Iron deficiency anemia,introduction, definition, causes,prevalence, etiology, metabolism, clinical sign, laboratory diagnosis and management.

1. By: Nityanand Upadhyay
Associate Professor
Department of MLT
Integral University, Lucknow

2. 1. INTRODUCTION
2. DEFINITION
3. PREVALENCE
4. IRON METABOLISM
5. STORAGE OF IRON
6. ETIOLOGY
7. CLINICAL FEATURES
8. DIAGNOSIS
9. MANAGEMENT

3. "anemia" usually refers to a condition in
which your blood has a lower than
normal number of red blood cells.”
“Iron is an essential mineral that is
needed to form hemoglobin, an
oxygen carrying protein inside red
blood cells.”

4. Iron deficiency anemia is the most
common form of anemia and it
develops over time if the body does
not have enough iron to manufacture
red blood cells.
Without enough iron, the body uses up
all the iron it has stored in the liver,
bone marrow and other organs.

5. “ IDA is characterized by Microcytic Hypochromic
red cell with MCV <80 fl and MCH <25pg.”
“ IDA is a micronutrient deficiency anaemia
occurs when storages form of Iron gets
exhausted or depleted”

7. . Once the stored iron is depleted, the body is
able to make very few red blood cells.
• If erythropoietin is present without
sufficient iron, there is insufficient fuel for
red blood cell production
• The red blood cells that the body is able to
make are abnormal and do not have a normal
hemoglobin-carrying capacity, as do normal
red blood cells.

8.  It is most common Anaemia prevalent in
India.
 In children in India varies from 35-45%.
 Its frequency is higher in Females, more so
in PREGNANCY when the prevalence rate
of IDA is as high as 45-60%.

9. Severity of anaemia is more in
. LOWER SOCIO- ECONOMIC GROUP
. CHILDREN
. PREGNANT WOMEN
. ELDERLY

10. 1. Iron Distribution: Body iron distribution
are-
Hb : 200-2500mg
Myoglobin : 400-500mg
Iron Stores : 500-1000mg
Plasma Iron : 2-3mg

11. 2. Daily Requirements:
Infants:
 0 to 6 months: 0.27 milligrams (mg)
 7 to 12 months: 11 mg
Children:
 1 to 3 years: 7 mg
 4 to 8 years: 10 mg
Males:
 9 to 13 years: 8 mg
 14 to 18 years: 11 mg
 19 years and older: 8 mg

12. Females:
 9 to 13 years: 8 mg
 14 to 18 years: 15 mg
 19 to 50 years: 18 mg
 51 years and older: 8 mg
 During pregnancy: 27 mg

13. 3. Iron Absorption: Diet should contain
10-15 mg of elemental iron.
. Iron of food in the presence of PEPSIN and
low pH (HCL) in stomach is broken into
Fe++ and Fe+++ ions.
. At the mucosal cell surface Fe+++ is
converted to Fe++ by DUODENAL
CHYTOCHROM-B.

14. . And is transported across the cell membrane by
DIVALENT METAL TRANSPORTER 1(DMT 1).
. Ferroportin 1 helps in transfer of Fe from
mucosal cell into circulation.
Iron is absorbed as Fe++.
4. Site of Absorption: Duodenum and
Upper Jejunum.

15. 5. Transport of Iron: Iron in blood is carried
over the body by a Beta- globulin- transferrin.
. Each molecule of Transferrin carries 2 atoms of
Iron.
. Iron is released from transferrin in the Bone
marrow for Erythropoisis and Transferrin is
reutilized to carry Iron.

16. 6. Iron Excretion: A small amount of iron
is lost in SWEAT and URINE.
Daily loss in Male: 1.0 mg
Daily loss in Female: 2.0 mg
7. Storage of Iron: Iron stored in the
body in 2 forms-

17. I. Haemosiderin: Brown pigment in the
Reticuloendothelial cells of BONE
MARROW,SPLEEN and LIVER.
II. Ferritin: Ferritin is present in
circulation(serum).

18. The common causes of IDA are-
1. Dietary deficiency of Iron:
.Commonest cause of IDA
. In developing countries
. Socio-Economically weaker.

19. 2. Malabsorption:
. Gluten induced interopathy.
. Atrophy gastrics: HCL secretion reduced.
. Total/Partial Gastrectomy.
3. Increased Blood Loss: Common cause
of IDA.
5mg iron is lost for loss of about 10 ml of
Blood.

20.  Hookworm infestation: Blood loss about
0.2ml/worm/day.
 Multiple pregnancy: Blood loss about
1300ml/Pregnancy.
Causes of Increase blood loss are-
A. Gastrointestinal causes:
. Peptic ulcer

21. . Haemorrhoids
. NSAID,s (Aspirin) intake
. Hookworm infestation
. Hiatus hernia
. Ulcerative colitis
. Malignancy of Stomach, Colon

22. B. Urinary Tract:
. Chronic Dialysis
. Haematuria due to kidney, bladder lesions
C. Uterine: (Relating to Uterus)
. Menorrhagia (Heavy Bleeding at Menstruation)
. Multiple Pregnancy
. Excessive Blood loss

23. 4. Increased Demands:
. Infancy
. Lactation
. Adolescence
. Pregnancy

24.  Fatigue
 Weakness
 Pallor
 Shortness of breath
 Dizziness
 Brittle nails(Koilonuchia/ Platynychia)
 Headache

25.  Pica: strange cravings to eat items that aren’t
food, such as dirt, ice, or clay
 A tingling or crawling feeling in the legs
 Glossitis: tongue swelling or soreness
 Cold hands and feet
 fast or irregular heartbeat

26.  Impaired growth and Development
 Chronic atrophic gastritis
 Congestive Heart failure
 Delayed mental development(Infancy): due
to lack synthesis of Myelin.

27. A. Haematological:
1. Hb: 5-10gm/dl. ( in sever anaemia Hb= as
low as 03 gm/dl).
2. Haematocrit: 13-30% .
3. Absolute values:
MCV = <80 fl RDW= >15% (increase)
MCH = <25 pg MCHC= < 27 gm/dl

28. 4. Blood Picture:
. Moderate degree of ANISOPOIKELOCYTOSIS.
.Red cells are MICROCYTIC HYPOCHROMIC with
few PENCIL/CIGAR , TEAR DROPS CELL shaped.
. Hypochromia is recognized by Central pallor >
1/3 , in sever anaemia central pallor becomes 2/3
to 3/4.
(In normal RBC,s central pallor is 1/3.)

31. 5. Reticulocyte count: Decrease with
degree of Anaemia.
6. TLC & DLC: Normal.
7. Platelets count: Increased , more so in
case associated with haemorrhage.

32. B. Bone marrow Examination:
1. Cellularity: Hypercellular.
2. Erythropoisis: Erythroid hyperplasia,
Normoblast are smaller and late
Micronormoblast demonstrate.

33. 3. Myeloopoisis: Normal.
4. Megakaryopoisis: Normal.
5. Bone marrow Iron: Depleted and Iron
grade is Zero. (Prussian Blue staining)

34. C. Others Examination:
1. Serum ferritin: <15.0 microgram/dl.
(Normal 50-300 microgram/dl ).
2. S. Iron: Reduced to 10-15 microgram/dl.
(Normal 50-150 microgram/dl).
3. TIBC: is increased to 350-450 microgram/dl.
(Normal 310-340 microgram/dl).
4. Transferrin saturation:<15%
(Normal30-40%)

35. 1. Oral Iron Therapy: Ferrous sulphate
200mg/day. (Containig 60mg elemental iron).
Duration: 3-6 Months.
2. Parenteral Iron Therapy: Iron-sorbitol
single dose/day.
. Late stage of pregnancy
. Post operation Patients
. Unable to take oral

36. THANK
YOU………..
nityanandu@iul.ac.in