VII. TEACHING POINTS

1. The etiology of an anemia should be established as early as possible so that appropriate management can be initiated.
1. Classification according to morphological criteria (normocytic normochromic, microcytic hypochromic, or macrocytic) is a first step in determining the cause and deciding which additional tests would help identify the cause of the anemia.
2. There are a number of tests that can be ordered to establish the diagnosis of iron deficiency: Serum iron, TIBC, serum ferritin and bone marrow aspiration for iron stores. The possibility of false positive and negative results should be recognized.
3. It is recognized that GI bleeding is the most common cause of blood loss and iron deficiency anemia. A GI workup is mandatory if the source of bleeding has not been identified. In the case presented here, a GI workup is not necessary because the cause of bleeding has been clearly established and she is scheduled for GYN surgery to correct the source of bleeding.
4. Management of iron deficiency:
1. Transfusions should only be given to avoid life-threatening complications of the anemia. This will avoid the risks of transfusion therapy.
2. Iron deficiency should be documented prior to instituting replacement therapy since thalassemia, anemia of chronic disease and other conditions can present with a microcytic anemia. Anemia of chronic disease can be associated with low serum iron levels.
3. The underlying cause for the iron deficiency must be identified and managed.
4. Oral iron is preferable to parenteral iron therapy and should be given at therapeutic doses and continued for 6 months to restore iron stores.
5. There are several options for monitoring the response to therapy: The most helpful is obtaining serial Hgb levels. The Hgb level will rise about 1 g/dL per week in patients with iron deficiency who are placed on replacement therapy. Thus, even severe anemias due to iron deficiency can be corrected within 2 to 3 months. Any deviation from this rate of response should suggest ongoing bleeding or another cause for the anemia.

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