BY Dr. Al Hussein Ragab Zaky Luxor International Hospital,egypt Tel:002 01113033672-00201012727282 Facebook : Al Hussein Ragab

1. Basics To Deal With Iron Deficiency
Anaemia
BY
Dr.Al Hussein Ragab Zaky
Luxor International Hospital
Em:alhussein.neoped@yahoo.com
Tel: 01113033672
Facebook : Al Hussein Ragab

23. Iron deficiency is the most widespread and
common nutritional disorder in the world. It is
estimated that 30% of the global population has
iron-deficiency anemia, and most of them live in
developing countries. nelson2016
A full-term newborn infant contains about 0.5 g of iron,
compared to 5 g of iron in adults. This change in quantity
of iron from birth to adulthood means that an average of
0.8 mg of iron must be absorbed each day during the
first 15 yr of life. A small additional amount is necessary
to balance normal losses of iron by shedding of cell.
nelson2016

24. It is therefore necessary to absorb approximately 1
mg daily to maintain positive iron balance in
childhood. Because <10% of dietary iron usually is
absorbed, a dietary intake of 8-10 mg of iron daily
is necessary to maintain iron levels. During infancy,
when growth is most rapid, the approximately 1
mg/L of iron in cow’s and breast milk makes it
difficult to maintain body iron. nelson2016
Breastfed infants have an advantage because
they absorb iron 2-3 times more efficiently than
infants fed cow’s milk nelson2016

27. CLINICAL MANIFESTATIONS
Most children with iron deficiency are asymptomatic and are identified
by recommended laboratory screening at 12 mo of age, or sooner if at
high risk. Pallor is the most important clinical sign of iron deficiency but
is not usually visible until the hemoglobin falls to 7-8 g/dL.
It ismost readily noted as pallor of the palms, palmar creases, nail beds,
or conjunctivae
compensatory mechanisms, including increased levels of 2,3-
diphosphoglycerate and a shift of the oxygen dissociation curve, may be
so effective that few symptoms of anemia aside from mild irritability
are noted. When the hemoglobin level falls to <5 g/dL, irritability,
anorexia, and lethargy develop, and systolic flow
murmurs are often heard.
As the hemoglobin continues to fall, tachycardia
and high output cardiac failure can occur.

28. Iron deficiency has nonhematologic systemic effects. Both iron
deficiency and iron-deficiency anemia are associated with
impaired neurocognitive function in infancy. There is also an
association of iron-deficiency anemia and later, possibly irreversible,
cognitivedefects. nelson2016
Some studies suggest an increased risk of seizures, strokes,
breathholding spells in children, and exacerbations of restless
leg syndrome in adults. nelson2016
Other nonhematologic consequences of iron deficiency include pica,
the desire to ingest nonnutritive substances, and pagophagia, the
desire to ingest ice. The pica can result in the ingestion of lead-
containingsubstances and result in concomitant plumbism.
nelson2016

39. In progressive iron deficiency, a sequence of biochemical and
hematologic events occurs First, tissue iron stores are depleted.
This depletion is reflected by reduced serum ferritin, an iron-
storage protein, which provides an estimate of body iron stores
in the absence of inflammatory disease. Next, serum iron levels
decrease, the iron-binding capacity of the serum (serum
transferrin) increases, and the transferrin saturation falls below
normal. As iron stores decrease, iron becomes unavailable to
complex with protoporphyrin to form heme .
Free erythrocyte protoporphyrins accumulate, and
hemoglobin synthesis is impaired. At this point, iron deficiency
progresses to iron-deficiency anemia. With less available
hemoglobin ineach cell, the red cells become smaller and varied
in size. The variation in red cell size is measured by an
increasing red cell distribution width.
This is followed by a decrease in mean corpuscular volume and
mean corpuscular hemoglobin. nelson2016