PATHOMECHANISM OF ANEMIA

Iron is a mineral that is important not only to all the cells in our body, but it is especially important to red blood cells. Red blood cells make hemoglobin, which carries oxygen to the tissues in our bodies. Normal Iron levels are 40-150 ug/dL (female) and 50-160 ug/dL (male). Normal values may vary from laboratory to laboratory. Iron deficiency anemia occurs when there is a lack of iron in your body, causing primarily a low hemoglobin concentration. Iron is vital for all living organisms because it is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport. Iron equilibrium in the body is regulated carefully to ensure that sufficient iron is absorbed in order to compensate for body losses of iron (see the image below). Whereas body loss of iron quantitatively is as important as absorption in terms of maintaining iron equilibrium, it is a more passive process than absorption. Bleeding for any reason produces iron depletion. If sufficient blood loss occurs, iron deficiency anemia ensues (see the image below). A single sudden loss of blood produces a posthemorrhagic anemia that is normocytic. The bone marrow is stimulated to increase production of hemoglobin, thereby depleting iron in body stores. Once they are depleted, hemoglobin synthesis is impaired and microcytic hypochromic erythrocytes are produced. Maximal changes in the red blood cell (RBC) cellular indices occur in approximately 120 days, at a time when all normal erythrocytes produced prior to the hemorrhage are replaced by microcytes. Before this time, the peripheral smear shows a dimorphic population of erythrocytes, normocytic cells produced before bleeding, and microcytic cells produced after bleeding. This is reflected in the red blood cell distribution width (RDW); thus, the earliest evidence of the development of an iron-deficient erythropoiesis is seen in the peripheral smear, in the form of increased RDW.

A 45-year-old woman was admitted to the hospital with a chief complaint of bloody diarrhea for a few month. She reported the passage of fresh red blood and mucus, intermitten abdominal pain and 5 kg of weight loss. She has history of consuming antidiarrhea but ineffectively stop the complaint. Physical examination revealed anemia and abdominal pain particularly in lower region.

ADDITIONAL ANAMNESIS 1) Patients information-name & occupation

2) What other symptoms are present and when it started nausea,vomit,fever? 3) Are she taking blood thinners (aspirin, warfarin, clopidogrel, Aggrenox) or NSAIDs (ibuprofen, naproxen)? 4) Have she had any trauma to the abdomen or rectum, or have swallowed a foreign object accidentally? 5) How about her eating habit? 6) Have she had more than one episode of blood in her stool? Is every stool this way? 7) Abdominal pain-when she started to feel the pain,what trigger it and what she have to do to re