Iron Deficiency of Anemia General Metabolism Morphology Clinical Manifestations & diagnosis Treatment PrognosisPROF: DR. RAFI AHMED GHORIMedical Unit-IVLiaquat University of Medical & Health Sciences,Jamshoro
Iron Deficiency Anemia General Probably most common nutritional disorders world-wide. In the U.S.A most particularly common in toddlers, adolescent girls, women of child-bearing Age. Etiology of IDA varies a little depending on populating group
Iron Deficiency Anemia Metabolism Total body iron contents women: ~2gm • women have smaller store of iron than do men even healthy young men: ~6gm Functional versus storage compartments Functional: ~80% in hemoglobin • reminder in mayoglobin, catalase, cytochromes Storage: ~15-20% in hemosiderin, ferritin
Iron Deficiency Anemia Metabolism Storage Ferritin protein iron complex particularly found in liver, spleen, bone marrow, skeletal muscles Liver: most stored in parenchymal cells Other tissue: most stored in mononuclear phagocytic cells Within cells, protein shells degraded, iron aggregated into hemosiderin granules
Iron Deficiency Anemia Metabolism Storage Ferritin (cont’d) Only trace amounts of hemosiderin usually found - principally in reticuloendothelial cells in BM, spleen, and liver Very small amounts of ferritin in plasma - level is very good indicator of body iron storage Storage iron pool important - readily mobilizable
Iron Deficiency Anemia Metabolism Mucosal uptake
Iron Deficiency Anemia Metabolism Transport of iron In plasma: transferrin, usually ~33%saturated with iron Transferrin delivers iron to cells Immature RBCs possess high-affinity receptors for transferrin
Iron Deficiency Anemia Metabolism Body losses of iron are limited Iron balance is maintained largely by regulation of absorptive uptake Factors are largely unknown • Rate and level of absorption are dependent on total body iron content and erythropoietin activity (need of erythroid precursors) As body storages rise, % of absorbed iron falls With ineffective erythropoieses, iron absorption increases
Iron Deficiency Anemia Etiology Iron requirement: 1 to 1.5 mg./day, so about 1 mg. must be absorbed /day only 10-15% of ingested iron is absorbed • daily iron requirement 5 to 10 mg. for men • 7 to 20 mg. for women average deit in “Western” world 15 to 20 mg.
Iron Deficiency Anemia Etiology Bioavailability is imoportant heme iron is more absorbable than inorganic iron - absorption or inorganic iron influenced by other dietary contents
Iron Deficiency Anemia Etiology Dietary lack Impaired absorption increased requirement Chronic blood loss
Iron Deficiency Anemia Etiology Dietary lack Rare in industrialized countries with abundant food supplies (including meat) • Elderly • Very poor • Infants • Children More common in developing countries where food is less abundant
Iron Deficiency Anemia Etiology Increased requirement Growing infants and children adolescents Premenopausal (particularly pregnant) women • economically deprived women multiple and frequent pregnancies
Iron Deficiency Anemia Etiology chronic blood loss Most important cause in Western world External hemorrhage depletes iron reseves GI tract ulcers, gastritis, carcinoma, hemorrhoids, parasitic diseases Urinary tract Tumors Genital tract Menorrhagia, uterine cancer
Iron Deficiency Anemia Etiology Iron deficiency in adult men andpostmenopausal women in the“Western” world GI blood loss should be top differential, unless proven otherwise
Iron Deficiency Anemia Clinical and laboratory Hypochromic, microcytic anemia Other changes (in long-standing deficiency) Koilonychia Alopecia Atrophic changes in tongue and gastric mucosa Intestinal malabsorbtion
Iron Deficiency Anemia Clinical and laboratory In early stages of blood loss (of negative iron balance), reserves usually adequate to maintain normal Hgb/Hct,serum iron, transferrin saturation Depletion of reserves eventually lowers serum iron, transferrin saturation Bone marrow attempts to keep up with increase erythroid activity
Iron Deficiency Anemia Clinical and laboratory anemia appears when all iron stores are depleted low serum iron, low transferrin saturation, low serum ferritin
Iron Deficiency of Anemia Morphology Bone marrow Mild to doderate increase in erythropoietic activity • Increased normoblasts Stainable iron disappears Peripheral blood smear red cells are small (microcytic) pale (hypochromic)
Iron deficiency Anemia Clinical and Laboratory Dominating signs often related to underlying cause fe anemia Diagnosis rests on laboratory studies Decreased Hgb/Hct Hypothermia, microcytosis, poikilocytosis Serum iron, serum ferritin low Total plasma iron-binding capacity high Decreased transferrin saturation
Iron deficiency Anemia Differentials Diagnosis Spherocytosis, hereditary Thalassemia, Alpha Thalasseamia, Beta Anemia of chronic disorders Hemoglobin CC disease Hemoglobin DD disease Lead poisoning Microcytic anemias Sideroblastic anemias
Iron deficiency Anemia Treatment Medical Care: • Iron deficiency should be treated with oral or injectable iron. • Diet • underlying etiology should be corrected so the deficiency does not recur. Surgical Care: • Surgical treatment consists of stopping hemorrhage and correcting the underlying defect.
Iron deficiency Anemia PrognosisIron deficiency anemia is an easily treateddisorder with an excellent outcome;however, it may be caused by an underlyingcondition with a poor prognosis, such asneoplasia. Similarly, the prognosis may bealtered by a comorbid condition such ascoronary artery disease.