Iron Deficiency Anaemia( Hypochromic Microcytic )

Presentation by

Laraib Ayesha

Iron Deficiency Anaemia• Most common cause of iron deficiency anaemia

• Iron Depletion Absent or decresed iron stores.

• Iron Deficiency Depletion of stores + low serum + ferritin

Iron Metabolism• Absorbtion in duodenum and upper jejnum• Transferrin transports iron to the cells• Ferritin and hemosiderin store iron.• 10% of daily iron is absorbed• Body iron is present in Hb• Reticuloendothelial system store iron released from

Hb as ferritin and hemosiderin.

• Total amount of body iron = 3-5g• Normal diet contain = 15 mg/day

Iron Metabolism• Normal Ranges• Iron conc =50-150ug/dl• Total iron binding capacity=250-370ug/dl• serum Transferrin=2-4g/l• Ferritin conc=50-300ug/l

• Daily iron requirements• Male: 1mg• Female: 2-3mg• Pregnant women:3-4mg

Causes of iron deficiency Anaemia• Chronic blood loss• Increased demand• Malabsorbtion of iron• Inadequate iron intake• Intravascular hemolysis

Hemoglobinuria-hemosiderinuria

Clinical Features• Fatigue• Angular somatitis• Plummer vinson syndrome• Gastric atrophy• Nail changes

(a) Brittle/fragility

(b) Koilonchia/spooning• Hair loss• splenomegaly

Lab Diagnosis• Hb,Htc,RBC:Low• MCV,MCH,MCHC:Low• RDW: High• Retics: Normal/Low• Plt:Normal/Low/High• WBC:Normal/Low• Smear:

Hypochromia,anisocytosis,microcytosis, poikilocytosis

Peripheral blood smear

Peripheral blood smear of a patient with severe iron deficient anaemia. Note the important microcytosis (compare red blood cells with lymphocyte) as well as hypochromia, target cells, and poikilocytosis

Lab Diagnosis• Serum Iron: (N: 60 – 180 μg/dL)• TIBC: (250 - 430 μg/dL)• Serum Ferritin • Transferrin saturation (Fe/TIBC): (<15%)

<5%:definitely indicates iron deficiency• Serum Transferrin Receptor: • Free Erythrocyte Protoporphyrin (17 – 27 μg/dL)

• Bone marrow : – Erythroid hyperplasia, – Absence of hemosiderin

Differential Diagnosis

• Microcytic anemias– Iron deficiency anemia– Thalassemia ,HbC,HbE etc– Sideroblastic anemia– Lead poisoning– Anemia of chronic diseases (sometimes)