Iron deficiency koilonychia

Specialty: Hematology.

• Spoon nails
• excavated nail dystrophy due to iron deficiency
• ferropathic onychodystrophy

Why it occurs

• Chronic and severe iron deficiency anemia (prolonged depletion of the body's iron stores alters the enzymes that contain this metal, such as cellular cytochromes and ribonucleotide reductase, weakening the keratinization of the nail matrix)
• Hereditary hemochromatosis (paradox of tissue accumulation of iron that deforms the structure of the nail due to deposition and local dysfunction)
• Plummer-Vinson/Paterson-Kelly syndrome (classic triad of severe iron deficiency anemia, esophageal webbing, and glossitis/koilonychia)
• Celiac disease or other chronic intestinal malabsorption syndromes (such as gastric or duodenal resection, which prevent adequate absorption of non-heme iron)
• Chronic exposure to petroleum-based industrial solvents or repetitive microtrauma of occupational origin.

Initial workup

Complete blood count with detailed erythrocyte indices (mean corpuscular volume - decreased MCV, mean corpuscular hemoglobin - decreased HCM, erythrocyte distribution amplitude - elevated RDW, confirming cellular heterogeneity or anisocytosis); comprehensive serum iron profile (serum iron determination, decreased serum ferritin typically <15-30 ng/mL, increased total iron binding capacity - TIBC and percent transferrin saturation less than 15%); peripheral blood smear to demonstrate microcytosis, marked hypochromia, elliptocytes and target cells; upper gastrointestinal endoscopy and colonoscopy (mandatory in men and postmenopausal women to identify the focus of gastrointestinal blood loss); screening for celiac disease using anti-tissue transglutaminase IgA antibodies and total serum IgA levels.

Standard management

• Sulfato ferroso — first choice oral supplement; provides 60-65 mg of elemental iron for each 200-325 mg tablet; It is preferably administered on an empty stomach and spaced from antacids or dairy products, and may be accompanied by ascorbic acid to improve gastrointestinal absorption; causes frequent adverse effects such as heartburn, constipation and darkening of stools
• Iron carboxymaltose — intravenous iron formulation, indicated for therapeutic failure or intolerable intolerance to oral iron, active malabsorption syndromes such as inflammatory bowel disease, or severe, rapidly evolving iron deficiency anemia
• Iron hydroxide and polymaltose complex — oral iron alternative with a lower incidence of gastrointestinal adverse effects due to its slower and more controlled release
• Ascorbic acid / Vitamin C (oral adjuvant supplement to promote the reduction of iron from its ferric to ferrous state, facilitating its transport through enterocytes).