Iron deficiency anemia


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Abdulaziz Rajeh Alanzi

Iron deficiency anemia

  1. 1. Iron Deficiency AnemiaMr.Abdulaziz R. AlanziMedical Student, Al-Imam UniversityRiyadh – Saudi Arabia
  2. 2. Objectives1. Normal physiology & structure of Hb2. Metabolism of iron3. Iron Deficiency Anemia:- Definition- Causes & RFs- Pathophysiology- S & S- Investigations- Management- Complications- Prevention- Differential Diagnosis
  3. 3. Normal physiology &structure of Hb
  4. 4. Normal physiology & structure of HbGlobular protein contain Heme + Globin Accounts for > 95% of protein in RBC Main functions: transportation of respiratory gases. It carries ~ 98.5% of all O2 Concentration of Hb in the Blood: Measured as g/dl (grams per deciliter, orper 100 ml) Average values: Male: 14-18 g/dl Female: 12-16 g/dl Infants: 14-20 g/dl
  5. 5. Haematological indices Mean corpuscular volume (MCV): The average size of the red blood cellsexpressed in femtoliters (fl). Normal value: 80-95 femtoliters (10-15 liters) abbreviated fl. - Macrocytic anemias– larger than normal cells - Normocytic anemia (MCV = 80-95 fl) – cells are normal in volume. - Microcytic anemias– cells are smaller than normal. Mean corpuscular Hb (MCH): The average amount of hemoglobin inside a RBC expressed in picograms (pg). Normal value: 27-33 pg (10-12 gram) - Normochromic - Hypochromic - Hyperchromic
  6. 6. Metabolism of iron
  7. 7. Metabolism of iron(Adapted from Bothwell TH,Charlton RW, Cook JD, FinchCA: In Iron Metabolism in Man.Oxford, UK: Blackwell Scientific,1979, p 24.)
  8. 8. Metabolism of iron
  9. 9. MetabolismofironSource:
  10. 10. Fate of Components of HemeSource: Dr.Ahmed Alshafei Lecture• Iron(Fe+3) - transported in blood attached to transferrin protein - stored in liver * attached to ferritin or hemosiderin protein - in bone marrow, iron is used for hemoglobin synthesis• Biliverdin (green) is converted to bilirubin (yellow) - bilirubin is secreted by liver into bile * converted to urobilinogen then stercobilin (brown pigment infeces) by bacteria of large intestine * if urobilinogen is reabsorbed from intestines into blood isconverted to a yellow pigment, urobilin and excreted in urine
  11. 11. Definition of IDA
  12. 12. Definition of IDA Anemia is defined as a reduction in the oxygen-carrying capacity ofthe blood caused by a diminished erythrocyte mass. Iron deficiency anemia develops when body stores of iron drop too lowto support normal red blood cell (RBC) production. Inadequate dietaryiron, iron absorption, bleeding, or loss of body iron in the urine maybe the cause. HGB<13.5 g/dL (men) <12 (women) HCT<41% (men) <36 (women) a ferritin concentration of more than 100 ng/mL (100 mg/L)effectively rules out iron deficiency, and a ferritin of less than 15ng/mL (15 mg/L) rules in iron deficiency. More common in women as a result of menstrual losses
  13. 13. Causes & RFs
  14. 14. RFs of IDA in Pregnancy Pregnant with more than one child Two pregnancies close together Vomiting a lot because of morning sickness Teenager who is pregnant Not enough foods that are rich in iron Heavy periods before pregnancySource :
  15. 15. Pathophysiology
  16. 16. PathophysiologyIncrease demands of ironIncrease iron lossDecrease iron intake
  17. 17. S & S
  18. 18. S & S Symptoms of anemia (eg, easy fatigability, tachycardia,palpitations and tachypnea on exertion) Skin and mucosal changes (eg, smooth tongue, brittlenails, spooning of nails [koilonychia], and cheilosis) insevere iron deficiency Dysphagia resulting from esophageal webs (Plummer-Vinson syndrome) may occur in severe iron deficiency Pica (ie, craving for specific foods [eg, ice chips, lettuce]often not rich in iron) is frequentSource: Chapter 103. Iron Deficiency and Other Hypoproliferative Anemias
  19. 19. Investigations
  20. 20. InvestigationsUseful tests include the following: Complete blood count Peripheral blood smear Serum iron, total iron-binding capacity (TIBC), and serum ferritin Evaluation for hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis Hemoglobin electrophoresis and measurement of hemoglobin A2 and fetalhemoglobin Reticulocyte hemoglobin contentSource:
  21. 21. InvestigationsTests useful for establishing the etiology of iron deficiency anemia and excludingor establishing a diagnosis of another microcytic anemia include the following: Stool testing Incubated osmotic fragility testing Measurement of lead in tissue Bone marrow aspirationSource:
  22. 22. InvestigationsCBC results in iron deficiency anemia include the following: Low mean corpuscular volume (MCV) Low mean corpuscular hemoglobin concentration (MCHC) Elevated platelet count (>450,000/µL) in many cases Normal or elevated white blood cell countSource:
  23. 23. InvestigationsPeripheral smear results in iron deficiency anemia are as follows: RBCs are microcytic and hypochromic in chronic cases Platelets usually are increased In contrast to thalassemia, target cells are usually not present, andanisocytosis and poikilocytosis are not marked In contrast to hemoglobin C disorders, intraerythrocytic crystals are not seenSource:
  24. 24. InvestigationsResults of iron studies are as follows: Low serum iron and ferritin levels with an elevated TIBC are diagnostic of irondeficiency A normal serum ferritin can be seen in patients who are deficient in iron andhave coexistent diseases (eg, hepatitis or anemia of chronic disorders)Source:
  25. 25. Management
  26. 26. Management Symptomatic elderly patients with severe iron-deficiency anemia andcardiovascular instability may require red cell transfusions. Younger individuals can be treated more conservatively with iron replacement. For the majority of cases of iron deficiency (pregnant women, growing childrenand adolescents, patients with infrequent episodes of bleeding, and those withinadequate dietary intake of iron), oral iron therapy will suffice. For patients withunusual blood loss or malabsorption, specific diagnostic tests and appropriatetherapy take priority. Once the diagnosis of iron-deficiency anemia and its cause ismade, There are three major therapeutic approaches.1- RED CELL TRANSFUSION:2- ORAL IRON THERAPY3- PARENTERAL IRON THERAPY: saccharated ferric oxide (SFO) and cideferron (CF), forthose who are not tolerated with oral iron therapy.Source: Harrison’s Principles of Internal Medicine 17th edition
  27. 27. Complications
  28. 28. Complications Effects of Anemia in Pregnant WomenPregnant women with significant anemia may have an increased risk for poor pregnancy outcomes,particularly if they are anemic in the first trimester. Complications from Anemia in Children and AdolescentsIn children, severe anemia can impair growth and motor and mental development. Children mayexhibit a shortened attention span and decreased alertness. Children with severe iron-deficiencyanemia may also have an increased risk for stroke. Effects of Anemia in the ElderlyAnemia is common in older people and can have significantly more severe complications thananemia in younger adults. Effects of anemia in the elderly include decreased strength and increasedrisk for falls. Anemia may have adverse effects on the heart and increase the severity of cardiacconditions, including reducing survival rates from heart failure and heart attacks. Even mild anemiamay possibly lead to cognitive impairment or worsen existing dementia. Iron OverloadSource:
  29. 29. Prevention
  30. 30. PreventionGood food sources of iron include the following: Meats--beef, pork, lamb, liver, and other organ meats Poultry--chicken, duck, turkey, liver (especially dark meat) Fish--shellfish, including clams, mussels, oysters, sardines, and anchovies Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, andcollards Legumes, such as lima beans and green peas; dry beans and peas, such aspinto beans, black-eyed peas, and canned baked beans Yeast-leavened whole-wheat bread and rolls Iron-enriched white bread, pasta, rice, and cerealsSource:
  31. 31. PreventionVitamin supplements containing at least 400 micrograms of folic acid are nowrecommended for all women of childbearing age and during pregnancy. Foodsources of folate include the following: Leafy, dark green vegetables Dried beans and peas Citrus fruits and juices and most berries Fortified breakfast cereals Enriched grain productsSource:
  32. 32. Differential Diagnosis
  33. 33. Differential DiagnosisMicrocytic anemia resulting from other causes Thalassemia Anemia of chronic disease Sideroblastic anemia Lead poisoningSource: Quick Medical Diagnosis & Treatment Book
  34. 34. Thank