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5. Iron deficiency anemia (1).ppt66666666
1.
2. Iron Deficiency Anemia
One of the most common medical problems
Most common cause of anemia
Iron deficiency anemia is the last step ;
Iron depletion: absent or decreased iron stores
Iron deficiency: depletion of stores + low serum iron and
ferritin
Iron deficiency anemia: Anemia developing in an iron
deficient patient
4. Iron Metabolism
Iron is located at the center of Hem molecules
of Hb (amount:1.5-2 gr)
and it is also;
Part of the myoglobin
Takes place in the tissue enzymes
Storage forms are
Ferritin
Hemosiderin
Location: Bone Marrow, Liver, Spleen
Transport iron is by transferrin.
5. Iron Metabolism
Transferrin picks up iron from ;
1. The GI cells to deliver it to Hb forming cells
2. Storage parts as a step of iron recycling process
Absorbtion + recycling provides the constant iron
supply of 1-2 mg/day necessary for Hb synthesis
7. Iron Metabolism
Iron absorbtion is restricted to the needs of the body
1mg of iron is lost each day
Menstruation and pregnancy/lactation are other major
causes of iron loss and incresed demand in women
8. Iron Metabolism
Normal diet contains about 14 mg of iron/day
1/10 of ingested iron is absorbed
Gastric acid releases iron from food
Iron is absorbed in the reduced form
Ascorbate increases absorbtion (by reducing)
Phytates,phosphates , Tea, infection,,antacids
decrease absorbtion by making complexes with
iron
9. Iron Metabolism
Main sites of absorbtion are;
Duodenum
Upper jejunum
Malabsorbtive states or gastrojejunostomy prevent
absorbtion.
10. Iron Metabolism
Transport of iron
Transferrin is the main iron carrier in plasma
It is produced in liver cells with increased synthesis in
iron deficiency
Transferrin binds 1-2 ferric iron molecules
Transferrin-iron complex is endocytosed by Hb
producing cells after linking to receptors.
11. Iron Metabolism
Total iron binding capacity and iron
Transferrin is measured by quantifying the iron binding
sites available
This is also called “Total iron binding capacity”
TIBC is 1/3 saturated under normal conditions
12. Causes of iron deficiency
Chronic blood loss
Increased demand
Malabsorbtion of iron
Inadequate iron intake
Intravascular hemolysis and hemoglobinuria-
hemosiderinuria
Combinations
14. Decreased intake
Decreased iron in the diet
Vegetarianism
Decreased absorbtion
Gastric surgery
Sprue
Pica
15. Increased iron loss
Menorrhagia
GIS hemorrhagia
•Colitis or imf. Bovel
disease
•Hemorrhoids
•NSAID use
•Parasites
•P.Ulcer
•Oesophagitis
•Varices
•Malignancy
16. Increased iron loss
Bleeding disorder
Pulmonary lesions with bleeding
Hemoglobinuria – hemosiderinuria (chronic
intravascular hemolysis)
Hematuria (chronic)
Frequent donation
250 mg iron /unit-blood
17. Clinical features
General symptoms of anemia
Fatigue may be disproportional to the degree of
anemia due to deficiency of tissue enzymes which
also need iron
Glossitis
Angular stomatitis
Paterson-Kelly (Plummer Vinson) syndrome
(oesephageal web leading to disphagia)
23. Differential diagnosis
Microcytic anemias
Iron deficiency anemia
Thalassemia ,HbC,HbE etc
Sideroblastic anemia
Lead poisoning
Anemia of chronic diseases (sometimes)
24. Important !!!!!!!
The diagnostic procedure is not complete until the
underlying pathology is disclosed.
25. Treatment
Replace iron and treat underlying disease.
Oral route is preferred for replacement.
Response can be followed by retic. increase in 1-2
weeks (5-7 days)
Hb response to treatment
half normal by a month
returns to normal by 2-4 months
Replacement therapy is prolonged by 6-12 months
to replenish stores of iron.
Ongoing bleeding may cause indefinite therapy.
27. Treatment
Oral iron therapy:
Total daily dose:150-200 mg elemental iron
Give in 3-4 divided doses,
Each one hour before meals.
Do not prefer enteric coated forms.
In case of GIS intolerance;
Change the route of administration or
Change the preparation or
Reduce dose
28. Treatment
Non responding patient:
possible causes
Misdiagnosis
Patient does not take the medicine
Continuing blood loss
Malabsorbtion
Change the drug
Change the route of administration
Underlying disease /comorbidity
Combined deficiency
29. Treatment
Parenteral iron therapy:
Routine use is not justified,
Response is not faster than oral replacement.
Indications
Malabsorbtion
Intolerance to oral replacement
Colitis/enteritis
Needs in excess of amount that can be given orally
Patient uncooperative/poor compliance
Autologous blood donation setting
Hemodialysis
30. Treatment
Parenteral iron therapy:
Total iron dose: (15-patient Hb) x bw x 3
– Iron Dextran: 50 mg/ml (iv/im)
Max daily dose is 100 mg im
– Ferric gluconate:
A test dose of 25 mg elemental iron (2 mL) must be
given in 50 mL saline over 60 minutes
– Ferric-hydroxy-sucrose (100 mg/5mL)
– 2.5 ml first day
– 5ml third day
– 2x5 ml/week
31. Parenteral replacement therapy may cause
allergic reactions,
local pain or induration,
serum sickness like disease,
lymphadenomegaly,
arthralgia,
myalgia etc.
Treatment