Iron Deficiency anemia

1. Iron deficiency anemia
Dr. Snehil Agrawal

2. ANAEMIA
 Haemoglobin concentration in blood below the lower limit of the normal range for
the age and sex of the individual.

3. Iron Deficiency Anemia
 Deficiency of iron is the most common nutritional disorder in
the world.
 The total body iron content is normally about 2 gm in women
and as high as 6 gm in men,
 divided into functional and storage compartments .
 Healthy young females have smaller stores of iron than do
males.
 Iron in the body is recycled extensively between the
functional and storage pools

4. Functional iron Storage iron
Hemoglobin Hemosiderin
Myoglobin Ferritin
Catalase
Cytochromes

5. 10 to 20 mg of diet 20% absorbable

6. Dietary source: meat , eggs , green leafy veggies
Site: duodenum and upper jejunum

7. Absorption increased Absorption decreased
citrates tannates (found in tea),
ascorbic acid carbonates
amino acids, and sugars oxalates, and phosphates

8.  DISTRIBUTION
Hemoglobin- 65%
Ferritin, Hemosiderin- 30%
Myoglobin,enzymes - 5%
 TRANSPORT
Transferrin 0.5%
 EXCRETION
0.5 to 1mg per day

9. Regulation of iron absorption

10. Transport form
 transported in plasma by an iron-binding glycoprotein called
transferrin
 synthesized in the liver.
 In normal individuals, transferrin is about 1/3 saturated with iron,
yielding serum iron levels that average 120 μg/dL in men and 100
μg/dL in women.
 The major function of plasma transferrin is to deliver iron to cells.
 Erythroid precursors possess high-affinity receptors for transferrin,
which mediate iron import through receptor-mediated endocytosis.

11. Iron metabolism

12. Ferritin
 Free iron is highly toxic .
 Ferritin is a ubiquitous protein-iron complex that is found at
highest levels in the liver, spleen, bone marrow, and skeletal
muscles.
 In the liver, most ferritin is stored within the parenchymal cells;
 in spleen and the BM, it is found mainly in macrophages.
 storage iron in macrophages is derived from the breakdown of
red cells.

13. ferritin
 its levels correlate well with body iron stores.
 In iron deficiency, serum ferritin is always below 12 μg/L,
 whereas in iron overload values approaching 5000 μg/L
can be seen.

14. hemosiderin
 partially degraded protein shells of ferritin aggregate into hemosiderin
granules.
 Iron in hemosiderin is chemically reactive and turns blue-black when
exposed to potassium ferrocyanide, which is the basis for the Prussian
blue stain.

15. CAUSE OF IDA
Four groups
 Inadequate iron intake
 Defective absorption
 Excessive loss of iron (5mg of iron is lost for loss of 10ml blood)
 Increased requirement
In infants and children(6-18 months), iron deficiency results from poor dietary intake
In adults iron deficiency is usually secondary to chronic blood loss.
In women of reproductive age group iron deficiency is usually result of menstrual
disorders and pregnancy.

16. Inadequate dietary intake of iron
 Defective absorption of iron
Subtotal gastrectomy
In partial gastrectomy-loss of gastric acidity result in impaired Fe absorption
In total gastrectomy food rapidly passes through duodenum and absorption of iron is impaired
Helicobacter pylori gastritis
 Excessive loss of iron
Gastrointestinal bleeding
Peptic ulcer,
Gastritis,
Hookworm infection,
Various neoplasms especially carcinoma of colon, marathon runners;
Urinary tract bleeding
Haematuria
Haemoglobinuria
Respiratory tract bleeding
Bleeding disorders
 Increased requirements for iron—Pregnancy, infancy, adolescents

17. High risk of IDA
 pregnancy
 Children
 Elderly
 Women of reproductive age
 adolescents

18. Pathogenesis.
 hypochromic microcytic anemia.
 initially reserves are utilized.
 Progressive depletion of these reserves first lowers serum iron and
transferrin saturation levels without producing anemia.
 In this early stage there is increased erythroid activity in the bone marrow.
 Anemia appears only when iron stores are completely depleted and is
accompanied by low serum iron, ferritin, and transferrin saturation levels.

19. Clinical Features
 Fatigue, restless legs, palpitations, breathlessness.
 Koilonychia: finger nail become thin, flattened, brittle & finally spoon shaped.
 Angular stomatitis, glossitis: papillae of tongue making the surface smooth.
 Dysphagia – difficulty in swallowing because of oesophageal web, known as
Plummer-Vinson syndrome
 Most common characteristics symptoms is PICA i.e. an abnormal and intense desire
to eat strange substances such as clay, paint, cardboard, coal, etc.

23. Stages in the deveopment of anemia
Depletion of
iron stores
Decrease in
transport iron
with reduced
availability
Normocytic
normochromic
anemia
Microcytic
anemia
MCHC ANEMIA

24.  Depletion of iron stores
• Serum ferritin conc. Decrease
• Absence of stainable iron in BM
 Decrease in transport iron with reduced availability of iron for
erythropoiesis
• Circulating iron level falls
• Serum iron & transferrin saturation decrease
• TIBC increase
• Free erythrocyte protoporphyrin(FEP) increases
 Development Of anemia
• Normocytic normochromic anaemia
• Microcytic anaemia
• Microcytic hypochromic anaemia
STAGES IN THE DEVELOPMENT OF IDA

26. Laboratory investigations of IDA
Routine RBC parameters
 Hb,
 RBC count
 haematocrit
 Red cell indices
Microscopic examination
 Peripheral blood film
 Grading of marrow iron stores
(Gold standard)
Serum assays
 Serum ferritin
 Serum iron
 Serum transferrin, TIBC
 Transferrin saturation
 Protoporphyrin
 Serum transferrin receptor
concentration

27. Hb – decreased
Reticulocyte count – normal or increased
MCV ,MCH ,MCHC – all are decreased
Peripheral smear shows – microcytic hypochromic
RBCs. tear drop cells, pencil cells and
polychromatophils
Leukocytes and platelets are normal

30. MICROCYTE HYPOCHROMIC SMEAR NORMAL SMEAR

32.  Hypercellular
 Erythroid hyperplasia
 Erythropoiesis is micronormoblastic
 Normoblast are smaller
 Late micronormoblasts demonstrate persistent basophilia
 Cytoplasmic border indicate incomplete hemoglobinization.
 Absence of stainable iron in the bone marrow on Perl’s Prussian blue
reaction is a specific and a reliable test for diagnosis of iron deficiency
anaemia.
 BMA smear shows completely devoid of iron and iron grade is 0 (NIL).
BONE MARROW FEATURES

35. Serum ferritin is decreased
TIBC is increased
Serum iron is decreased
Red cell protoporphyrin is increased

36. INVESTIGATIONS FOR CHARATERIZATION OF
ANAEMIA
 Haemoglobin
 PCV
 RBC
 MCV
 MCH
 MCHC
 RDW
 TLC
 Platelets
 Retic count
 DLC
 Decreases
 Decreases
 Varies with severity of anemia
 Decreases
 Decreases
 Decreases
 Increases
 Normal or mild decreased
 Normal or increase
 Normal/reduced/increase
 Usually normal

37. treatment
 Ferrous sulphate 200mg
 Parenteral- iron dextran,iron sucrose