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Case Study

Jesica 21 yo white female who is on the university track team. She come into
student health clinic complaining of shortness of breath and deteriorration in her
level of athletic performance.

She reports experiencing:

Difficulty concentrating

P. Exam reveals;

Very pale skin

Cracked lips
Brittle finger nails
Rapid pulse

Stage of iron deficiency

Normal: Iron stores are full and there is plenty of iron in plasma to support
RBC synthesis in bone marrow.

Stage 1: Iron stores begin to drop. Iron is stored as ferritin primarily in the
liver, bone marrow, and spleen. Low plasma ferritin is an index of
depleted iron stores.

Stage 2: Iron stores are depleted and will no longer be able to supply ireon to
the plasma. Iron is transported in the plasma as transferrin. This iron
is used for haemoglobin synthesis.

Stage 3: As plasma iron declines, iron available to the bone marrow for
haemoglobin synthesis begin to decline. Small pale blood cells begin
to be produced due to a lack of haemoglobin.

Stage 4: Anemia. RBC synthesis is reduced. O2 capacity of the blood

declined causing:

Difficulty concentrating

Lab Tests: To confirm the diagnosis of anemia.

1. Hematocrit cutoff values for nonprenant women 18+ years are

as follows
Deficient < 31%
Normal > 32%

Jessica hematocrit = 20%

2. Hemoglobin
Deficient < 12g/dl
Normal 12g/dl

Jessica hematocrit = 8.5g/dl

3. Ferritin
Detects early stage of iron deficiency.
Low serum ferritin is spesific for iron deficiency.
Jessica Ferritin = 8ng/dL

4. RBC Indices

Normal Normal RBC

Iron deficiency anemia RBC smaller (microcytic) & pale

(hypochromic) due to low hemoglobin content

Pernicious Anemia - RBC larger (macrocytic) & darker

(hyperchromic) due to high hemoglobin content.

Mean Cell Volume (MCV) used to classify types of anemia based

on cell size

Microcytic < 80fL (Iron deficiency anemia)

Normal < 80 - 96fL
Microcytic > 98fL (deficiency of folate & vit B12

Jessica = 62.5fL

Mean Cell Hemoglobin (MCH) index used to classify types of

anemia based on the amount of hemoglobin

Hypochromic(low hemoglobin) < 27pg (Iron deficiency

Normal = 27 32pg
Hyperchromic > 32pg (associated with pernicious anemia)

Jessica = 21.25pg