anemia

1. Iron deficiency Anemia
Hypochromic anemia

2. Defective Hb synthesis

3. Hypochromic anemia
 Fe deficiency
 20% of women in child bearing age
group
 Adult males 2%
 Microcytic Hypochromic anemia
 All indices are reduced

4. Other causes of hypochromic anemia
1. Sideroblastic anemia
2. Thalassemia
3. Anemia of chronic disorders

5. Loss of Fe from the body
 Males  1 mg /day
 Females  1.5 – 2 mg/ day
 Pregnancy 750 mg of Fe is lost from the
mother
1. 400 mg for fetus
2. 200 mg for blood loss and lactation
3. 150 mg for placenta

6. Source of Fe
1. Food  leafy vegetables , beans ,
meat , liver
2. Recycling from old red cells

7.  Average western diet contains 10 – 15
mg Fe
 Absorption  5 – 10%
 In pregnancy and Fe deficiency  20
– 30% abs,
 Absorption  duodenum and proximal
jejenum

9.  Haem is better absorbed than Non
haem

11. Absorption non heme
 Inc
1. Vit C
2. Citric acid
3. Aminoacids
4. Sugars
5. Gastric secretions
6. Hcl
 Dec
1. Antacids
2. Milk
3. Tannates
4. Phytates
5. Pancreatic secretions
6. EDTA
7. Phosphates

12.  Transport to transferrin is by two
vehicle transporter
1. Ferroportin
2. Hephaestin
 Actual mechanism of Haem Fe is not
known

13. Transport
 Beta globulin Transferrin synthesised
in liver
 Erythroblasts have transferrin
receptors
 Transferrin – Fe is not deposited
mononuclear – phagocytic cells
 These cells get Fe deposits from the
phagocytosis of old RBC

14. Storage forms of Fe in REcells
1. Ferritin
2. Hemosiderin
 Normally not functional
 Mobilised in response to demand

15. Excretion
 Lost  0.5 – 1 mg / day
 Menstruating women – 1- 2 mg / day
 Pregnancy loss 750 mg
1. Foetus – 400 mg
2. Blood loss and lactation  200 mg
3. Placenta 100mg

16. Loss
1. Desquamtion of epithelial cells from
GIT
2. Urine
3. Sweat
4. Hair and nails
5. Feces

18. C/F
 Anemia – pica may develop
 Epithelial tissue change
1. Koilonychia
2. Atrophic glossitis
3. Angular stomatitis
4. Esophageal web

21. Stages of anemia
1. Fe store depletion
2. Fe deficiency erythropoiesis
3. Frank Fe deficiency anemia

22. Lab diagnosis
1. Blood picture and Red cell indices
2. Bone Marrow findings
3. Biochemical findings

23. Blood picture and indices
 Hb – reduced
 Red cells –
1. count reduced
2. Hypochromic
3. Mcrocytic
4. Anisocytosis
5. poikilocytosis

24. Red cells
 Target cells
 Elliptical forms
 Polychromatic cells

25. Reticulocyte count
 Normal / reduced
 After haemorrhage  slightly raised
 i.e. 2 – 5 %

27. Red cell indices
 All reduced

28. WBC count and platelets
 Normal
 After haemorrhage – neutrophil count
may inc
 Normal plt count --, inc if recent
haemorrhage

29. Bone marrow findings
 Marrow cellularity inc (dec M:E ratio)
 Eryothropoiesis Micronormoblasts
 Other cells  normal
 Marrow Fe dec RE iron stores & red.
siderotic fe granules in normobasts

32.  Cytoplasmic maturation lags behind
 Late normoblasts have pyknotic
nucleus + persisting polychromatic
cytoplasm

33. Biochemical findings
 Decreased
1. Serum Fe
2. Serum Ferritin
3. Red cell
protoporphyrin
 Increased
1. Total Fe binding
capacity
2. Serum Transferrin
receptor protein

34. Treatment
 Correction of disorder
 Correction of Fe deficiency