Core IM | Internal Medicine Podcast #147 Iron Deficiency: Grey Matters Segment
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Mar 13, 2024 Exploring iron deficiency labs interpretation in inflammation, heavy menstrual bleeding evaluation, and when a woman with iron deficiency should have endoscopy. Highlights the importance of investigating iron deficiency anemia causes in women, including GI cancers, colitis, ulcers, and celiac disease. Emphasizes the diagnostic significance of time in iron deficiency management, advocating for time-limited trials and recurrence monitoring post-repletion.
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Patient's Heavy Menstrual Bleeding Story
- A 32-year-old woman with longstanding heavy menstrual bleeding presented with severe anemia and hemoglobin of 7.2.
- She was unfazed by her anemia, having adapted to symptoms like fatigue and cognitive difficulties over years.
Iron Deficiency Affects Brain Early
- Iron deficiency compromises brain and muscle function before anemia develops.
- The body prioritizes iron for red blood cell production at the expense of other tissues like the brain.
Optimal Ferritin Cutoff For Diagnosis
- A ferritin cutoff of 15 is highly specific but misses many with iron deficiency.
- Using a higher cutoff like 45 improves sensitivity with minimal loss of specificity.