this slide is about iron deficiency anemia made by a medical student.

1. IRON DEFICIENCY ANEMIA
Presenting by: Maryam Mousavi

2. Total body iron:
 Hemoglobin 65%
 Myoglobin 6%
 Transferrin 0.1%
 Ferritin 13%
 Hemosiderin 12%
 Enzymes 3.6%

3. Exposure to acid & protease  heme iron oxidized to ferric state  hemin  enter the
mucosal cell
Nonheme iron (Fe3+) must be converted to ferrous ion to be absorbed
Intestinal absorption
 Proximal GI (Duodenum)
 Gastric acidity
Human have 2 pathway
1. Uptake of heme iron
2. ferrous(Fe2+)

4. Enhance absorbtion:
Vit C
Animal tissue(beef,pork,chicken)
Cycteine
Ketosuger
Decrease absorbtion:
Soy
bovine milk
Phytate
Polyphenols
phosphate

5. Iron excretion:
GI tract,epidermal cell of skin,mensturation,sweat,urinary excretion
Total average of daily loss of iron is about:
0.6_1.6mg(1mg) in men and nonmensturating female
2mg in menstruating female
3.5mg in pregnant female

8. IDA
Most common cause of anemia worldwide.
The minimum daily dietary iron requirement during adolescence is
12 to 15 mg/day .
Most functional Iron in the body is from recycling of iron(erythron)

9. STAGES OF IRON DEFICIENCY
 1st stage :prelatent iron deficiency or iron
depletion (reduction in Fe store without
reduced serum Fe
 2nd stage : latent I.D ,Fe store exhusted but Hb
level Nl (reduced transferrin saturation,
increased TIBC, increased FEP& TFRC)
 3rd stage : IDA ,Hb fall below nl limit

10. Etiology
 I.D is late manifestation of negative iron balance
 decreased Fe intake :
1. Inadequate diet
2. impaired absorption (gastric surgery, celiac,pica)
 Increased iron loss (GI loss, infection with
hookworms, neoplasm, heavy mensturation
,Hburia)
 Increased requirment

11. Increased requirment
 Infancy
 adolescence
 Lactation
 pregnancy

12. Clinical features
× Pallor is the most important sign
× Look for pallor:face,nails,palms,conj,mucus membrane
× Pagophasia(pica for ice)
× Anxiety,poor appetite
× Tachycardia and systolic murmur,dyspnea,palpitation
× Hairloss and lightheadedness
× Fatigue
× Mouth ulcer,glossitis,angular cheilitis
× Constipation
× Depression
× Muscles,tingling,numbness or burning sensation
× Koilonychia(spoon shaped nail)
× Dysphagia due to formation of esophageal web(plummer vinson sx)

14. DIAGNOSIS
 The primary laboratory values obtained  complete
blood count with red blood cell indices and serum
ferritin.
 Iron deficiency is identified by a low serum ferritin
concentration and iron deficiency anemia by a
hemoglobin concentration below 11.0 g/dL
combined with a low serum ferritin.
 The anemia typically is microcytic and hypochromic
The standard cutoff is a serum ferritin concentration of less than 15 ng/mL; however,
both higher and lower cutoffs have been suggested in adolescents

15. If symptoms of anemia is present Hb<8
MCV& MCH are reduced in most pt
MCHC is reduced in long standing or sever anemia
Content of reticulocyte Hb is an early sensitive index of ID
Anisocytosis is an important early sign of ID
RDW is increased
Gold standard is bone marrow
aspiration,hypercellular,macrophage iron is absent or
reduced

16. Mentzer index
 MCV/RBC(10 6)>14  suggestive IDA
 MCV/RBC(10 6)12-14 Intermediate
 MCV/RBC(10 6)<12  suggestive of
thalassemia trait

17. TREATMENT
 The treatment of iron deficiency may include
both dietary measures and administration of
iron supplements.

18. Dietary iron
 Dietary sources of iron are found in meat,
grains, fruits, egg yolk,and vegetables

19.  The most common preparation is ferrous sulfate  is the main
stay of treatment
 It is effective ,well tolerated & inexpensive
 If equivalent amounts of elemental iron are given ferrous
gluconte & ferrous fumarate are equally satisfactory & the same
incidence of side effects
Oral iron supplements

20. Parenteral iron preparation
 Iron –dextran complex (50mg/ml)
 Sodium ferric gluconate (ferrlecit) 12.5mg/ml
 Iron sucrose (venofer)20mg/ml
 Iron maltose (Ferrinject) 500mg

21. Follow-up
 The hemoglobin and hematocrit and red
blood cell indices should be checked six to
eight weeks after initiation of iron therapy to
assess clinical improvement and therapeutic
efficacy.