Iron deficiency
Upcoming SlideShare
Loading in...5
×
 

Iron deficiency

on

  • 3,950 views

 

Statistics

Views

Total Views
3,950
Slideshare-icon Views on SlideShare
3,946
Embed Views
4

Actions

Likes
0
Downloads
120
Comments
0

2 Embeds 4

http://wearemedstudents.blogspot.com 2
http://www.slideshare.net 2

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Iron deficiency Iron deficiency Presentation Transcript

    • Disorders of iron metabolism and hem synthesis
      • I ron deficiency and iron deficiency anemia
      • T he anemia of chronic disorders
      • S ideroblastic anemias
      • M ethemoglobinemia and other disorders with cyanosis
      • H emochromatosis
      • P orphyria
    • Iron metabolism
      • Most body iron is present in haemoglobin in circulating red cells
      • The macrophages of the reticuloendotelial system store iron released from haemoglobin as ferritin and haemosiderin
      • They release iron to plasma, where it attaches to transferrin which takes it to tissues with transferrin receptors – especially the bone marrow – where the iron is incorporated by erythroid cells into haemoglobin
      • There is a small loss of iron each day in urine, faeces , skin and nails and in menstrua ting females as blood (1-2 mg daily) is replaced by iron absorbed from the diet.
    • Stages in the development of iron deficiency
      • Prelatent
        • reduction in iron stores without reduced serum iron levels
          • Hb (N), MCV (N), iron absorption (  ), transferin saturation (N), serum ferritin (  ), marrow iron (  )
      • Latent
        • iron stores are exhausted, but the blood haemoglobin level remains normal
          • Hb (N), MCV (N), TIBC (  ), serum ferritin (  ), transferin saturation (  ), marrow iron (absent)
      • Iron deficiency anemia
        • blood haemoglobin concentration falls below the lower limit of normal
          • Hb (  ), MCV (  ), TIBC (  ), serum ferritin (  ), transferin saturation (  ), marrow iron (absent)
    • Iron deficiency and iron deficiency anemia
      • The characteristic sequence of events ensues when the total body iron level begins to fall:
      • 1. decreases the iron stores in the macrophages of the liver, spleen and bone marrow
      • 2. increases the amount of free erythrocyte
      • protoporphiryn (FEP)
      • 3. begins the production of microcytic erythrocytes
      • 4. decreases the blood haemoglobin concentration
    • Iron deficiency anemia Definition and etiologic factors
      • T he end result of a long period of negative iron balance
        • d ecreased iron intake
          • inadequate diet, impaired absorption, gastric surgery, celiac disease
        • i ncreased iron loss
          • gastrointestinal bleeding ( haemorrhoids , salicylate ingestion , peptic ulcer , neoplasm , ulcerative colitis )
          • excessive menstrual flow , blood donation , disorders of hemostasis
        • i ncreased physiologic requirements for iron
          • infancy, pregnancy, lactation
        • cause unknown (idiopathic hypochromic anemia)
    • Iron deficiency anemia Clinical manifestation
      • P resentation of
        • underlying disease 37%
        • anemia symptoms 63%
    • Symptoms of anemia
      • Fatigue
      • Dizziness
      • Headache
      • Palpitation
      • Dyspnea
      • Lethargy
      • Disturbances in menstruation
      • Impaired growth in infancy
    • Symptoms of iron deficiency
      • Irritability
      • Poor attention span
      • Lack interest in surroundings
      • Poor work performance
      • Behavioural disturbances
      • Pica
      • Defective structure and function of epithelial tissue
        • especially affected are the hair, the skin, the nails, the tongue, the mouth, the hypopharynx and the stomach
      • Increased frequency of infection
    • Pica
      • The habitual ingestion of unusual substances
        • earth, clay (geophagia)
        • laundry starch (amylophagia)
        • ice (pagophagia)
      • Usually is a manifestation of iron deficiency and is relieved when the deficiency is treated
    • Abnormalities in physical examination
      • P allor of skin, lips, nail beds and conjunctival mucosa
      • N ails - flattened, fragile, brittle, koilonychia, spoon-shaped
      • T ongue and mouth
        • glossitis, angular cheliosis, stomatitis
        • dysphagia ( Peterson-Kelly or Plummer-Vinson syndrome (carcinoma in situ)
      • S tomach
        • atrophic gastritis, (reduction in gastric secretion, malabsorbtion)
      • The cause of these changes in iron deficiency is uncertain, but may be related to the iron requirement of many enzymes present in epithelial and other cells
    • Laboratory findings (1)
      • Blood tests
        • erythrocytes
          • hemoglobin level 
          • the volume of packed red cells (VPRC) 
          • RBC 
          • MCV and MCH 
          • anisocytosis
          • poikilocytosis
          • hypochromia
        • leukocytes
          • normal
        • platelets
          • usually thrombocytosis
    • Laboratory findings (2)
      • Iron metabolism tests
        • serum iron concentration 
        • total iron-binding capacity 
        • saturation of transferrin 
        • serum ferritin levels 
        • sideroblasts 
        • serum transferrin receptors 
        • FEP 
    • Laboratory findings (3)
      • Bone marrow test
        • high cellularity
        • mild to moderate erythroid hyperplasia ( 25-35%; N 16 – 18% )
        • the cytoplasm of polychromatic and pyknotic erythroblasts is scanty, vacuolated and irregular in outline. This type of erythropoiesis has been described as micronormoblastic
        • bone marrow showing absence of stainable iron
    • Management of iron deficiency anemia
      • Correction of the iron deficiency
        • orally
        • intramuscularly
        • intravenously
      • Treatment of the underlying disease
    • Oral iron therapy
      • The optimal daily dose - 200 mg of elemental iron
        • Ferrous
          • Gluconate 5 tablets/day
          • Fumarate 3 tablets/day
          • sulphate 3 tablets/day
            • iron is absorbed more completely when the stomach is empty
            • it is necessary to continue treatment for 3 - 6 months after the anemia is relived
            • iron absorption
              • is enhanced: vitC, meat, orange juice, fish
              • is inhibited: cereals, tea, milk
          • side effects
            • heartburn, nausea, abdominal cramps, diarrhoea
    • Failure of oral iron therapy
      • I ncorrect diagnosis
      • C omplicating illness
      • F ailure of the patient to take prescribed medication
      • I nadequate prescription (dose or form)
      • C ontinuing iron loss in excess of intake
      • M alabsorbtion of iron
    • Parenteral iron therapy (1)
      • Is indicated when the patient
        • demonstrated intolerance to oral iron
        • loses iron (blood) at a rate to rapid for the oral intake
        • has a disorder of gastrointestinal tract
        • is unable to absorb iron from gastrointestinal tract
    • Parenteral iron therapy (2)
      • Preparations and administration
        • iron - dextran complex (50mg iron /ml)
          • intramuscularly or intravenously
          • necessary is the test for hypersensitivity
          • the maximal recommended daily dose - 100mg (2ml)
        • total dose is calculated from the amount of iron needed to restore the haemoglobin deficit and to replenish stores
          • iron to be injected (mg) = (15-pts Hb/g%/) x body weight (kg) x 3
    • Parenteral iron therapy (3)
      • Side effects
          • local: pain at the injection site, discoloration of the skin, lymph nodes become tender for several weeks, pain in the vein injected, flushing, metallic taste
          • systemic:
            • immediate: hypotension, headache, malaise, urticaria, nausea, anphylactoid reactions
            • delayed: lymphadenophaty, myalgia, artralgia, fever