As iron levels fall, transferrin levels increase in compensation. However, a low or normal ferritin level does not exclude the diagnosis of iron deficiency anemia because ferritin is an acute-phase reactant protein, and its level increase during the time of infections. Ferritin levels below 12 ng/ml in the absence of scurvy are a reliable indicator of iron deficiency anemia. TIBC is usually increased in iron deficiency anemia, while transferrin saturation is markedly decreased in iron deficiency anemia. The Next test to perform is iron studies which take a look at transferrin saturation, total iron-binding capacity, and ferritin. These parameters comment on the quantity of hemoglobin inside the RBCs they are both usually decreased in hypochromic microcytic anemia. CBC will show different RBC indices like MCV and MCHC. The first test to perform is complete blood count (CBC) which will indicate the presence of anemia after a thorough physical exam. ![]() Reduced hemoglobin in the RBCs decreases the amount of oxygen delivered to the peripheral tissues leading to tissue hypoxia. It may be due to acute or chronic blood loss and also due to suddenly increased demands of pregnancy or major trauma and surgery. Iron deficiency hypochromic microcytic anemia is caused due to disruption of iron supply in diet due to decreased iron content in the diet, pathology of the small intestines like sprue and chronic diarrhea, gastrectomy, and deficiency of vitamin C in the diet. As the newly produced RBCs contain less amount of hemoglobin, they are of relatively small size when compared to normal RBCs, thus the name, microcytic. ![]() Reduced iron stores halt the production of hemoglobin chains, and its concentration begins to decrease in the newly formed RBCs since the red color of RBCs is due to hemoglobin the color of the newly formed RBCs begins to fade thus the name, hypochromic. It has four globin chains two of which are alpha-globin chains while the other two are beta-globin chains, these four chains are attached to a porphyrin ring (heme) the center of which contains iron in the form of ferrous (reduced iron) capable of binding four molecules of oxygen. Hemoglobin is a globular protein that is a major component of RBCs it is manufactured in the bone marrow by erythroid progenitor cells. Hypochromic microcytic anemia is caused by any factor which reduces the body's iron stores. This process of iron absorption from the gut is controlled by hepcidin, a protein that regulates the amount of iron absorbed from the diet. In the liver, it is stored in parenchymal cells while in other tissues it is stored in macrophages. Iron is stored in the form of ferritin a ubiquitous iron protein that is found predominantly in the liver, spleen, bone marrow, and skeletal muscles. Iron is subsequently absorbed from the duodenum and upper parts of the jejunum through an iron transporter called ( ferroportin) while transferrin protein carries this iron in the blood. Ingested iron is freed from other food constituents by gastric HCL while ascorbic acid (vitamin C) prevents precipitation of ferric. This diet is usually sufficient to maintain a healthy iron pool. An average male contains 6grams of iron while a female contains 2.5 gm of iron. The cause of low non-heme iron bioavailability is due to its interactions with tannins, phosphates, and other food constituents. Iron from animal sources is in the form of Haeme iron which has a bioavailability of 10% to 20% compared to non-heme iron which has a limited bioavailability of 1% to 5%. ![]() The normal western diet contains approximately 10 mg to 20 mg of iron. An adult human being requires 1 mg to 2 mg per day of iron.
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