Podcaster:Caitlyn VlasschaertMedical Discipline/Topic:Hematology, Internal MedicineIntended AudienceYear 1, Year 2, Year 3, Year 4Brief Synopsis/Key Takeaways:1. Think of the 4 major AOLI causes (alcohol, overload, liver, inflammation), keeping in mind that several are likely contributing in one patient.2. Transferrin saturation >45% is highly suggestive of iron overload as a contributing factor, including hemochromatosis, and would warrant referral to hematology. Other key tests to order include: CBC, ESR, CRP, Cr and lytes, LFTs and hepatitis serology (B and C), abdominal U/S, glucose, A1C, lipids, and HFE gene testing if you’re suspicious of hemochromatosis.3. Good rule of thumb: High ferritin is anything >300, but for those in the 300-1000 range, lifestyle modification targeting the non-iron overload causes is appropriate, with hematology referral for ferritin above 1000 as this plus high transferrin saturation is specific for hemochromatosis and phlebotomy may be necessary. Alcohol cessation is also recommended in hemochromatosis.

NOSMSS Student-led MCS Podcast

Approach to High Ferritin

Podcaster:Caitlyn VlasschaertMedical Discipline/Topic:Hematology, Internal MedicineIntended AudienceYear 1, Year 2, Year 3, Year 4Brief Synopsis/Key Takeaways:1. Ferritin below 15 equals iron deficiency. In the setting of chronic inflammation, ferritin below 30 and transferrin saturation below 20% can be used as cutoffs. Iron deficiency can cause anemia and non-anemic fatigue. Treatment is appropriate in both cases.2. Treat underlying causes when possible. Causes can be split into decreased iron intake and increased blood loss. Think about decreased iron intake with vegetarianism, autoimmune gastritis, H. pylori gastritis, celiac disease, gastric bypass, as well as blood loss – commonly GI (including malignancy) and heavy menstrual bleeding. 3. To replete iron deficiency, aim to restore 1-1.5 g of iron, whether that is more rapidly with iron infusions or over a few months with oral iron supplements. Pay attention to amount of elemental iron in what you’re prescribing. Oral iron should be taken at least 2 hours after meals with Vitamin C and without calcium or PPIs. Check for response to iron supplementation in 4-6 weeks. 

Approach to Low Ferritin and Iron Deficiency Anemia

Podcaster:Sean PlumleyMedical Discipline/Topic:Chiropractic ProfessionIntended AudienceYear 1, Year 2, Year 3, Year 4Brief Synopsis/Key Takeaways:This is an interview with Dr. Quesnele, a chiropractor in Sudbury, and Dr. Tara Baldisera, a family physician who commonly refers patients to Dr. Quesnele. We cover topics such as typical conditions that benefit from chiropractic care, what a typical visit / treatment plan would look like, cost of chiropractic care to patients, and evidence for chiropractic treatment. 