D-aminolevulinic-acid-the rate –limiting step in heme production

Zinc will be incorporated in place of iron in IDA

Chronic anemia may have no manifestations because of compensation of the body
Different normal values of haemoglobin levels in different institutions
WHO classification define anemia to be <13 g/dL in men, abd,12 g/dL in women

Classification of anemia
-Decreased production anemia
-bone marrow problem
-anemia plus corrected reticulocyte count <2
-Increased destruction
-hemolysis
-Acute blood loss

Can be further grouped by size (MCV, MCHC, MCH)

-microcytic
-normocytic
-macrocytic

When you say good CBC, it must include the RBC indices
Must determine if it is really iron-deficiency because giving iron in not IDA case may give harm than
good
Folate storage is easy to deplete compared to vit B12
Serum ferritin is also an inflammatory marker
-reflects the iron stores of the body
Anemia in male, always consider GI blood loss, unless proven otherwise

Iron in hgb is entirely recycled

Transferrin bound iron goes to bone marrow for RBC production

Hemochromatosis- iron-overload, excess iron can be deposited to liver, heart, pancreas, gonads,
thyroid, brain
-thus, do not give iron when the problem is not IDA
Thalasemmia is haemolytic; thus, do not give iron because it will add up to iron overload in the body

Best way to check for iron stores is staining of bone marrow

Iron-ferritin- is the best and not invasive way to check for iron stores. But inflammation can mask it
because it can increase the iron ferritin (an inflammatory marker)
Transferrin saturation

Normocytic Anemia
Anemia of chronic disease or chronic inflammation
Level of anemia is usually moderate to mild
Reticulocyte count will reflect the marrow activity
If less than 2 retic count, marrow is not responding to the anemia
Inflammation can

Give only iron if the case is a clear IDA. Iron tablet is very cheap but when overload happens, irob
chelation is very expensive

Macrocytic Anemia
Low reticulocyte also because of deficiency in vitamins needed (B12 and folate)

Hemolysis