iron deficiency anemia

1. Classification of Anaemia
•
Anaemia may be subdivided into two
broad categories of underlying
pathology:
•
Increased loss: Haemorrhagic
Anaemia
•
Increased rate of destruction of red
blood cells: haemolytic Anaemia
•
Reduced production of red blood cells,
With hypercellular bone marrow,
dyserythropoietic anaemia (IDA &MA)
With hypocellular bone marrow,

2. Iron deficiency anemia

3. Blood Smear Interpretation

4. Normal blood picture

5. Iron stain

6. Blood film, high concentration

7. Blood film, low concentration

8. Iron deficiency is defined as a
decreased total iron body
content. Iron deficiency anemia
occurs when iron deficiency is
sufficiently severe to diminish
erythropoiesis and cause the
development of anemia. Iron
deficiency is the most prevalent
single deficiency state on a
worldwide basis

9. •
Iron is vital for all living
organisms because it is essential
for multiple metabolic processes,
including oxygen transport, DNA
synthesis, and electron transport.
Iron equilibrium in the body is
regulated carefully to ensure that
sufficient iron is absorbed in
order to compensate for body
losses of iron.

10. •
Iron balance is achieved largely
by regulation of iron absorption
in the proximal small intestine.
•
Factors that enhance iron
absorption. Facilitators: ascorbate,
citrate, amino acids, iron deficiency

11. •
Factors that prevent iron
absorption.
•
Inhibitors: , tannins, iron
overload, antacids
•
Daily requirement in different
situations, children and adults
•
increased in children and
pregnant women. Normal intake
in adult males.

12. Causes of iron deficiency
•
Either diminished absorbable
dietary iron or excessive loss
of body iron can cause iron
deficiency. Diminished
absorption usually is due to
an insufficient intake of
dietary iron in an absorbable
form, so causes include:
•
Dietary causes specially in
under developed countries.
•
Then blood loss

13. •
Common in premenpausal women,
i.e. gynecologic causes.(4 - 8% have
IDA)
•
In men and menopausal women, the
gastrointestinal tract bleeding is
source of anemia e.g. PU, tumors,
varices plus parasites such as hook
worms, schistosomes.. etc . Others
•
Malabsorption of iron
•
Increase requirement such as in
growing children and pregnancy.

14. Schistosomes & Eggs

15. iron deficiency anemia

16. iron deficiency anemia

17. iron deficiency anemia

18. iron deficiency anemia

19. Distinct microcytosis (compare with size of the
lymphocyte). Some of erythrocytes are hypochromic. A
few pencil shaped cells are seen

20. iron deficiency anemia

21. The arrow shows elongated pencil - like cell

22. The arrow shows elongated pencil - like cell

23. severe iron deficiency anemia

24. •
Bone marrow is hypercellular with partial reduction of
fat amount, erythropoiesis is increased. Numerous
megakaryocytes are present
.

25. The majority of the bone marrow cells belong
to the erythroid cell series. Erythroblasts are
small and have faint and irregularly stained
cytoplasm. The white cell series are normal

26. •
The arrow shows brighter area (what correspond
to smaller amount of hemoglobin) of cytoplasm
of the polychromatophilic erythroblast

27. Iron stain

28. •
marrow particle stained for detection of free iron
shows no trace of the element
.

29. Iron stain, depleted stores

30. Iron stain, depleted stores

31. Iron deficient Dual population treated

32. Diagnosis
•
History and clinical examination of the patient,
specially dietary history
•
Peripheral blood picture, hypochromic microcytic
anemia
•
Measurement of
•
Serum iron
•
Serum ferritin
Normal blood levels are 30-300 ng/mL for males and 15-
200 ng/mL for females
•
Stainable iron in bone marrow
•
total iron-binding capacity

33. Serum Iron (SI)
•
Men: 65 to 176 µg/ dL
•
Women: 50 to 170 µg/ dL
•
Newborns: 100 to 250 µg/ dL
•
Children: 50 to 120 µg/ dL
•
:
µg/ dL
TIBC:240-450

34. CBC, iron deficiency anemia. Microcytosis is indicated by the low MCV.
Hypochromia correlates here with the low MCH.

35. Clinical features
anemia
The most common symptoms of
anemia are pallor, fatigue and
dyspnea

36. koilonychia

37. koilonychia

38. koilonychia

39. Angular cheilitis

40. Angular cheilitis

41. Iron deficiency double population, treated