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Dr.M.Siva kumar Reddy MD Department of biochemistry Sri venkatewara medical college

INTRODUCTION Total content of iron in an adult body is 3-5 g. 70% of this occurs in the erythrocytes of blood as a constituent of hemoglobin5% body iron is present in myoglobin of muscle. Heme is a constituent of several proteins/enzymes (hemoproteins) Hemoglobin Myoglobin Cytochromes Xanthine oxidase CatalaseTryptophan pyrrolasePeroxidase

Certain other proteins contain non- Heme iron e.g. transferrin, ferritin, hemosiderin.

INTRODUCTION

Biochemical functionsHemoglobin and myoglobin are required for the transport of 02 and CO2.

Cytochromes and certain non-Heme proteins are necessary for electron transport chain and oxidative phosphorylation. Biochemical functions

Peroxidase, the lysosomal enzyme, is required for phagocytosis and killing of bacteria by neutrophils. Biochemical functions Neutrophil phagocytosis of Streptococcus pyogenes

Dietary requirements

Sources of iron

liver heart Rich sources of iron kidney

Sources of iron

Molases Apples Dry fruits

Poor sources of iron

Milk wheatPolished rice

Absorption

About 10% of dietary iron is usually absorbedAnemic individuals and growing children, higher proportion of dietary iron is absorbed to meet the increased body demands.lron is mostly found in the foods in ferric form (Fe3+), bound to proteins or organic acidsAcid medium provided by gastric HCl, the Fe3+ is released from foods . vitamin C and cysteine convert ferric iron (Fe3+) to ferrous form (Fe2+). lron in the ferrous form is soluble and readily absorbed.

Factors effecting iron absorption

Lumen of gutFood + IronFe3+Fe2+HclOrganic acidsAscorbic acidcysteine

Mucosal cells of GITFe2+

Mucosal cells of GIT

Mucosal cell of GITFe2+ Fe3+ferroxidase ApoferritinFerritin Fe3+ferroreductase Fe2+ Fe2+ plasma

plasma

Fe2+ Fe3+ApotransferrinTransferrin (Fe3+) Ceruloplasmin or Ferroxidase IITissues

Tissues(liver)

Ferritin Hemosiderin Transferrin (Fe3+)

Tissues (bone marrow)

Hemoglobin Transferrin (fe3+)

Tissues (muscles)

Transferrin (fe3+)Myoglobin

Iron is one way substance !lron metabolism is unique as it operates in a closed system. very efficiently utilized and reutilized by the body. losses from the body are minimal (< 1 mg/day) Excretion may occur through bile, sweat, hair loss. lron is not excreted in to urine.

Iron metabolism over view Body stores 4000 mg fe Myoglobin and other compounds 300mg. Plasma transferrin 4mg feErythrocyte hemoglobin2500mg feFoodFeFe lost absorption1-2 mg1-2 mg5mg/d5mg/d 20mg/d For synthesis 20mg/d bydegradation

DISEASED STATES OF IRON

HEMOSIDEROSIS Excessive iron in the bodyExcessive iron is deposited as ferritin and hemosiderin. commonly observed in subjects Repeated blood transfusions Hemolytic anemia, Hemophilia.Excessive iron is deposited as ferritin and hemosiderin. Bantu tribe in South Africa.Iron vessels and corn as staple food.

Bantu tribes of Africa

Cooking in iron vessels(corn)

Hemosiderosis of liver

Hepatocytes and kuffper cells are deposited with granular hemosiderin granules Micro nodular cirrhosis / pigment cirrhosis

ILEUM HEMOSIDEROSIS

Histopathology of the renal biopsy

normal Abnormal

Hemochromatosis Iron is directly deposited in the tissues.liver, spleen, pancreas and skin.Bronzed-pigmentation of the skincirrhosis of liverpancreatic fibrosis Hemochromatosis causes a condition known as bronze diabetes.

TIME IRON ACCUMULATIONNo symptomsFatigueWeaknessWeight lossAbd painArthralgia ArthritisAmmenorrhoeaEarly menopauseLoss of libidoimpotenceArthritisAbnor liver fnDiabetesChr abd painSevere fatigueHypopitutarismHypogonadismCardiomyopathyArrythmiaLiver cirrhosisLiver CancerHeart failureBronze pigmentation.

Blood lacks adequate healthy red blood cells.Iron deficiency anemia is due to insufficient iron.Without enough iron, your body can't produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin).

Causes of IDAIf you aren't consuming enough iron, or if you're losing too much iron, your body can't produce enough hemoglobin, and iron deficiency anemia will eventually develop.People with increased riskWomenInfants and children.VegetariansFrequent blood donors.Causes of iron deficiency anemia include:Blood loss Lack of iron in your dietInability to absorb ironPregnancy

Symptoms Initially, iron deficiency anemia can be so mild that it goes unnoticed.Iron deficiency anemia signs and symptoms may include:Extreme fatigueWeaknessPale skinChest pain, fast heartbeat or shortness of breathHeadache, dizziness or lightheadednessCold hands and feetInflammation or soreness of your tongueBrittle nailsUnusual cravings for non-nutritive substances, such as ice, dirt or starchPoor appetite, especially in infants and children with iron deficiency anemia.

Diagnosis Red blood cell size and color: Red blood cells are smaller and paler in color than normal.Hematocrit: percentage of your blood volume made up by red blood cells. (34.9 and 44.5 percent for adult women) ( 38.8 to 50 percent for adult men.) Hemoglobin: The normal hemoglobin range is generally defined as 13.5 to 17.5 g/ dl for men and 12.0 to 15.5 g/dL for women. Ferritin: This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron.Serum iron and TIBC are also useful investigations for IDA

Microcytic and hypochromic RBC

Decreased counts of RBC

Other test we may need..Endoscopy: check for bleeding from a hiatal hernia, an ulcer or the stomach with the aid of endoscopy.

Colonoscopy: To rule out lower intestinal sources of bleeding.

Ultrasound: Women may also have a pelvic ultrasound to look for the cause of excess menstrual bleeding, such as uterine fibroids.

Colonoscopy

Endoscopy

Ultra sound abdomen

complicationsMild iron deficiency anemia usually doesn't cause complications. However, left untreated, iron deficiency anemia can become severe and lead to health problems, including the following:Heart problems. rapid or irregular heartbeat. enlarged heart or heart failure.Problems during pregnancy. premature births low birth weight babies. Growth problems. delayed growth and development. increased susceptibility to infections.

Management of IDAOral iron:oral iron supplementation with.. Ferrous sulphate Ferrous fumerate Ferrous gluconate

Vitamin C aids in absorption of iron.stomach upset and/or darkening of the feces are commonly experiencedsome clinicians prescriberecombinant erythropoitin orepoetin alfa , to stimulate RBC production.

Parenteral ironcases where oral iron has either proven ineffective, would be too slow (pre-operatively) or where absorption is impeded ( cases of inflammation),parenteral ironcan be used.

Iron sucrose Ferric carboxy maltose

Parenteral iron usually supplemented along with erythropoeitin.

Injectable forms of iron

Blood transfusionsBlood transfusions in those without symptoms is not recommended until the hemoglobin is below (6 to 8g/dl).Risk of following infections :Human immunodeficiency virus (HIV)Hepatitis viruses.(Hcv,Hbsag)West Nile virus (WNV)Cytomegalovirus (CMV)Human T-cell lymphotrophic viruses (HTLVs)Parvovirus B19. some infections might be in window period.

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