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IRON DEFICIENCY ANAEMIA
DR.HARIVANSH CHOPRA
M.D.,DCH
PROFESSOR
DEPT. OF COMMUNITY MEDICINE
L.L.R.M.MEDICAL COLLEGE,MEERUT
...
Anaemia is the most common public
health problem in India as well as in
other developing countries.
INTRODUCTION
Although there are a number of causes of anaemia in young
children but commonly anaemia is classified as :
Microcytic Hypo...
MICROCYTIC HYPOCHROMIC ANAEMIA
IRON DEFICIENCY ANAEMIA
LEAD POISONING
HEMOLYTIC ANAEMIA
NORMOCHROMIC NORMOCYTIC ANAEMIA
BLOOD LOSS (ACUTE OR CHRONIC)
ANAEMIA OF RENAL ORIGIN
ANAEMIA DUE TO CHRONIC DISEASE
MEGALOBLASTIC ANAEMIA
VITAMIN B 12 DEFICIENCY
FOLIC ACID DEFICIENCY
By far the commonest anaemia is iron
deficiency anaemia and despite of
having a national program for the
control of anaemi...
The main reason for failure of this program is
lack of life cycle approach in the prevention of
iron deficiency anaemia. A...
The main cause of this high prevalence of
anaemia in young children is failure to provide
supplementary iron right from th...
INTRODUCTION
Especially it becomes more profound in
adolescent females again due to lack of
therapeutic approach in this p...
DR.HARIVANSH CHOPRA
What is Iron
Functions
Rich sources
Daily requirement
Public health importance
OBJECTIVES
DR.HARIVANSH CHOPRA
Diagnostic features of
deficiency
Treatment of Iron deficiency
anemia
OBJECTIVES
DR.HARIVANSH CHOPRA
HIDDEN HUNGER
The term was coined by WHO in 1986 & refers to the problems
associated with the deficien...
DR.HARIVANSH CHOPRA
IRON IN NATURE
Iron is among the abundant minerals on
earth.
Of the 87 elements in the earth’s crust...
DR.HARIVANSH CHOPRA
What is Iron?
•Iron is vital to the health of
the human body, and is
found in every human cell.
DR.HARIVANSH CHOPRA
What is Iron?
•The human body contains
approximately 4 grams of
iron.
DR.HARIVANSH CHOPRA
What is Iron?
•Iron is an integral part of
many proteins and enzymes
that maintain good health.
DR.HARIVANSH CHOPRA
What is Iron?
•In humans, iron is an essential
component of proteins involved
in oxygen transport.
DR.HARIVANSH CHOPRA
What is Iron?
• It is also essential for the regulation of cell
growth and differentiation
• It helps ...
DR.HARIVANSH CHOPRA
What is Iron?
Dietary iron comes in two forms:
Heme iron
Non-heme iron
DR.HARIVANSH CHOPRA
What is Iron?
• Heme iron is found only in animal flesh,
as it is derived from the hemoglobin and
myog...
DR.HARIVANSH CHOPRA
•Oxygen Distribution
•Iron serves as the core of the
hemoglobin molecule, which is the
oxygen-carrying...
DR.HARIVANSH CHOPRA
•Red blood cells pick up oxygen
from lungs and distribute the
oxygen to tissues throughout
the body
Ho...
DR.HARIVANSH CHOPRA
•The ability of red blood cells
to carry oxygen is attributed
to the presence of iron in
hemoglobin mo...
DR.HARIVANSH CHOPRA
•If we lack iron, we will
produce less hemoglobin,
and therefore supply less
oxygen to our tissues.
Ho...
DR.HARIVANSH CHOPRA
•Iron is also an important
constituent of another
protein called myoglobin.
How it Functions?
DR.HARIVANSH CHOPRA
•Myoglobin, like hemoglobin, is an
oxygen-carrying molecule, which
distributes oxygen to muscles cells...
DR.HARIVANSH CHOPRA
• Energy Production
• Iron also plays a vital role in the
production of energy as a constituent of
sev...
DR.HARIVANSH CHOPRA
How it Functions?
• It is also involved in the production of
carnitine, a nonessential amino acid
impo...
DR.HARIVANSH CHOPRA
MAGNITUDE OF PROBLEM
Iron deficiency is the most common micronutrient deficiency in the world
affecti...
DR.HARIVANSH CHOPRA
In developing countries, about 50 percent of
women and young children are anemic.
MAGNITUDE OF PROBLEM
DR.HARIVANSH CHOPRA
MAGNITUDE OF PROBLEM
The highest overall rates of anemia are reported in
southern Asia and certain re...
DR.HARIVANSH CHOPRA
PREVALENCE IN WORLD
REGION 6 – 59 MONTHS PREGNANT
WOMEN
NON PREGNANT
WOMEN
AFRICA 60.2 % 44.6 % 37.6 %...
DR.HARIVANSH CHOPRA
PREVALENCE IN INDIA
ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA
AGE GROUP PREVALENCE
6 – 59 MONTHS 58.4 ...
DR.HARIVANSH CHOPRA
PREVALENCE IN UTTAR PRADESH
ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA
AGE GROUP PREVALENCE
6 – 59 MONT...
DR.HARIVANSH CHOPRA
ANEMIA IN CHILDREN < 5 YEARS
NORMAL
31%
MILD ANAEMIA
26%
MODERATE
ANAEMIA
40%SEVERE ANAEMIA
3%
ANAEMIA...
74
79
4 5
0
10
20
30
40
50
60
70
80
90
Any anaemia Severe anaemia
NFHS-2 NFHS-3
Percent
10/5/2017 37
Anaemia among Childre...
DR.HARIVANSH CHOPRA
According to the epidemiological data
collected from multiple countries by the
WHO, Some 35 % of women...
DR.HARIVANSH CHOPRA
Whole-grain and enriched breads.
Cereals.
Dark green, leafy vegetables, such as
spinach & dried beans....
DR.HARIVANSH CHOPRA
Milk, yogurt & cheese.
Meat, fish, poultry,
Jaggery
Eggs
FOOD SOURCE
DR.HARIVANSH CHOPRA
•The amount of iron needed depends on age, gender, &
activity level.
•Iron needs increase during perio...
DR.HARIVANSH CHOPRA
• Women and teenage girls need more iron than
men because of menstrual losses.
• Competitive athletes ...
DR.HARIVANSH CHOPRA
Adult male : 17mg/d
Adult female : 21mg/d
Pregnant female : 35mg/d
Lactating female : 21mg/d
Children ...
DR.HARIVANSH CHOPRA
IMPACT OF COOKING, STORAGE AND PROCESSING
• Much of the iron in whole
grains is found in the bran
and ...
DR.HARIVANSH CHOPRA
As a result, the milling of grain, which
removes the bran and germ,
eliminates about 75% of the natura...
DR.HARIVANSH CHOPRA
Impact of Cooking,
Storage and Processing
• Refined grains are often fortified
with iron, but the adde...
DR.HARIVANSH CHOPRA
•Cooking with iron cookware
will add iron to food, a
practice that can eventually
lead to iron toxicit...
DR.HARIVANSH CHOPRA
• Iron absorption is increased when there is
an increased physiological need for iron,
as occurs in ch...
DR.HARIVANSH CHOPRA
•Iron absorption is decreased in people with low
stomach acid (hypochlorhydria),
•Iron absorption is d...
DR.HARIVANSH CHOPRA
Phytates, found in whole grains, and
oxalates, found in spinach and chocolate,
may also decrease iron ...
DR.HARIVANSH CHOPRA
DEMOGRAPHIC FACTORS
DR.HARIVANSH CHOPRA
DIETARY FACTORS
DR.HARIVANSH CHOPRA
Social/physical factors
DR.HARIVANSH CHOPRA
• Use of the following medications may increase the
amount of iron needed :
1) Aspirin and NSAIDS (for...
DR.HARIVANSH CHOPRA
• Dietary iron may impact the absorption of the following medications:
1) Iron binds with sulfasalazin...
DR.HARIVANSH CHOPRA
•Iron supplements may interfere with the action of
carbidopa, a drug used in the treatment of Parkinso...
DR.HARIVANSH CHOPRA
How do other nutrients interact with iron?
Several nutrients increase iron absorption
including ascorb...
DR.HARIVANSH CHOPRA
Amino acids also improve iron absorption by
stimulating the secretion of hydrochloric acid in
the stom...
DR.HARIVANSH CHOPRA
What health conditions require special
emphasis on iron?
HEALTH CONDITIONS
Alcoholism
Attention defici...
DR.HARIVANSH CHOPRA
Colitis
Diabetes
Excessive menstrual blood loss
HEALTH CONDITIONS
DR.HARIVANSH CHOPRA
Iron deficiency anemia
Leukemia
Parasitic infections
HEALTH CONDITIONS
DR.HARIVANSH CHOPRA
Restless leg syndrome
Stomach ulcers
Tuberculosis
HEALTH CONDITIONS
DR.HARIVANSH CHOPRA
• Many people with iron deficiency don't have
any signs and symptoms because the body's
iron stores ar...
DR.HARIVANSH CHOPRA
Rapid heartbeat or a new heart murmur
Irritability
Decreased appetite
CLINICAL FEATURES
DR.HARIVANSH CHOPRA
CLINICAL FEATURES
Hair loss
Dizziness or feeling of
being lightheaded.
Rarely, Pica.
DR.HARIVANSH CHOPRA
• Also known as Paterson Kelly syndrome.
Characterized by :
1) Iron-deficiency anaemia,
2) Atrophic ch...
DR.HARIVANSH CHOPRA
Plummer-Vinson Syndrome
3) Koilonychia (spoon-shaped finger
nails),
4) Dysphagia. The dysphagia is due...
DR.HARIVANSH CHOPRA
CUT OFF POINTS FOR DIAGNOSIS
OF ANAEMIA (WHO)
Adult male 13g/dl (venous)
Adult female (non pregnant) 1...
DR.HARIVANSH CHOPRA
Hb in IDA
DR.HARIVANSH CHOPRA
•A complete blood count (CBC) may
reveal low Hb levels and low
hematocrit.
•The CBC gives information ...
DR.HARIVANSH CHOPRA
•RBCs with low hemoglobin tend
to be smaller and less
pigmented.
DIAGNOSIS
DR.HARIVANSH CHOPRA
The reticulocyte count measures the
number of immature red blood cells
being produced. This is a usefu...
DR.HARIVANSH CHOPRA
•Serum iron directly measures the
amount of iron in the blood, but
may not accurately reflect how
much...
DR.HARIVANSH CHOPRA
Serum ferritin reflects total body iron stores. It's one of the earliest
indicators of depleted iron ...
DR.HARIVANSH CHOPRA
1) A low MCV (normal-85±8 fl)
2) Low MCH (normal-30±2.5 pg)
3) Low MCHC (normal-33±2.5g/dl), indicate
...
DR.HARIVANSH CHOPRA
Low serum ferritin (normal 150-2000
ng/dl),
Low serum iron level (normal 80-180
µg/dl),
DIAGNOSIS
DR.HARIVANSH CHOPRA
1) Elevated serum transferrin and
2) High total iron binding capacity
(TIBC) (normal 250-450 µg/dl).
D...
DR.HARIVANSH CHOPRA
A definitive diagnosis requires a
bone marrow aspiration, with the
marrow stained for iron.
DIAGNOSIS
DR.HARIVANSH CHOPRA
Normal bone marrow is shown here.
Note the erythroid islands where erythropoiesis is occurring.
DIAGNO...
DR.HARIVANSH CHOPRA
• The diagnosis of iron deficiency anemia requires further
investigation as to its cause. It can be a ...
DR.HARIVANSH CHOPRA
Diversion of iron to fetal erythropoiesis
during pregnancy,
Intravascular hemolysis &
Hemoglobinuria o...
DR.HARIVANSH CHOPRA
Treatment for underlying problem-
• Deworming of patients
• Change in dietary habits
• Wearing of shoe...
DR.HARIVANSH CHOPRA
•Iron-rich foods are encouraged.
•Causes of persistent blood loss if any
(polyps, chronic dysentery, u...
DR.HARIVANSH CHOPRA
ORAL IRON THERAPY :
The optimal dose of iron is 3-6mg/kg body
weight given orally in 3 doses.
With thi...
DR.HARIVANSH CHOPRA
Oral therapy should be continued
for at-least 8 – 12 weeks.
Vitamin C should be included in
diet and p...
DR.HARIVANSH CHOPRA
•If malabsorption is present, it may
be necessary to administer iron
parenterally
•(e.g., iron dextran...
DR.HARIVANSH CHOPRA
•Iron requirement is determined from the following
equation :
IRON (mg) =Wt (kg) X Hb deficit (g/dl) X...
DR.HARIVANSH CHOPRA
Follow up evaluation with CBC is
essential to demonstrate whether
the treatment has been effective.
TR...
Children 6 – 60 months
SUPPLEMENTATION
•20 mg of elemental iron and
100 mcg of folic acid in
biweekly regimen
DR.HARIVANSH...
Children 6 – 60 months
• MILD ANEMIA (Hb 10 – 10.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not respon...
Children 6 – 60 months
• MODERATE ANEMIA (Hb 7 – 9.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not resp...
Children 6 – 60 months
• SEVERE ANEMIA (Hb < 7 )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH...
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS
HISTORY TO BE TAKEN FOR
Duration of ...
EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH C...
Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for ce...
DOSE OF IFA SYRUP FOR ANEMIC CHILDREN
6 MONTHS – 5 YEARS
AGE OF CHILD DOSE FREQUENCY
6 months – 12 months
(6-10 kg)
1 ml o...
SUPPLEMENTATION
Tablets of 45mg elemental iron
and 400mcg of folic acid
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH T...
• MILD ANEMIA (Hb 11 – 11.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of ane...
• MODERATE ANEMIA (Hb 8 – 10.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of ...
• SEVERE ANEMIA (Hb < 8 gm/dl )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
C...
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 5 – 10 YEARS
HISTORY TO BE TAKEN FOR
Duration of sympto...
EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH C...
Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for ce...
ADOLESCENTS 10 – 19 YEARS
104
SUPPLEMENTATION
100mg elemental Iron and
500mcg folic acid
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE...
• MILD ANEMIA (Hb 11 – 11.9 gm/dl)
60mg of iron/day for 3months
In case the child has not responded to treatment of anemia...
• MODERATE ANEMIA (Hb 8 – 10.9 gm/dl)
60 mg of iron/day for 3 months
In case the child has not responded to treatment of a...
• SEVERE ANEMIA (Hb < 8 gm/dl )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
A...
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN ADOLESCENT
HISTORY TO BE TAKEN FOR
Duration of symptoms
Usual di...
EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH C...
Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for ce...
PREGNANT AND LACTATING WOMEN
112
• Hb level 9 – 11gm/dl
• IFA tablets 100mg iron and 500
mcg folic acid
• 2 IFA tablets per day for at least
100 days
2 IFA...
• Hb 8 – 9 mg/dl
Cause of IDA must be investigated
• 2 tablet IFA to be given daily
DR.HARIVANSH CHOPRA
PREGNANT AND LACTA...
• Hb 7 – 8 mg / dl
• Before starting the treatment, the
women should be investigated to
detect the cause of anemia
• Injec...
• Hb 5 – 7 mg / dl
• Continue Parenteral iron therapy
as for Hb level between 7-8mg/dl.
• Hb testing to be done after 8
we...
• Hb < 5 gm /dl
• injectable IV sucrose preparations
• Immediate Hospitalization irrespective
of period of gestation in ho...
118
LEVEL OF Hb TREATMENT FOLLOW UP REFERRAL
MILD ANEMIA
(11 -11.9 gm/dl)
60mg of elemental
iron daily for 3 months
Follow...
DR.HARIVANSH CHOPRA
Prevention of iron deficiency can be achieved
by following measures :
Dietary changes
Fortification of...
DR.HARIVANSH CHOPRA
Iron Supplementation v/s Iron Therapy – Cost
Iron Supplementation, 30
Iron Therapy, 70
DR.HARIVANSH CHOPRA
PREVENTION
Infection control
Research & monitoring
Programme implementation.
DR.HARIVANSH CHOPRA
•Launched in 1970 to prevent nutritional
anaemia in mother & children.
•This program is now a part of ...
DR.HARIVANSH CHOPRA
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM
• Under this program, prophylactic treatment
for expe...
DR.HARIVANSH CHOPRA
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM
• Children are given one tablet containing 20mg
eleme...
NATIONAL IRON + INITIATIVE
Launched to bring existing
Programmes together and
establish new age groups
125
Bi weekly iron supplementation for pre school
children 6 months to 5 years
DR.HARIVANSH CHOPRA
Weekly Supplementation for ...
Weekly supplementation for out of school
children (5 – 10 years) at Anganwadi Centers.
DR.HARIVANSH CHOPRA
Weekly Suppleme...
Pregnant and lactating women
DR.HARIVANSH CHOPRA
Weekly Supplementation for women in
reproductive age
NATIONAL IRON + INIT...
LACK OF AWARENESS IN MASSES AND PERIPHERAL HEALTH WORKERS
REGARDING ANAEMIA
LACK OF STRATEGY TO REACH EVERY CHILD
LACK OF ...
DR.HARIVANSH CHOPRA
CONCLUSION
Iron deficiency is the commonest deficiency disorder.
If not treated in time, it results in...
DR.HARIVANSH CHOPRA
• Normal requirement of iron in children is-
1. 0.1mg/kg/day
2. 0.5mg/kg/day
3. 1mg/kg/day
4. 5mg/kg/d...
DR.HARIVANSH CHOPRA
• The prevalence of anaemia in pregnancy in India is –
1. 10-20%
2. 20-30%
3. 30-40%
4. 40-50% ANS. 4
DR.HARIVANSH CHOPRA
• WHO Cut off point for diagnosis of anaemia for children (6month-
6year) is :
1) 11g/dl
2) 12g/dl
3) ...
DR.HARIVANSH CHOPRA
• Normal serum iron level is :
1. 30-80 µg/dl
2. 80-180 µg/dl
3. 150-250 µg/dl
4. 250-450 µg/dl ANS. 2
DR.HARIVANSH CHOPRA
• The content of a tablet used for prevention of Nutritional Anaemia in
Pregnant female is :
1. 50mg i...
DR.HARIVANSH CHOPRA
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Iron deficiency anaemia

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iron deficiency anaemia is the commonest nutritional anaemia in India as well as other developing countries. till an effective supplementation is implemented right from the age of 4 months the problem can not be solved. there is an urgent need to develop effective strategy to reach every infant in the country and give iron supplementation to every infant irrespective of class, creed, caste and society.

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Iron deficiency anaemia

  1. 1. IRON DEFICIENCY ANAEMIA DR.HARIVANSH CHOPRA M.D.,DCH PROFESSOR DEPT. OF COMMUNITY MEDICINE L.L.R.M.MEDICAL COLLEGE,MEERUT harichop@gmail.com
  2. 2. Anaemia is the most common public health problem in India as well as in other developing countries. INTRODUCTION
  3. 3. Although there are a number of causes of anaemia in young children but commonly anaemia is classified as : Microcytic Hypochromic Anaemia Normocytic Normochromic Anaemia Megaloblastic Anaemia INTRODUCTION
  4. 4. MICROCYTIC HYPOCHROMIC ANAEMIA IRON DEFICIENCY ANAEMIA LEAD POISONING HEMOLYTIC ANAEMIA
  5. 5. NORMOCHROMIC NORMOCYTIC ANAEMIA BLOOD LOSS (ACUTE OR CHRONIC) ANAEMIA OF RENAL ORIGIN ANAEMIA DUE TO CHRONIC DISEASE
  6. 6. MEGALOBLASTIC ANAEMIA VITAMIN B 12 DEFICIENCY FOLIC ACID DEFICIENCY
  7. 7. By far the commonest anaemia is iron deficiency anaemia and despite of having a national program for the control of anaemia it is not been able to make a dent on the prevalence in India INTRODUCTION
  8. 8. The main reason for failure of this program is lack of life cycle approach in the prevention of iron deficiency anaemia. As per various National Family Health Surveys, the prevalence of anemia has been staggering around 70% among the children below 3 years of age. INTRODUCTION
  9. 9. The main cause of this high prevalence of anaemia in young children is failure to provide supplementary iron right from the age of 4 months of life and this results in child becoming anaemic by the end of first year and then this anemia remain persistent in pre school, school going and adolescent age group. INTRODUCTION
  10. 10. INTRODUCTION Especially it becomes more profound in adolescent females again due to lack of therapeutic approach in this particular age group. the failure to treat anaemia in adolescent results in propagation of anaemia in pregnancy.
  11. 11. DR.HARIVANSH CHOPRA What is Iron Functions Rich sources Daily requirement Public health importance OBJECTIVES
  12. 12. DR.HARIVANSH CHOPRA Diagnostic features of deficiency Treatment of Iron deficiency anemia OBJECTIVES
  13. 13. DR.HARIVANSH CHOPRA HIDDEN HUNGER The term was coined by WHO in 1986 & refers to the problems associated with the deficiency of 3 essential micronutrients: IRON IODINE VITAMIN A
  14. 14. DR.HARIVANSH CHOPRA IRON IN NATURE Iron is among the abundant minerals on earth. Of the 87 elements in the earth’s crust, Iron constitutes 5.6% and ranks fourth behind Oxygen (46.4%), Silicon (28.4%) and Aluminum (8.3%).
  15. 15. DR.HARIVANSH CHOPRA What is Iron? •Iron is vital to the health of the human body, and is found in every human cell.
  16. 16. DR.HARIVANSH CHOPRA What is Iron? •The human body contains approximately 4 grams of iron.
  17. 17. DR.HARIVANSH CHOPRA What is Iron? •Iron is an integral part of many proteins and enzymes that maintain good health.
  18. 18. DR.HARIVANSH CHOPRA What is Iron? •In humans, iron is an essential component of proteins involved in oxygen transport.
  19. 19. DR.HARIVANSH CHOPRA What is Iron? • It is also essential for the regulation of cell growth and differentiation • It helps cells to "breathe." • Iron works with protein to make the hemoglobin in red blood cells.
  20. 20. DR.HARIVANSH CHOPRA What is Iron? Dietary iron comes in two forms: Heme iron Non-heme iron
  21. 21. DR.HARIVANSH CHOPRA What is Iron? • Heme iron is found only in animal flesh, as it is derived from the hemoglobin and myoglobin in animal tissues. • Non-heme iron is found in plant foods and dairy products.
  22. 22. DR.HARIVANSH CHOPRA •Oxygen Distribution •Iron serves as the core of the hemoglobin molecule, which is the oxygen-carrying component of the red blood cell. How it Functions?
  23. 23. DR.HARIVANSH CHOPRA •Red blood cells pick up oxygen from lungs and distribute the oxygen to tissues throughout the body How it Functions?
  24. 24. DR.HARIVANSH CHOPRA •The ability of red blood cells to carry oxygen is attributed to the presence of iron in hemoglobin molecule. How it Functions?
  25. 25. DR.HARIVANSH CHOPRA •If we lack iron, we will produce less hemoglobin, and therefore supply less oxygen to our tissues. How it Functions?
  26. 26. DR.HARIVANSH CHOPRA •Iron is also an important constituent of another protein called myoglobin. How it Functions?
  27. 27. DR.HARIVANSH CHOPRA •Myoglobin, like hemoglobin, is an oxygen-carrying molecule, which distributes oxygen to muscles cells, especially to skeletal muscles and to the heart. How it Functions?
  28. 28. DR.HARIVANSH CHOPRA • Energy Production • Iron also plays a vital role in the production of energy as a constituent of several enzymes, including iron catalase, iron peroxidase, and the cytochrome enzymes How it Functions?
  29. 29. DR.HARIVANSH CHOPRA How it Functions? • It is also involved in the production of carnitine, a nonessential amino acid important for the proper utilization of fat. • The function of the immune system is also dependent on sufficient iron.
  30. 30. DR.HARIVANSH CHOPRA MAGNITUDE OF PROBLEM Iron deficiency is the most common micronutrient deficiency in the world affecting 1.3 billion people i.e. 24% of the world population.
  31. 31. DR.HARIVANSH CHOPRA In developing countries, about 50 percent of women and young children are anemic. MAGNITUDE OF PROBLEM
  32. 32. DR.HARIVANSH CHOPRA MAGNITUDE OF PROBLEM The highest overall rates of anemia are reported in southern Asia and certain regions of Africa
  33. 33. DR.HARIVANSH CHOPRA PREVALENCE IN WORLD REGION 6 – 59 MONTHS PREGNANT WOMEN NON PREGNANT WOMEN AFRICA 60.2 % 44.6 % 37.6 % LATIN AMERICA AND CARIBBEAN 29.1 % 28.6 % 19.1 % NORTH AMERICA 07.0 % 17.1 % 12.4 % ASIA 42.0 % 39.3 % 31.9 % EUROPE 19.3 % 24.5 % 20.1 % OCENIA 26.2 % 29.0 % 20.0 % GLOBAL 42.6 % 38.2 % 29.4 %
  34. 34. DR.HARIVANSH CHOPRA PREVALENCE IN INDIA ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA AGE GROUP PREVALENCE 6 – 59 MONTHS 58.4 % PREGNANT WOMEN (15 – 49 YEARS) 53.1 % NON PREGNANT WOMEN (15 – 49 YEARS) 50.3 % ALL WOMEN 15 – 49 YEARS 53.0 % MEN 22.7 %
  35. 35. DR.HARIVANSH CHOPRA PREVALENCE IN UTTAR PRADESH ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA AGE GROUP PREVALENCE 6 – 59 MONTHS 63.2 % PREGNANT WOMEN (15 – 49 YEARS) 52.5 % NON PREGNANT WOMEN (15 – 49 YEARS) 51.0 % ALL WOMEN 15 – 49 YEARS 52.4 % MEN 23.7 %
  36. 36. DR.HARIVANSH CHOPRA ANEMIA IN CHILDREN < 5 YEARS NORMAL 31% MILD ANAEMIA 26% MODERATE ANAEMIA 40%SEVERE ANAEMIA 3% ANAEMIA IN CHILDREN 6 - 59 MONTHS (NFHS 3)
  37. 37. 74 79 4 5 0 10 20 30 40 50 60 70 80 90 Any anaemia Severe anaemia NFHS-2 NFHS-3 Percent 10/5/2017 37 Anaemia among Children Age 6-35 Months
  38. 38. DR.HARIVANSH CHOPRA According to the epidemiological data collected from multiple countries by the WHO, Some 35 % of women and 43 % of young children in the world are affected by anemia. MAGNITUDE OF PROBLEM
  39. 39. DR.HARIVANSH CHOPRA Whole-grain and enriched breads. Cereals. Dark green, leafy vegetables, such as spinach & dried beans. FOOD SOURCE
  40. 40. DR.HARIVANSH CHOPRA Milk, yogurt & cheese. Meat, fish, poultry, Jaggery Eggs FOOD SOURCE
  41. 41. DR.HARIVANSH CHOPRA •The amount of iron needed depends on age, gender, & activity level. •Iron needs increase during periods of rapid growth, such as during pregnancy, childhood, & adolescence when new tissue is being built. DAILY REQUIREMENT
  42. 42. DR.HARIVANSH CHOPRA • Women and teenage girls need more iron than men because of menstrual losses. • Competitive athletes may also experience an increased need for iron. DAILY REQUIREMENT
  43. 43. DR.HARIVANSH CHOPRA Adult male : 17mg/d Adult female : 21mg/d Pregnant female : 35mg/d Lactating female : 21mg/d Children : 1mg/kg/day DAILY REQUIREMENT
  44. 44. DR.HARIVANSH CHOPRA IMPACT OF COOKING, STORAGE AND PROCESSING • Much of the iron in whole grains is found in the bran and germ.
  45. 45. DR.HARIVANSH CHOPRA As a result, the milling of grain, which removes the bran and germ, eliminates about 75% of the naturally occurring iron in whole grains. IMPACT OF COOKING, STORAGE AND PROCESSING
  46. 46. DR.HARIVANSH CHOPRA Impact of Cooking, Storage and Processing • Refined grains are often fortified with iron, but the added iron is less absorbable than the iron that naturally occurs in the grain. IMPACT OF COOKING, STORAGE AND PROCESSING
  47. 47. DR.HARIVANSH CHOPRA •Cooking with iron cookware will add iron to food, a practice that can eventually lead to iron toxicity. IMPACT OF COOKING, STORAGE AND PROCESSING
  48. 48. DR.HARIVANSH CHOPRA • Iron absorption is increased when there is an increased physiological need for iron, as occurs in children during rapid growth periods and during pregnancy and lactation. Predisposing factors for Deficiency
  49. 49. DR.HARIVANSH CHOPRA •Iron absorption is decreased in people with low stomach acid (hypochlorhydria), •Iron absorption is decreased by caffeine and tannic acid found in coffee and tea and by phosphates found in carbonated soft drinks. Predisposing factors for Deficiency
  50. 50. DR.HARIVANSH CHOPRA Phytates, found in whole grains, and oxalates, found in spinach and chocolate, may also decrease iron absorption by forming complexes with the mineral that cannot be absorbed through the digestive tract. Predisposing factors for Deficiency
  51. 51. DR.HARIVANSH CHOPRA DEMOGRAPHIC FACTORS
  52. 52. DR.HARIVANSH CHOPRA DIETARY FACTORS
  53. 53. DR.HARIVANSH CHOPRA Social/physical factors
  54. 54. DR.HARIVANSH CHOPRA • Use of the following medications may increase the amount of iron needed : 1) Aspirin and NSAIDS (for eg, ibuprofen) 2) Histamine blockers 3) Neomycin 4) Stanozolol, 5) Warfarin (Coumadin) DRUG -NUTRIENT INTERACTIONS
  55. 55. DR.HARIVANSH CHOPRA • Dietary iron may impact the absorption of the following medications: 1) Iron binds with sulfasalazine, decreasing sulfasalazine absorption. 2) Iron decreases the absorption of tetracycline. 3) Iron supplements may decrease absorption of thyroid hormone medications. DRUG -NUTRIENT INTERACTIONS
  56. 56. DR.HARIVANSH CHOPRA •Iron supplements may interfere with the action of carbidopa, a drug used in the treatment of Parkinson's disease. •Iron supplements decrease the absorption of methyldopa, a drug used to lower blood pressure in people with high blood pressure. DRUG -NUTRIENT INTERACTIONS
  57. 57. DR.HARIVANSH CHOPRA How do other nutrients interact with iron? Several nutrients increase iron absorption including ascorbic acid (vitamin C), copper, cobalt, and manganese. NUTRIENT INTERACTIONS
  58. 58. DR.HARIVANSH CHOPRA Amino acids also improve iron absorption by stimulating the secretion of hydrochloric acid in the stomach. High dietary intake of calcium may decrease absorption of dietary iron. NUTRIENT INTERACTIONS
  59. 59. DR.HARIVANSH CHOPRA What health conditions require special emphasis on iron? HEALTH CONDITIONS Alcoholism Attention deficit disorder
  60. 60. DR.HARIVANSH CHOPRA Colitis Diabetes Excessive menstrual blood loss HEALTH CONDITIONS
  61. 61. DR.HARIVANSH CHOPRA Iron deficiency anemia Leukemia Parasitic infections HEALTH CONDITIONS
  62. 62. DR.HARIVANSH CHOPRA Restless leg syndrome Stomach ulcers Tuberculosis HEALTH CONDITIONS
  63. 63. DR.HARIVANSH CHOPRA • Many people with iron deficiency don't have any signs and symptoms because the body's iron stores are depleted slowly. As anemia progresses, following symptoms maybe recognized: 1) Fatigue and weakness 2) Pale skin and mucous membranes CLINICAL FEATURES
  64. 64. DR.HARIVANSH CHOPRA Rapid heartbeat or a new heart murmur Irritability Decreased appetite CLINICAL FEATURES
  65. 65. DR.HARIVANSH CHOPRA CLINICAL FEATURES Hair loss Dizziness or feeling of being lightheaded. Rarely, Pica.
  66. 66. DR.HARIVANSH CHOPRA • Also known as Paterson Kelly syndrome. Characterized by : 1) Iron-deficiency anaemia, 2) Atrophic changes in buccal, glossopharyngeal, and esophageal mucous membranes, Plummer-Vinson Syndrome
  67. 67. DR.HARIVANSH CHOPRA Plummer-Vinson Syndrome 3) Koilonychia (spoon-shaped finger nails), 4) Dysphagia. The dysphagia is due to a web formed in the post cricoid region.
  68. 68. DR.HARIVANSH CHOPRA CUT OFF POINTS FOR DIAGNOSIS OF ANAEMIA (WHO) Adult male 13g/dl (venous) Adult female (non pregnant) 12g/dl Adult female (pregnant) 11g/dl Children (6month-6yr) 11g/dl Children (6-14yr) 12g/dl
  69. 69. DR.HARIVANSH CHOPRA Hb in IDA
  70. 70. DR.HARIVANSH CHOPRA •A complete blood count (CBC) may reveal low Hb levels and low hematocrit. •The CBC gives information about the size of the red blood cells (RBCs). DIAGNOSIS
  71. 71. DR.HARIVANSH CHOPRA •RBCs with low hemoglobin tend to be smaller and less pigmented. DIAGNOSIS
  72. 72. DR.HARIVANSH CHOPRA The reticulocyte count measures the number of immature red blood cells being produced. This is a useful test because it can indicate a problem before anemia develops. DIAGNOSIS
  73. 73. DR.HARIVANSH CHOPRA •Serum iron directly measures the amount of iron in the blood, but may not accurately reflect how much iron is concentrated in the body's cells. DIAGNOSIS
  74. 74. DR.HARIVANSH CHOPRA Serum ferritin reflects total body iron stores. It's one of the earliest indicators of depleted iron levels, especially when used in conjunction with other tests, such as a CBC. Stool test to detect occult blood loss and to detect presence of eggs of any worms. DIAGNOSIS
  75. 75. DR.HARIVANSH CHOPRA 1) A low MCV (normal-85±8 fl) 2) Low MCH (normal-30±2.5 pg) 3) Low MCHC (normal-33±2.5g/dl), indicate microcytic anemia. DIAGNOSIS
  76. 76. DR.HARIVANSH CHOPRA Low serum ferritin (normal 150-2000 ng/dl), Low serum iron level (normal 80-180 µg/dl), DIAGNOSIS
  77. 77. DR.HARIVANSH CHOPRA 1) Elevated serum transferrin and 2) High total iron binding capacity (TIBC) (normal 250-450 µg/dl). DIAGNOSIS
  78. 78. DR.HARIVANSH CHOPRA A definitive diagnosis requires a bone marrow aspiration, with the marrow stained for iron. DIAGNOSIS
  79. 79. DR.HARIVANSH CHOPRA Normal bone marrow is shown here. Note the erythroid islands where erythropoiesis is occurring. DIAGNOSIS
  80. 80. DR.HARIVANSH CHOPRA • The diagnosis of iron deficiency anemia requires further investigation as to its cause. It can be a sign of other disease, such as DIAGNOSIS Colon cancer Malabsorption Chronic blood loss
  81. 81. DR.HARIVANSH CHOPRA Diversion of iron to fetal erythropoiesis during pregnancy, Intravascular hemolysis & Hemoglobinuria or other forms of chronic blood loss should all be considered. DIAGNOSIS
  82. 82. DR.HARIVANSH CHOPRA Treatment for underlying problem- • Deworming of patients • Change in dietary habits • Wearing of shoes TREATMENT
  83. 83. DR.HARIVANSH CHOPRA •Iron-rich foods are encouraged. •Causes of persistent blood loss if any (polyps, chronic dysentery, ulcerative colitis etc.) need to be treated. TREATMENT
  84. 84. DR.HARIVANSH CHOPRA ORAL IRON THERAPY : The optimal dose of iron is 3-6mg/kg body weight given orally in 3 doses. With this, hemoglobin level should rise by 0.4g/dl / day. TREATMENT
  85. 85. DR.HARIVANSH CHOPRA Oral therapy should be continued for at-least 8 – 12 weeks. Vitamin C should be included in diet and phytate avoided. TREATMENT
  86. 86. DR.HARIVANSH CHOPRA •If malabsorption is present, it may be necessary to administer iron parenterally •(e.g., iron dextran). TREATMENT
  87. 87. DR.HARIVANSH CHOPRA •Iron requirement is determined from the following equation : IRON (mg) =Wt (kg) X Hb deficit (g/dl) X 80 100 X 3.4 X 1.5 Or, Wt (kg) X Hb deficit (g/dl) X 4 TREATMENT
  88. 88. DR.HARIVANSH CHOPRA Follow up evaluation with CBC is essential to demonstrate whether the treatment has been effective. TREATMENT
  89. 89. Children 6 – 60 months SUPPLEMENTATION •20 mg of elemental iron and 100 mcg of folic acid in biweekly regimen DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE
  90. 90. Children 6 – 60 months • MILD ANEMIA (Hb 10 – 10.9 gm/dl) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE
  91. 91. Children 6 – 60 months • MODERATE ANEMIA (Hb 7 – 9.9 gm/dl) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE
  92. 92. Children 6 – 60 months • SEVERE ANEMIA (Hb < 7 ) Refer urgently to DH/FRU DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE
  93. 93. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS HISTORY TO BE TAKEN FOR Duration of symptoms Usual diet (before current illness) Family circumstances Prolonged fever Worm infestation Bleeding from any site Any lumps in the body 93
  94. 94. EXAMINATION FOR Severe palmar pallor Skin bleeds Lymphadenopathy Hepato splenomegaly Signs of heart failure DR.HARIVANSH CHOPRA MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS
  95. 95. Investigations Indication for blood transfusion Blood transfusion • Full blood count and examination of a thin film for cell morphology • Blood films for malaria parasites • Stool Examination for ova, cyst, and occult blood  All children with Hb ≤4gm/dl  Children with Hb 4-6 gm/dl with any of the following :  Dehydration  Shock  Impaired Consciousness  Heart Failure  Deep and labored Breathing  Very high parasitemia If packed cells are available, give 10ml/kg over 3-4 hours preferably. If not, give whole blood 20ml/kg over 3-4 hours 95
  96. 96. DOSE OF IFA SYRUP FOR ANEMIC CHILDREN 6 MONTHS – 5 YEARS AGE OF CHILD DOSE FREQUENCY 6 months – 12 months (6-10 kg) 1 ml of IFA syrup Once a day 1 year – 3 years (10 – 14 kg) 1.5 ml of IFA syrup Once a day 3 years – 5 years (14 – 19 kg) 2 ml of IFA syrup Once a day 96
  97. 97. SUPPLEMENTATION Tablets of 45mg elemental iron and 400mcg of folic acid DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS
  98. 98. • MILD ANEMIA (Hb 11 – 11.9 gm/dl) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS
  99. 99. • MODERATE ANEMIA (Hb 8 – 10.9 gm/dl) 3mg of iron/Kg/day for 2 months In case the child has not responded to treatment of anemia for 2 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS
  100. 100. • SEVERE ANEMIA (Hb < 8 gm/dl ) Refer urgently to DH/FRU DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE CHILDREN 5 – 10 YEARS
  101. 101. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 5 – 10 YEARS HISTORY TO BE TAKEN FOR Duration of symptoms Usual diet (before current illness) Family circumstances Prolonged fever Worm infestation Bleeding from any site Any lumps in the body 101
  102. 102. EXAMINATION FOR Severe palmar pallor Skin bleeds Lymphadenopathy Hepato splenomegaly Signs of heart failure DR.HARIVANSH CHOPRA MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN CHILDREN 5 – 10 YEARS
  103. 103. Investigations Indication for blood transfusion Blood transfusion • Full blood count and examination of a thin film for cell morphology • Blood films for malaria parasites • Stool Examination for ova, cyst, and occult blood  All children with Hb ≤4gm/dl  Children with Hb 4-6 gm/dl with any of the following :  Dehydration  Shock  Impaired Consciousness  Heart Failure  Deep and labored Breathing  Very high parasitemia If packed cells are available, give 10ml/kg over 3-4 hours preferably. If not, give whole blood 20ml/kg over 3-4 hours 103
  104. 104. ADOLESCENTS 10 – 19 YEARS 104
  105. 105. SUPPLEMENTATION 100mg elemental Iron and 500mcg folic acid DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS
  106. 106. • MILD ANEMIA (Hb 11 – 11.9 gm/dl) 60mg of iron/day for 3months In case the child has not responded to treatment of anemia for 3 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS
  107. 107. • MODERATE ANEMIA (Hb 8 – 10.9 gm/dl) 60 mg of iron/day for 3 months In case the child has not responded to treatment of anemia for 3 months, refer the child to the FRU/DH with F-IMNCI trained MO/Pediatrician/Physician for further investigation DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS
  108. 108. • SEVERE ANEMIA (Hb < 8 gm/dl ) Refer urgently to DH/FRU DR.HARIVANSH CHOPRA THERAPEUTIC APPROACH THROUGH THE LIFE CYCLE ADOLESCENTS 10 – 19 YEARS
  109. 109. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN ADOLESCENT HISTORY TO BE TAKEN FOR Duration of symptoms Usual diet (before current illness) Family circumstances Prolonged fever Worm infestation Bleeding from any site Any lumps in the body 109
  110. 110. EXAMINATION FOR Severe palmar pallor Skin bleeds Lymphadenopathy Hepato splenomegaly Signs of heart failure DR.HARIVANSH CHOPRA MANAGEMENT OF SEVERE ANEMIA AT FRU/DH (as per F-IMNCI) IN ADOLESCENT
  111. 111. Investigations Indication for blood transfusion Blood transfusion • Full blood count and examination of a thin film for cell morphology • Blood films for malaria parasites • Stool Examination for ova, cyst, and occult blood  All children with Hb ≤4gm/dl  Children with Hb 4-6 gm/dl with any of the following :  Dehydration  Shock  Impaired Consciousness  Heart Failure  Deep and labored Breathing  Very high parasitemia If packed cells are available, give 10ml/kg over 3-4 hours preferably. If not, give whole blood 20ml/kg over 3-4 hours 111
  112. 112. PREGNANT AND LACTATING WOMEN 112
  113. 113. • Hb level 9 – 11gm/dl • IFA tablets 100mg iron and 500 mcg folic acid • 2 IFA tablets per day for at least 100 days 2 IFA tablets Hb estimation monthly If stores do not improve: Referral DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN
  114. 114. • Hb 8 – 9 mg/dl Cause of IDA must be investigated • 2 tablet IFA to be given daily DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN 2 IFA tablets Hb estimation monthly If stores do not improve: Referral
  115. 115. • Hb 7 – 8 mg / dl • Before starting the treatment, the women should be investigated to detect the cause of anemia • Injectable IM preparations DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN
  116. 116. • Hb 5 – 7 mg / dl • Continue Parenteral iron therapy as for Hb level between 7-8mg/dl. • Hb testing to be done after 8 weeks Parenteral iron Hb estimation at 8 weeks Hb 9-11 2 tablets / day DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN
  117. 117. • Hb < 5 gm /dl • injectable IV sucrose preparations • Immediate Hospitalization irrespective of period of gestation in hospitals for blood transfusion DR.HARIVANSH CHOPRA PREGNANT AND LACTATING WOMEN
  118. 118. 118 LEVEL OF Hb TREATMENT FOLLOW UP REFERRAL MILD ANEMIA (11 -11.9 gm/dl) 60mg of elemental iron daily for 3 months Follow up every month Hb estimation after completing 3 months of treatment to assess if Hb estimates are >12 gm/dl In case the child has no improvement in Hb levels after 3 months of treatment, adolescent will be referred to DH/FRU for further investigation MODERATE ANEMIA (8 – 10.9 gm/dl) 60mg of elemental iron daily for 3 months Investigation Follow up every month Hb estimation after completing 3 months of treatment to assess if Hb estimates are >12 gm/dl In case the child has no improvement in Hb levels after 3 months of treatment, adolescent will be referred to DH/FRU for further investigation SEVERE ANEMIA (<7gm/dl) Refer urgently to DH/FRU Severely Anaemic adolescents would be line listed by ANM
  119. 119. DR.HARIVANSH CHOPRA Prevention of iron deficiency can be achieved by following measures : Dietary changes Fortification of foods Supplementation PREVENTION
  120. 120. DR.HARIVANSH CHOPRA Iron Supplementation v/s Iron Therapy – Cost Iron Supplementation, 30 Iron Therapy, 70
  121. 121. DR.HARIVANSH CHOPRA PREVENTION Infection control Research & monitoring Programme implementation.
  122. 122. DR.HARIVANSH CHOPRA •Launched in 1970 to prevent nutritional anaemia in mother & children. •This program is now a part of RCH II program. NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAM
  123. 123. DR.HARIVANSH CHOPRA NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAM • Under this program, prophylactic treatment for expected and nursing mothers are given one tablet containing 100 mg elementary iron and 0.5 mg folic acid.
  124. 124. DR.HARIVANSH CHOPRA NATIONAL NUTRITIONAL ANAEMIA PROPHYLAXIS PROGRAM • Children are given one tablet containing 20mg elemental iron and 0.1 mg folic acid for a period of 100 days. • For therapeutic purpose, number of tablets is increased to 2 daily.
  125. 125. NATIONAL IRON + INITIATIVE Launched to bring existing Programmes together and establish new age groups 125
  126. 126. Bi weekly iron supplementation for pre school children 6 months to 5 years DR.HARIVANSH CHOPRA Weekly Supplementation for children from 1st to 5th grade in Govt. and Govt. aided school NATIONAL IRON + INITIATIVE
  127. 127. Weekly supplementation for out of school children (5 – 10 years) at Anganwadi Centers. DR.HARIVANSH CHOPRA Weekly Supplementation for adolescents (10 – 19 years) NATIONAL IRON + INITIATIVE
  128. 128. Pregnant and lactating women DR.HARIVANSH CHOPRA Weekly Supplementation for women in reproductive age NATIONAL IRON + INITIATIVE
  129. 129. LACK OF AWARENESS IN MASSES AND PERIPHERAL HEALTH WORKERS REGARDING ANAEMIA LACK OF STRATEGY TO REACH EVERY CHILD LACK OF STRATEGY TO SUPPLEMENT IRON FROM AGE OF 4 MONTHS LACK OF ADEQUATE SUPPLY OF IRON SYRUPS AND DROPS FAILURE TO ADDRESS SOCIAL FACTORS RELATED TO HIGH FERTILITY AND MORE STRESS ON POPULATION CONTROL
  130. 130. DR.HARIVANSH CHOPRA CONCLUSION Iron deficiency is the commonest deficiency disorder. If not treated in time, it results in mortality in the vulnerable period of life. Despite having a technically good programme for its prevention, cost effective supplementation is still not implemented..!!
  131. 131. DR.HARIVANSH CHOPRA • Normal requirement of iron in children is- 1. 0.1mg/kg/day 2. 0.5mg/kg/day 3. 1mg/kg/day 4. 5mg/kg/day ANS. 3
  132. 132. DR.HARIVANSH CHOPRA • The prevalence of anaemia in pregnancy in India is – 1. 10-20% 2. 20-30% 3. 30-40% 4. 40-50% ANS. 4
  133. 133. DR.HARIVANSH CHOPRA • WHO Cut off point for diagnosis of anaemia for children (6month- 6year) is : 1) 11g/dl 2) 12g/dl 3) 13g/dl 4) 10g/dl ANS. 1
  134. 134. DR.HARIVANSH CHOPRA • Normal serum iron level is : 1. 30-80 µg/dl 2. 80-180 µg/dl 3. 150-250 µg/dl 4. 250-450 µg/dl ANS. 2
  135. 135. DR.HARIVANSH CHOPRA • The content of a tablet used for prevention of Nutritional Anaemia in Pregnant female is : 1. 50mg iron, 0.1mg folic acid 2. 50mg iron, 0.5mg folic acid 3. 100mg iron, 0.1mg folic acid 4. 100mg iron, 0.5mg folic acid ANS. 4
  136. 136. DR.HARIVANSH CHOPRA

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