Iron deficiency anemia

1. Dr Shubham Upadhyay
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© Medi - Lectures Dr Shubham Upadhyay

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© Medi - Lectures Dr Shubham Upadhyay

3. CONTENTS
• Hypoproliferative Anemia
• Iron Metabolism
• Iron Cycle
• Nutritional Iron Balance
• Iron Deficiency Anemia
• Stages of Iron Deficiency
• Causes
• Clinical Presentation
• Laboratory Studies
• Differential Diagnosis
• Treatment
• Red Cell Transfusion
• Oral Iron Therapy
• Parenteral Iron Therapy
• Other Hypoproliferative Anemia
• Anemia of Acute and Chronic
Inflammation/Infection
• Anemia of Chronic Kideney
Disease (CKD)
• Anemia in Hypometabolic States
• Endocrine Deficiency States
• Protein Starvation
• Anemia in Liver Disease
• Anemia in Aging
• Treatment
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© Medi - Lectures Dr Shubham Upadhyay

4. HYPOPROLIFERATIVE ANEMIA
• NCNC red cells
• Inappropriately loe reticulocyte
response (RPI < 2.5)
• MC anemia out of which Fe
deficiency is the MCC f/b anemia
of inflammation
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© Medi - Lectures Dr Shubham Upadhyay

5. IRON METABOLISM
• Major role : Carry O2
• Present in:
• Hemoglobin
• Myoglobin in muscles
• Enzymes including Cytochrome system in Mitochondria
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© Medi - Lectures Dr Shubham Upadhyay

6. IRON CYCLE IN HUMANS
• Transferrin (Iron Transport Protein)
• Transferrin Receptors
• Clathrin Coated Pits
• Apoferritin -> Ferritin
• Reticuloendothelial System
• Daily Requirements
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© Medi - Lectures Dr Shubham Upadhyay

7. NUTRITIONAL IRON BALANCE
• Route of Iron Loss
• Route of Iron Intake
• Iron Bioavailability
• ↑ Demand
• Iron Absorption
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© Medi - Lectures Dr Shubham Upadhyay

8. IRON DEFICIENCY ANEMIA
• Most prevalent form of malnutrition
• 50% anemia is due to Iron Deficiency Anemia
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9. STAGES OF IRON DEFICIENCY
1. Negative Iron Balance
2. Iron Deficient Erythropoesis
3. Iron Deficiency Anemia
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10. Laboratory Studies in the Evolution of Iron Deficiency 10
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11. CAUSES OF IRON DEFICIENCY
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12. CLINICAL PRESENTATION
• “A cardinal rule is that the appearance of iron deficiency in an adult
male or post-menopausal female means gastrointestinal blood loss
until proven otherwise.”
• Usual Signs & Symptoms of anemia
• Cheilosis
• Koilonychia
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© Medi - Lectures Dr Shubham Upadhyay

13. LABORATORY STUDIES
• S. Iron & TIBC
• S. Ferritin
• Bone Marrow Iron Stores
• Red Cell Protoporphyrin Levels
• s. Levels of Transferrin Receptor
protein
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14. DIFFERENTIAL DIAGNOSIS
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15. TREATMENT
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16. RED CELL TRANSFUSION
• Reserved for individuals:
Symptoms of Anemia
Cardiovascular Instablility
Continued & Excessive Blood Loss
• Advantage:
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© Medi - Lectures Dr Shubham Upadhyay

17. ORAL IRON THERAPY
• Asymptomatic pt of Fe deficiency
Anemia with intact GI tract
• Dose: 200 mg elemental Fe per day
• Empty Stomach
• Goal of therapy
• Complications:
• Reticulocyte Response
• Iron Tolerance Test
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© Medi - Lectures Dr Shubham Upadhyay

18. PARENTERAL IRON THERAPY
• Given in:
• Unable to tolerate
• Acute needs
• Persistent GI or Menstrual blood loss
• Old vs New Formulations
• Used in two ways
• Dose
• Anaphylaxis 18
© Medi - Lectures Dr Shubham Upadhyay

19. OTHER HYPOPROLIFERATIVE ANEMIAS
• Other than Fe Deficiency, these are
1. Chronic Inflammation
2. Renal Disease
3. Hypometabolic States (Endocrine & Nutritional Deficiencies)
4. Marrow Damage
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21. ANEMIA OF INFLAMMATION/INFECTION
Suppression of Erythropoesis by Inflammatory Cytokines
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22. ANEMIA OF CKD
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23. ANEMIA IN HYPOMETABOLIC STATES
• Endocrine Deficiency States
• Protein Starvation
• Anemia in Liver Disease
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24. TREATMENT OF HYPOPROLIFERATIVE ANEMIA
• Transfusions
• Erythropoetin
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© Medi - Lectures Dr Shubham Upadhyay