2..iron deficiency of anemia.2

Iron Deficiency of Anemia Iron Deficiency of Anemia

General MetabolismMorphology

Clinical Manifestations & diagnosis Treatment Prognosis

PROF: DR. RAFI AHMED GHORIPROF: DR. RAFI AHMED GHORIMedical Unit-IV Medical Unit-IV Liaquat University of Medical & Health Liaquat University of Medical & Health Sciences, JamshoroSciences, Jamshoro

Iron Deficiency AnemiaGeneral

Iron Deficiency AnemiaGeneral

Probably most common nutritional disorders world-wide.

In the U.S.A most particularly common in toddlers, adolescent girls, women of child-bearing Age.

Etiology of IDA varies a little depending on populating group

Iron Deficiency AnemiaMetabolism


Total body iron contents

women: ~2gm

• women have smaller store of iron than do men even healthy

young

men: ~6gm

Functional versus storage compartments

Functional: ~80% in hemoglobin

• reminder in mayoglobin, catalase, cytochromes

Storage: ~15-20% in hemosiderin, ferritin



Storage Ferritin protein iron complex

particularly found in liver, spleen, bone marrow, skeletal muscles

Liver: most stored in parenchymal cells Other tissue: most stored in mononuclear

phagocytic cells Within cells, protein shells degraded, iron

aggregated into hemosiderin granules



Storage Ferritin (cont’d)

Only trace amounts of hemosiderin usually found

- principally in reticuloendothelial cells in BM, spleen, and liver

Very small amounts of ferritin in plasma- level is very good indicator of body iron storage

Storage iron pool important- readily mobilizable



Mucosal uptake



Transport of iron

In plasma: transferrin, usually ~33%saturated with iron

Transferrin delivers iron to cells Immature RBCs possess high-affinity receptors for

transferrin



Body losses of iron are limited Iron balance is maintained largely by regulation of

absorptive uptake Factors are largely unknown

• Rate and level of absorption are dependent on total body iron content and erythropoietin

activity (need of erythroid precursors) As body storages rise, % of absorbed iron falls With ineffective erythropoieses, iron absorption

increases

Iron Deficiency Anemia Etiology


Iron requirement: 1 to 1.5 mg./day, so about 1 mg. must be absorbed /day

only 10-15% of ingested iron is absorbed

• daily iron requirement 5 to 10 mg. for men

• 7 to 20 mg. for women average deit in “Western” world 15 to 20

mg.



Bioavailability is imoportant heme iron is more absorbable than

inorganic iron

- absorption or inorganic iron influenced by other dietary contents



Dietary lack Impaired absorption increased requirement Chronic blood loss



Dietary lack Rare in industrialized countries with

abundant food supplies (including meat)• Elderly • Very poor• Infants• Children

More common in developing countries where food is less abundant



Impaired absorption Sprue Intestinal steatorrhea Chronic diarrhea Gastrectomy Food items



Increased requirement Growing infants and children adolescents Premenopausal (particularly pregnant)

women• economically deprived women multiple and

frequent pregnancies



chronic blood loss Most important cause in Western world External hemorrhage depletes iron reseves GI tract

ulcers, gastritis, carcinoma, hemorrhoids, parasitic diseases

Urinary tract Tumors

Genital tract Menorrhagia, uterine cancer



Iron deficiency in adult men and postmenopausal women in the “Western” world

GI blood loss should be top differential, unless proven otherwise

Iron Deficiency AnemiaClinical and laboratory Iron Deficiency AnemiaClinical and laboratory

Hypochromic, microcytic anemia Other changes (in long-standing deficiency)

Koilonychia Alopecia

Atrophic changes in tongue and gastric mucosa

Intestinal malabsorbtion

Iron Deficiency AnemiaClinical and laboratoryIron Deficiency AnemiaClinical and laboratory

Plummer-Vinson syndrome

(AKS Paterson-Brown-kelly syndrome) Microcytic hypochromic anemia Atrophic glossitis

Esophageal webs


In early stages of blood loss (of negative iron balance), reserves usually adequate to maintain normal Hgb/Hct,serum iron, transferrin saturation

Depletion of reserves eventually lowers serum iron, transferrin saturation

Bone marrow attempts to keep up with increase erythroid activity


anemia appears when all iron stores are depleted

low serum iron, low transferrin saturation,

low serum ferritin

Iron Deficiency of Anemia Morphology

Iron Deficiency of Anemia Morphology

Bone marrow Mild to doderate increase in erythropoietic activity

• Increased normoblasts Stainable iron disappears

Peripheral blood smear red cells are small (microcytic) pale (hypochromic)

HYPOCHROMIC, MICROCYTIC PICTURE OF

R.B.Cs

HYPOCHROMIC, MICROCYTIC PICTURE OF

R.B.Cs

Iron deficiency Anemia Clinical and Laboratory Iron deficiency Anemia Clinical and Laboratory

Dominating signs often related to underlying cause fe anemia

Diagnosis rests on laboratory studies Decreased Hgb/Hct

Hypothermia, microcytosis, poikilocytosisSerum iron, serum ferritin lowTotal plasma iron-binding capacity high Decreased transferrin saturation

Laboratory Findings Laboratory Findings

Lab Testing Algorithm for Lab Testing Algorithm for Iron Deficiency Anemia (IDA)Iron Deficiency Anemia (IDA)

Iron deficiency Anemia

Differentials Diagnosis

Iron deficiency Anemia

Differentials Diagnosis

Spherocytosis, hereditary Thalassemia, Alpha Thalasseamia, Beta Anemia of chronic disorders Hemoglobin CC disease Hemoglobin DD disease Lead poisoning Microcytic anemias Sideroblastic anemias

Iron deficiency Anemia Treatment

Iron deficiency Anemia Treatment

Medical Care:• Iron deficiency should be treated with oral or

injectable iron.

• Diet

• underlying etiology should be corrected so the deficiency does not recur.

Surgical Care:• Surgical treatment consists of stopping hemorrhage

and correcting the underlying defect.

Iron deficiency Anemia Prognosis

Iron deficiency Anemia Prognosis

Iron deficiency anemia is an easily treated disorder with an excellent outcome; however, it may be caused by an underlying condition with a poor prognosis, such as neoplasia. Similarly, the prognosis may be altered by a comorbid condition such as coronary artery disease.

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2..iron deficiency of anemia.2