Medical Case Dolores Welborn is a E-year-old attorney living in Portland, Oregon

Question

Medical Case Dolores Welborn is a E-year-old attorney living in Portland, Oregon. Dolores is in the second trimester of pregnancy with her first child, and though her pregnancy had been progressing normally, recently she has noticed that she tires very easily and is short of breath from even the slightest exertion. She also has experienced periods of light-headedness, though not to the point of fainting. Other changes she has noticed are cramping in her legs, a desire to crunch on ice, and the fact that her tongue is sore. She doubts that all of these symptoms are related to one another, but she is concerned, and she makes an appointment to see her physician. Upon examining Dolores, her physician finds that she has tachycardia, pale gums and nail beds, and her tongue is swollen. Given her history and the findings on her physical exam, the physician suspects that Dolores is anemic and orders a sample of her blood for examination. The results are shown in Table . A diagnosis of anemia due to iron deficiency is made and oral iron supplements prescribed. Dolores' symptoms are eliminated within

Explanation / Answer

1. Adult hemoglobin contains 2 alpha and 2 beta polypeptide chain. Each chain is associated with porphyrin ring (heme) that has Iron at its center. Thus each hemoglobin consist of 4 polypeptide and 4 heme group. The iron of heme group binds to oxygen (cooperative binding) therefore each hemoglobin molecule transport 4 oxygen molecule.

2. Iron is absorbed from duodenum of small intestine. It then binds to apoferretin (which is present in mucosal cell) and forms ferretin which is main form of storage. Ferritin is then reduced and binds to transferrin (present in blood). Transferrin is main transporter of iron, it transport iron to other tissue like bone marrow, liver etc. Iron is mainly stored in liver as ferritin and hemosiderin

3. Iron deficiency anemia results from deficiency of anemia. As iron is needed for synthesis of hememglobin therefore if it is deficient the hemoglobin and RBCs production decreases and patient develops anemia.

IAD is most common cause of anemia (intact IDA forms 50% of total anemia cases).

4. Most common causes of IDA are -

5. IDA is more common in women because -

6. Red blood cell indices -

Diagnostic test for IDA

7. Treatment - it is done by iron supplementation . The common formulation are syrup, tablets and intramuscular injections. The dose is is calculated based upon amount of iron deficiency

IDA can be prevented by - taking diet rich in iron (like green leafy vegetable), periodic deworming , fortification of food with iron, iron supplementation in high risk group

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