low serum folate, megaloblastic anemia on smear.

Treatment Options (Examples)

• Iron deficiency: Iron supplementation
• Thalassemia: No iron treatment, refer to hematologist, blood transfusions, genetic counseling.
• Vitamin B12 deficiency: Oral or injections of vitamin B12, address underlying cause (pernicious anemia).
• Folate deficiency: Folate supplements, address underlying cause (e.g., medications, alcohol).

Additional Note

• Anemia in pregnancy: Special considerations for the underlying causes and management.
• Chronic disease anemia: Requires addressing the underlying chronic condition.
• Acute blood loss anemia: Requires prompt management to stop the bleeding.

Vitamin B12 and Folate Deficiency (Specifics)

• Vitamin B12 Deficiency Diagnostic Testing: Low serum Vitamin B12, Elevated Methylmalonic Acid, possible history of gastrectomy, megaloblastic anemia on smear. Intrinsic Factor Antibodies (IFAB) testing may be needed.
• Folate Deficiency Diagnostic Testing: Low serum folate, Elevated Homocysteine, megaloblastic anemia on smear.
• Treatment: B12: Oral B12, injections (depending on severity); Folate: Folate supplementation.

Patient Presentation and Relevant Information (Example)

• PICA: Associated with iron deficiency.
• Medications: Antacids, H2 blockers, PPIs, NSAIDs, aspirin, zinc, metformin, methotrexate.
• Family history: Important in identifying hereditary conditions like thalassemia.
• Dietary habits: Evaluate for insufficient iron intake, vegetarian or vegan diet, alcohol use and potential malnutrition.
• Menstrual history (women): Heavy or prolonged periods may indicate blood loss.
• Gastrointestinal issues: Include problems like ulcers or recent surgeries.
• Symptoms: Fatigue, shortness of breath, difficulty walking, pallor, tachycardia.
• Objective Findings (Physical Exam): Pallor, tachycardia, glossitis, angular stomatitis, koilonychia, nail changes, and other symptoms.

This quiz covers the definitions of anemia, particularly focusing on women and pregnant women. It includes important metrics like hemoglobin levels and MCV classifications, as well as diagnostic measures such as iron indices and their significance. Test your knowledge of anemia and its implications for health care.