2..iron deficiency of anemia.2


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2..iron deficiency of anemia.2

  1. 1. Iron Deficiency of Anemia General Metabolism Morphology Clinical Manifestations & diagnosis Treatment PrognosisPROF: DR. RAFI AHMED GHORIMedical Unit-IVLiaquat University of Medical & Health Sciences,Jamshoro
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Iron Deficiency Anemia Metabolism Mucosal uptake
  7. 7. 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
  8. 8. 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
  9. 9. 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.
  10. 10. Iron Deficiency Anemia Etiology Bioavailability is imoportant  heme iron is more absorbable than inorganic iron - absorption or inorganic iron influenced by other dietary contents
  11. 11. Iron Deficiency Anemia Etiology Dietary lack Impaired absorption increased requirement Chronic blood loss
  12. 12. 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
  13. 13. Iron Deficiency Anemia Etiology Impaired absorption  Sprue  Intestinal steatorrhea  Chronic diarrhea  Gastrectomy  Food items
  14. 14. Iron Deficiency Anemia Etiology Increased requirement  Growing infants and children  adolescents  Premenopausal (particularly pregnant) women • economically deprived women multiple and frequent pregnancies
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. Iron Deficiency Anemia Clinical and laboratory Plummer-Vinson syndrome  (AKS Paterson-Brown-kelly syndrome)  Microcytic hypochromic anemia  Atrophic glossitis  Esophageal webs
  19. 19. 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
  20. 20. Iron Deficiency Anemia Clinical and laboratory anemia appears when all iron stores are depleted  low serum iron, low transferrin saturation, low serum ferritin
  21. 21. 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)
  23. 23. 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
  24. 24. Laboratory Findings
  25. 25. Lab Testing Algorithm forIron Deficiency Anemia (IDA)
  26. 26. 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
  27. 27. 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.
  28. 28. 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.