Should I give iron if patient has anemia but normal iron levels?
Question
I have a young patient with anemia, I have started giving him iron supplements and probiotics, but the labs show normal iron, normal MCV, normal tibc, ferritin, and transferrin. He also has a positive ASO titre. Any thoughts?
Answer
You wouldn't believe how many times doctors have asked me this same question. The main concern is over the proper differential breakdown for anemia.
Anemia is diagnosed by lab work NOT SYMPTOMS (not a good idea).
There are many different causes of anemia that do not include iron, so it is important to know how map it out. This is one of the first things that I learned in internal medicine rounds and it has served me well.
1st Does the patient have anemia? Female Hemoglobin (not RBC) < 12.5 g/dl // Males <13.5 g/dl
If yes, What is the size of the red blood cell (MCV)?
Less than 80; The most common cause is iron deficiency (60%), then anemia of chronic disease (30%), Thalassemia and Sideroblastic.
Between 80-100; you will need to follow up with a reticulocyte count.
Normal tic% <2 could be acute blood loss <7 days, Anemia of chronic disease (70%), early iron deficiency anemia, malignancy, renal disease, and aplastic anemia.
High tic% >3% relates to 5 defects and 1 acute blood loss <7 days.
MCV of >100 points to folate deficiency (Most common), B12 deficiency, alcoholism, hypothyroidism, aplastic anemia, myelodysplastic syndrome, and chemotherapy. You may be able to assume acetominophen consumption and high glycemic / fatty diet would also impair the liver to cause this.
So this patient has normocytic anemia that is obviously not iron deficiency. You are going to have to do a reticuloctye count. asap. You also have to d/c the iron supplementation.
My initial clinical insight would be that the patient may have the beginnings of anemia caused by chronic infection due to the positive ASO. Because the ASO is positive, this is most likely not an acute infection but has been brewing. You can kill the strep bacteria with many herbs, foods, and silver.
I hope that helps.
Patrick
Dr. Patrick Garrett
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Posted by Functional Medicine at 9/2/2010 12:51 PM 
Categories: Doctor On Call
Tags: anemia iron deficiency anemia iron
Categories: Doctor On Call
Tags: anemia iron deficiency anemia iron
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