Iron Deficiency Anemia: Iron Studies

00:02 Okay.

00:02 So now, let’s walk through in order how to then evaluate your iron studies, shall we? Number one, and I’m going to walk you through this slowly again.

00:13 And then as we go through more of our type of microcytic anemias, I am going to go a heck a lot quicker.

00:17 So get it down now.

00:20 I introduced the normal in the previous discussion.

00:23 I told you number one, pay attention to serum iron.

00:25 Number two, you take a look at ferritin.

00:28 Ferritin has an inverse relationship with? What are you going to use, laboratory? Transferrin or TIBC? TIBC.

00:37 Inverse relationship with TIBC.

00:38 And number four, what’s that called? Transferrin saturation.

00:42 Okay, so those are the four that we looked in normal.

00:45 Let us now play around with iron deficiency.

00:50 Serum iron, obviously, decreased.

00:53 Number two.

00:54 You see that ferritin box right there? Wow! Very little green shade.

01:00 That green shade represents iron.

01:04 So very little ferritin, number two.

01:06 What kind of relationship does ferritin have with TIBC? Inverse relationship.

01:11 So therefore, a decrease in ferritin means an increase in TIBC.

01:16 Number three, your next question that you’re asking yourself is what is it that fills up this transferrin, this column that you see here on your left.

01:29 Now, it’s moved up because TIBC’s increased up to 500.

01:33 Total iron binding capacity’s increased.

01:36 So if your binding capacity’s increased, but you’re iron deficient, well, what is the body trying to do? It’s trying to bind as much iron that it can.

01:43 But it can’t find any, huh? Because you’re iron deficient.

01:48 Why? Maybe your female had menorrhagia, you get my point.

01:50 So the binding capacity’s increased.

01:54 But you can’t bind to any.

01:56 So therefore, what’s your saturation percentage? Decreased.

02:00 Clear? Now, tell about how the transferrin’s being saturated.

02:07 What does that mean? Does this mean that transferrin is delivering iron to itself? That makes no sense.

02:13 The transferrin is transporting the iron, Fe, to the bone marrow.

02:22 Why? Oh, I think that’s where RBC production is taking place? Yeah, that’s exactly what’s happening.

02:26 Okay.

02:28 So then, what is it that’s filling up this transferrin.

02:31 You won’t think of this as being -- ferritin kind of regulates that, okay? So if your ferritin’s decreased, then how in the world can you then release enough iron to saturate this big block.

02:40 You'd find it completely empty.

02:43 See this column here, and that whole thing is TIBC.

02:46 Welcome to iron deficiency.

02:49 Number one, serum iron decreased.

02:49 Number two, decreased ferritin.

02:50 Number three, increased TIBC.

02:53 And number four, you’d find a decrease in percentage saturation.

02:57 Let’s continue.

02:59 Laboratory values, in words, is what we just talked about.

03:01 A decreased hemoglobin, hematocrit, RBC count.

03:06 Well, that’s pretty nonspecific.

03:07 MCV, decreased, definitely puts you into the realm of microcytic.

03:12 What’s your magic number? Good.

03:16 Less than 80.

03:17 Next, stop.

03:18 If you have iron deficiency – I can’t even from proper heme or globin, which one? Heme.

03:25 Okay? So what is that iron gives -- What kind of color does iron give your heme? Red.

03:35 Red.

03:35 So if you’re iron deficient and you can’t form proper heme, what color is your RBC? Rather pale.

03:41 What do you call that? Pallor.

03:44 What about that central pallor? Should you have a little bit of central pallor in a normal RBC? Sure.

03:49 But what about in iron deficiency? That pallor, pallor, pallor increases.

03:53 So increased central pallor.

03:55 What do you call this clinically? Oh, yeah.

03:59 Hypochromic, there you go.

04:00 So what lab tells you that the RBC is hypochromic? Take a look.

04:08 MC -- you pay attention -- HC.

04:11 Hemoglobin concentration.

04:12 So once again, if you don’t have iron, I don’t have proper production of heme.

04:18 I don’t have proper amounts of hemoglobin concentration in my RBC.

04:24 What color is your RBC? Hypochromic.

04:25 Look at that. It makes perfect sense.

04:27 You have a decreased MCV and you had MCHC, what do you call this clinically? You call this hypochromic microcytic.

04:34 That you’ve memorized so many different times.

04:37 But to actually see in laboratory, isn’t that fascinating? I’m a dork.

04:42 I love this stuff because the labs actually speak to you.

04:44 Anything that laboratory was, EKG, ultrasounds, all these give you vital information.

04:51 Next, well, tell me about the RBCs in a peripheral blood smear.

04:55 Peripheral blood smear.

04:56 They’re microcytic, correct. And they’re hypochromic.

05:00 All at the same time? Could it be possible that you might have some RBCs that are bigger? Some are smaller.

05:06 So bigger, smaller, bigger – Can I be any more dramatic? So in a peripheral blood smear, you have big RBCs, little RBCs, big RBCs, little RBCs, and you then call this red blood cell distribution width.

05:21 Because you don’t have uniformity of your RBCs on a peripheral blood smear, guess what your RDW is.

05:30 Increased.

05:30 So what does that mean? Uniformity is what should come to mind when we think RDW.

05:36 You don’t have it usually with an iron deficiency type of picture.

05:41 Let’s move on.

05:42 That’s huge, huge.

05:44 That second and third bullet point are huge, aren’t they? For iron deficiency.

05:49 Now, what about your iron studies? Well, you tell me.

05:50 Close your eyes.

05:51 Serum iron, decreased.

05:54 Number two, ferritin, decreased.

05:55 Ferritin, decreased. TIBC, increased.

05:57 Transferrin saturation, decreased.

05:59 You see how easy that was? You spend time with that normal graph first in the previous discussion.

06:05 You go through this cycle that I’m giving you.

06:08 Every single time, you can’t miss a question.

06:12 Increased TIBC.

06:14 What does BC mean? Binding capacity.

06:18 but the problem is, you can’t bind to anything because you’re iron deficient.

06:24 On your left is going to be your pathology.

06:27 Let’s take a look at that central region.

06:28 See that increased pallor? “Compared to what, Dr. Raj?” Take a look at the right, that’s normal.

06:35 You see the central pallor in the right.

06:37 The pallor? Yeah, it’s there.

06:39 But not much.

06:39 On the left, oh, it’s too much.

06:41 There you go.

06:44 What lab gives you increased central pallor or lack of color? What gives you hypochromicity? MCHC.

06:53 Are we clear? So hemoglobin concentration is decreased on the left.

06:56 Therefore giving you hypochromic and to be technical, you know that MCV is decreased.

07:03 So microcytic hypochromic anemia, iron deficiency.