Classification of anemiaCauses of anemia-Blood loss.-Iron deficiency.-Infection.-RBC destruction (hemolysis)e.g. G6PD.-B12 and Folate deficiency.Red cells size and their indices-Hb concentration and Hematocrit-MCV, MCH, MCHC.↓MCV-IDA-Thal↑MCV-B12-FolatNormal MCV-hemolyticanemia
Iron deficiency anemiaNormal iron metabolism:-The primary function is oxygen transport.-Iron is absorbed by duodenum and jejunim-Average total body iron content 3500-4000 mg.-Approximately 2/3 found in hemoglobin,-Iron is also stored in RE cells (BM, Spleen and liver)as hemosiderin and ferratin.-Also iron found in myglobin and myeloperoxidaseand in certain electron transfer.-Iron is more stable in ferric state (Fe+++) than inferrous state (Fe++).
Iron Absorption1-2 mg onlyPlasma FeTransferrin carriers4 mgBody stores1000 mg (M)300-500 mg (F)Myglobin300 mg20 mg FeReturned to immature RBCin BMRBC2500 mgR.E. 20 mgReleased dailyVia RE system90% extra vascular5-10% intra vascularLoss (from GI tract)1-2 mg dailyDaily Fe++turnover continuous process
Dietary iron:Iron is present in food as ferric hydroxides (ferric-proteincomplexes and hem-protein complexes).-meat, liver-vegetables, eggs.-The average diet contains 10-15mg and only 5-10% is normallyabsorbed.Iron requirements:It varies depending on sex and age:Male/female 0.5-1 mg/dayPregnant female 1-2 mg/dayChildren 0.5 mg/day
Clinical features:• When ID is developing, the RE stores (hemosiderin andferritin) become completely depleted before anemia occurs.• At an early stage, no clinical abnormalities.• Later, patient may develops general symptoms and signs ofanemia.• In severe case of IDA ridged or spoon nails.