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Iron Deficiency Anemia

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on 2 April 2014

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Transcript of Iron Deficiency Anemia

Iron Deficiency Anemia
"Mind Mapping" Method
Iron transport & storage by 3 proteins :

1- Transferrin.
2- Transferrin receptor.
3- Ferritin.

Body iron distribution & transport
Iron Physiology
Body iron distribution & transport.
Dietary iron.
Iron absorption.
Iron requirements.


Iron requirements

Iron required each day to compensate for losses from body & growth

varies

with

age

&

sex

;it is highest in pregnancy ,adolescent and menstruating females .


Occurs when
decreas

iron
in blood.
Most
common
cause of anemia.?
Body has limited ability to absorb iron
Excess loss of iron

(hemorrhage is frequent)
Most important cause of
microcytic hypo chromic anemia .
Caused by:
defect in Hb synthesis .
Transferrin & Transferrin receptor
Transferrin delivers iron to tissues with transferrin
receptors
(erythroblasts) in BM which incorporate iron into Hb.
RBC broken down in
MQ
of
RES
and iron released form Hb enters plasma and provides most of iron on transferrin .
Small plasma transferrin iron comes from dietary iron ,absorbed through duodenum & jejunum .

Ferritin & haemosiderin (store)
Some iron stored in RES cells as ferritin & haemosiderin , amount varying.
-
Ferritin:
water –soluble protein, contains
20 %
of its weight as iron and
not visible
by
light microscopy
.
-
Haemosiderin :
water – insoluble protein, varying composition containing
37%
iron by weight,
visible
in MQ & other cells by light microscopy after staining by perls`
(Prussian blue )


Dietary iron
Iron in food as

ferric
. Both iron content Proportion of iron absorbed differ from food to food ;

meat & liver

is better source than vegetables ,egg or dairy foods.
Diet contains

10-15 mg

of iron from which only

5-10%

is normally absorbed . Proportion

20-30%

in

IDA

or

pregnancy

but, even in these situations ,most dietary iron remains

unabsorbed
.


Iron absorption

Factors Increase Absorption

Heam iron .
Ferrous (fe ++) .
Acids ( Hcl ,vitamin c ) .
Solubilizing agents (e.g. sugars, amino acids ) .
Iron deficiency .
erythropoiesis .
Pregnancy .
Hereditary haemochromatosis .

Factors Decrease Absorption

inorganic iron .
Ferric (fe +++) .
Alkalis –antacids, pancreatic secretion .
Precipitation agents – phytates ,phosphates .
Iron excess .
 erythropoiesis .
Infection .
Tea .

Causes of iron deficiency

Chronic blood loss:
Uterine , gastrointestinal ,e.g. peptic ulcer ,, Oesophageal varices , aspirin (or other non steroid anti –inflammatory drugs) partial gastrectomy ,carcinoma of stomach ,caecum, colon or rectum ,colitis ,etc.
Increased demands:
Prematurity , growth , pregnancy , erythropoietin therapy.
Malabsorption .
Poor diet .


General
symptoms & signs of anemia and show painless glossitis , angular stomatitis brittle, ridged or spoon nails (
koilonychia
), dysphagia as a result of pharyngeal webs (paterson – kelly or plummer - vinson syndrom) unusual dietary cravings
Children
IDA cause irritability , poor cognitive function and decline in psychomotor deveopment .

Clinical features
1. Red blood cell

Dimorphic

If IDA associated

Megaloblastic

anemia  'dimorphic ' film (dual population of RBC “macrocytic + microcytic” and “hypo chromic; indices may be normal .
IDA patients received recent

iron therapy

population of new wel- filled normal- size RBC

Patient transfused
.

3- platelets
2. Leukocytes
Laboratory findings
Earliest change of IDA is
anisocytosis
&  red cell distribution width (
RDW
) .
Mild ovalocytosis ,target cells .
Elongated hypo chromic elliptocytes (
pencil cells
) .
Progressive hypochromia ( MCH) & microcytosis ( MCV), MCHC variable .
Reticulocytes: normal or  .
RBC count ,Hb level, Hct: proportionately  .

Leukopenia
(300 - 4400/Ml ) is found in small number of patients.
Differential count is normal .

Children:
: 33 %
N: 33 %
: 33 %
Adults:
: 33 %
N: 66%



BM examination
: not essential to assess iron stores except in complicated cases.


4. Bone marrow iron

Serum iron: 
TIBC: TIBC < 10% saturated .
This contrasts both with anemia of
chronic disorders
when serum iron & TIBC are both reduced and with other hypo chromic anemia's where serum iron is normal or even raised .

5. Serum iron & TIBC
6. Serum transferrin receptor (sTfR)
Transferrin

receptor is shed from cells into plasma .
sTfR Level

in

IDA


N

in anemia of

chronic disease

or

thalassaemia

trait .

if erythropoiesis is
.

7. Serum ferritin


<

10
mg/liter are
characteristic
of
IDA
.

10 - 20
mg/liter are
presumptive
, but
not

diagnostic
.
May be  with
concomitant
inflammatory diseases (e.g. rheumatoid arthritis) ,gaucher disease , chronic renal disease , malignancy ,hepatitis , or iron administration .
IDA

suspected
in rheumatoid arthritis if ferritin level is
<
60
mg /liter .

8. Free Erythrocyte protoporphyrin
Usually in IDA .
Very sensitive
for diagnosis of IDA & suitable for large –scale
screening
of children, detecting both IDA & lead poisoning .

Lab diagnosis of hypochromic Anemia
MCV & MCH


Serum iron

TIBC

sTFR

Serum ferritin

BM iron stores

Erythroblast Iron

Hb electrophoresis


IDA


a severity of anemia



 





Absent

Absent

N
Chronic Disorder


N /






N /

N /

Present

Absent

N

Thalassaemia trait ( or  )

anemia


N

N

Variable

N

Present

Present

Hb A2 
in  form

Sideroblastic anemia

MCV :  congenital but  in acquired




N

N



Present

Ring forms


N
Thank you ...
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