Iron Deficiency Anemia: Etiology

00:00 Let’s begin with iron deficiency anemia, extremely common in our society.

00:05 Let’s take a look at all the different causes as to why you are iron deficient.

00:08 Maybe you’re losing blood.

00:11 On a monthly basis, a female who is in her reproductive lifespan is always going to have her menses.

00:20 She’s always going to have her menstrual cycle.

00:21 Maybe perhaps during her menses, she might be losing a little bit of blood.

00:25 So therefore, she might then, over a period of time, become iron deficient.

00:29 Is that common? Extremely.

00:31 Number two, what if you have a patient that has arthritis and has been taking NSAIDs, nonsteroidals, for ten, fifteen, twenty years.

00:42 How common is arthritis in the world? Ridiculously common.

00:45 You can’t help it sometimes, right? So it’s a wear and tear type if arthritis.

00:50 Your joints can become weak.

00:52 Patient is in pain, inflammation, so therefore, takes NSAIDs, correct? “What does that mean, Dr. Raj?” Meaning to say with NSAID, you’re trying to relieve your anti-inflammatory type of – You’re trying to relieve some of that inflammation.

01:06 But in the process, you’re also knocking out the prostaglandin, aren’t you? You knock out the prostaglandin, then don’t you need your prostaglandin to properly protect the lining of the stomach? Of course, you do.

01:16 So over ten, fifteen, twenty years, you take NSAIDs or aspirin even, and you knock out the prostaglandin, your patient is now at risk for? Good A gastric peptic ulcer disease, correct? What’s one of the most common causes of painless rectal bleeding in the United States? Diverticulosis.

01:33 Give me another one.

01:34 Angiodysplasia.

01:35 Do you see how common iron deficiency would be? Is it possible that you actually have one type of anemia in which you’re peeing or urinating and you see red urine.

01:46 Oh, my goodness! Red urine.

01:48 And maybe this is in the morning or after you exercise.

01:51 With that type of history, it’s automatically paroxysmal nocturnal hemoglobinuria, high in the differential.

01:56 And the point is, as you continue having one type of anemia, such as PNH, and you’re releasing red urine, what does that red mean? Oh, yeah, this is hemoglobinuria.

02:05 What’s in hemoglobin? Oh, yeah, iron.

02:09 So you have iron deficiency and a normocytic and a microcytic anemia at the same time? Sure.

02:17 Do you see where I’m getting at? Iron deficiency, extremely common.

02:20 Ulcers, diverticulosis, colon cancers, especially right side is big.

02:26 Gyne bleeding.

02:26 This is as I said a female who has menorrhagia, and that’s quite a bit of menses taking place every single month.

02:31 Maybe, maybe this is a female that has von Willebrand disease, huh? Von Willebrand disease.

02:38 Iron deficiency, well very young, very old.

02:40 Sure.

02:42 In the nursing home, maybe they’re not being fed properly, malnourished.

02:45 Very young, once again, maybe iron deficient because your child might just be on a McDonald’s diet, do you see where I’m getting at? Well, that might actually have enough iron in it because of the meat, but you get my point.

02:56 So malnourishment is every possibility, very young, very old.

02:58 Malabsorption is always an issue as well.

03:02 Remember the type of iron that you’re taking in is ferric.

03:05 Ferric.

03:06 But that is not at all usable for us.

03:09 So what do you want to do with that ferric? You remove the one valent, and now you get what? Ferrous.

03:15 Give me a couple of things that will then help you convert that ferric into ferrous? In other words, convert the methemoglobin into ferrous.

03:23 I need some acid.

03:25 Where do you have acid? In the esophagus? Are you kidding me? Physiologically, you should never have acid in the esophagus.

03:31 In the stomach.

03:32 And this acid’s going to do what? It will help you convert the ferric into ferrous.

03:37 What else might you require? A lot of times, you might find a treatment modality and this could be ascorbic acid.

03:46 Well, there you go.

03:47 In a form of vitamin C, helps to convert ferric into ferrous.

03:51 My point is this, any point in time that you knock out your gastric acid, you might then be rendered iron deficient because you cannot convert your ferric into ferrous.

04:00 Are we clear about this? I hope so.

04:03 And the point is, say that you have a – Give me an autoimmune type of anemia that then knocks out the parietal cells.

04:10 "Oh, I know that one." Of course, you do.

04:12 That’s pernicious anemia, isn’t it? And so there are two anemias, two different types.

04:17 So one is going to be your microcytic, megaloblastic anemia known as vitamin B12 deficiency secondary to? Pernicious anemia.

04:25 I don’t have the acid, and so therefore I’m also iron deficient.

04:28 Be careful.

04:29 Okay.

04:31 Use common sense.

04:31 Small bowel resection.

04:34 Okay, that is always a possibility.

04:34 Say that you have patient who has increased heart rate at 200 maybe, 300 beats per minute, and on your EKG, you find --- Well, you can’t even find the P waves because they’re all wavy.

04:48 Diagnosis, atrial fibrillation, good.

04:50 Why am I bringing this up? You have you possibility with atrial fibrillation that you might then form a thrombi.

04:55 Of course, that’s why you use a drug called Coumadin for prophylaxis, right? But I’d say that then take place and you ended up embolizing.

05:04 Embolizing where? Ischemic type of issue.

05:08 Ischemic bowel disease.

05:09 You might end up in the superior mesenteric artery.

05:11 No joke.

05:12 So remove the small bowel, your patient might become iron deficient.