ALL ABOUT IRON DEFICIENCY ANAEMIA BY STUDENTS OF IMS & SH,BHUBANESWAR

1. IRON DEFICIENCY ANEMIA
1

2. case-
• An 18 year old female reported to the physician for
consultation . She complained of --
• generalised weakness, lethargy and inability to
do routine work from the previous few month.
• On further questioning she revealed that she was
having excessive bleeding during mensturation
from the previous six months.
• She complained of breathlessness and
palpitation while climbing stairs for her house .
• She also had experienced periods of light-
headedness , though not to the point of fainting.
• there was no history of any fever , drug intake or
abdominal discomfort . Her appetite had also
decreased and she was taking meals only once a
day.

3. On examination
• She had tachycardia , pale gums and nail beds and
her toungue was swollen.
• Her blood examination show-
• Red blood cell count – 3.5millon/mm3
• Hemoglobin – 7g/dl
• Haematocrit - 30%
• Serum iron - low
• Mean corpuscular volume (MCV)- low
• Mean corpuscular Hb concentration (MCHC)-low
• Total iron binding capacity in blood (TIBC) - high

4. Case discussion
• The most likely diagnosis is Iron Deficiency Anemia.
• Generalised weakness, exercise intolerance, dyspnoea,
palpitaion, history of blood loss during menstruation,
tachycardia and low Hb, all suggestive of iron deficiency
anemia.

5. Clinical features
• Symptoms:
• fatigue, dyspnoea, palpitaion

6. -Dizziness , headache, vertigo

7. -Sleep disturbance , lack of
concentration

8. -Nausea , bowel disturbance

9. -Symptoms of cardiac failure

10. signs
pallor of skin, palms, oral mucous membrane , nail
beds and palpebral conjunctiva.

11. - koilonychia

12. - odema

13. -Glossitis

14. - Angular chelitis

15. DIAGNOSIS
• History
• CBC: low Hb, low
hematocrit, low MCV,
MCH,MCHC
• PS: hypochromic
microcytic RBCs. May
also show poikilocytosis
and anisocytosis.
Target cells, elliptical
cells are often present.

16. • Serum iron & TIBC:
Serum iron represents the amount of circulating
iron bound to transferrin.
TIBC is an indirect measure of circulating
transferrin.
Normal serum iron: 50 - 150 µg/dl
 normal TIBC range: 300- 360 µg/dl
• Serum ferritin:
Most convenient test to estimate iron stores.
Serum ferritin level falls as iron stores are
depleted.
Normal range: 15 – 300µg/L

17. • Red cell protoporphyrin level:
Intermediate in patheway of heme synthesis.
Accumulates inside RBC when heme synthesis is
impaired.
Normal value: <30µg/dl, in iron deficiency
>100µg/dl
• Serum level of transferrin receptor protein:
Erythroid cells have highest no of transferrin
receptors.
Normal value 4-9µg/L
Raised in iron deficiency due to its release in
circulation.
• bone marrow iron store:
Provides info about effective iron delivery to
developing erythroblasts.

18. TESTS VALUE
smear Microcytic / hypochromic
Serum iron(µg/dl) <30
TIBC(µg/dl) >360
Percent saturation <10%
Ferritin (µg/L) <15

19. MANAGEMENT
• Depends on severity and causes of iron deficiency.
• Oral iron therapy:
Simple iron salts to complex iron compounds
designed for sustained release.
Upto 200mg of elemental iron per day is given in
divided doses.
S/E: nausea, abdominal discomfort, diarrhoea
Iron salts Iron content Elemental iron
Ferrous sulfate 325mg 65mg
Ferrous fumarate 325mg 107mg
Ferrous gluconate 325mg 39mg
Polysaccharide iron 150mg 150mg

20. Ferrous sulphate 200mg 3 times daily is adequate
and should be continued for 3-6 months to replete
iron stores.
Ferrous gluconate 300mg twice daily(70mg
elemental iron per day)
The Hb should rise by around 10g/L every 7-10
days and a reticulocyte response will be evident in
a week.

21. • Parenteral iron therapy:
Patient with malabsorption or chronic gut disease
may need parenteral iron.
The total dose is calculated by a simple formula:
body wt(kg) X 2.3 X (15 - pt’s Hb) + additional
500mg for building up iron stores.
Commonly used iron dextran, iron sucrose.
Newer preparation: iron isomaltose and iron
carboxymaltose.
Either given in a single large dose to correct Hb
and replenish iron stores or given in small divided
doses for a longer period of time.
Anaphylaxis is commonly seen in case of iron
dextran. Test dose of 25mg is given prior to it.

22. • Red cell transfusion:
Not commonly used.
Reserved for individual who have symptoms of
anemia, cardiovascular instability and excessive
blood loss.