A presentation describing the prevalence and management of anemia in women.

1. Summary
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2. Anemia in Women
Dr/ Mahmoud Abdel-Aleem
Professor of Obstetrics and Gynecology

3. Thanks
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For
the invitation
For
the awareness
For
the collaboration

4. I declare no conflict of
interest
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5. • Hb levels below 2SD of the mean for Hb in a
normal population of the same gender and age
who are living at the same altitude WHO (<11
gm/dL).
• It is the commonest blood disorder in women.
• Anemia begins in childhood, worsens during
adolescence in girls and gets aggravated during
pregnancy
• There is low oxygen-carrying ability, causing
unusual complications during life time.
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6. Agenda
• Importance of the subject.
• Iron deficiency and iron deficiency anemia.
• Prevention of iron deficiency anemia.
• Treatment: Modern iron replacement therapy.

7.  Anemia Prevalence: global and local
 Target 2025
 Complications.
 The Age of Iron.
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Importance of the
subject

8. I. Prevalence
of iron
deficiency
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43% of children: 273 million
38% of pregnant women: 32 million pregnant
29% of nonpregnant women: 496 million
29% of all women of reproductive age

9. Egypt
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Whole
Population

10. Children
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11. All Women
Pregnant
Women
Non-
Pregnant
Women
1. Faulty dietary habit.
2. Faulty absorption mechanism.
3. More iron loss due to sweating and
repeated pregnancy at short
interval.
4. Prolonged period of lactation.
5. Excess demand of iron.
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12. The good news: we are
moving forward !!!
The 2014 EDHS
• There is a sizable decline from the 2005
EDHS when 39% of ever-married
women tested positive for anemia.
• 25% of ever-married women are
anemic.
• Anemia in children is most common
among in children age 9-11 months
(49%).
• Older children are slightly less likely to
be anemic.
• 21% of female children age 5-19 are
anemic in Egypt, and almost all of these
are mild cases.
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13. 3/6/2020
Children
29
30
31
32
33
34
35
36
37
38
2009 2010 2011 2012 2013 2014 2015 2016
Prevalence of anemia in Children 5 years_ Egypt
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14. Prevalence of anemia in Pregnant
women
26.97
26.2
25.46
24.73
24.02
23.37
22.91
22.6
20
21
22
23
24
25
26
27
28
2009 2010 2011 2012 2013 2014 2015 2016
Prevalence of anemia in Pregnant women_Egypt
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Prevalence
of anemia
in Non-
Pregnant
women

16. II. 2025
Targets
Reducing anaemia is the 2nd global nutrition target for 2025 calls for a 50% reduction
of anaemia in women of reproductive age.
If the current trends are maintained, the chance of achieving this goal is < 25%.
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17. III.
Complicatio
ns of
anemia
Pregnancy-related
• Maternal mortality:
• 20 % (direct cause).
• 20-40% (indirect cause).
• Fetal loss and perinatal
deaths.
• Hb < 8 gm/dL: 2-3 folds.
• Hb < 5.0 g/dl : 8-10 fold.
• Increased PTB (28%).
• Increased PET (31%).
• Increased maternal sepsis.
Non-pregnancy related
• Disturbed Thyroid function
• Increased heavy metal
absorption.
• Impaired Mental development
• Economic Implications and
effect on human capital
development.
• Effect on sexual function.
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18. IV. The
golden age
of iron
The need for Iron
The Progress in Iron
• The need !!!!
• Iron is crucial to biologic functions, including
respiration, energy production, DNA synthesis, and
cell proliferation.
• RBCs = 84% (24.9 / 30 trillions) of total cells (the
most numerous cells of the human body).
• Production rate: 2.4 millions/ second =
• 1-2 mg/day (intake)
• 20–25 mg/day (recycling by macrophages).
• The progress !!!:
• Enormous progress in understanding iron
homeostasis.
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HIGH Hepcidin levels:
1- inflammations.
2- Men > women.
3- Post-menopausal women.
LOW levels:
1- Girls and young women

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Iron deficiency
&
Iron deficiency
anemia
1
2
3
4

21. Iron deficiency
Without
anemia
Iron deficiency
anemia
I
R
O
N
Deficiency
No mobilizable iron
stores and in which
signs of a low
supply of iron to
tissues is present
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22. Iron
deficienc
y
without
anemia
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Neurocognitive symptoms +/- Fatigue and poor physical performance.
+
Normal Hb
+
Low Ferritin
+
Exclusion of other causes of symptoms
• Intervention: Iron therapy to correct Ferritin levels and assess the symptoms. Then stop iron
therapy and re-assess the symptoms.

23. Determinants of ID and IDA

24. Diagnosis
Signs
• Pallor.
• Glossitis.
• Stomatitis.
• Edema legs.
• Soft systolic murmur in mitral
area.
Symptoms
• Lassitude.
• Feeling of exhaustion.
• Weakness.
• Anorexia.
• Indigestion.
• Palpitation.
• Swelling in the legs.
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Take care of the uncommon types of anemia.

26. 2 Major Recommendations
1- Uniform screening using serum ferritin is generally not recommended
except in areas with high prevalence of “at risk” women.
2- Serum Fe and TIBC and Transferrin levels are unreliable indicators of
availability of iron to the tissues because of wide fluctuation in levels.

27. Prevention and
Treatment of ID and IDA
3
0

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29. Prevention
Strategies
(Targets)
Reduce poverty
Improve access to diversified diets
Improve health services and sanitation
Promote better care and feeding
practices.
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30. Examples of
simple but
effective
alterations in
meal
patterns
AVOID: tea with food
EMPAHSIZE: Ascorbic acid
contacting food
ORGANIZE: Diary meals away
from main meals
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31. Modern
iron replacement therapy
3
4

32. The TWO cornerstones
Recognition and
management of the
underlying cause(s) is
mandatory.
Replenish the lost iron;
both the in-use and the
stored iron.
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33. Algorithm
for
Treatment

34. EBM
and strategies for
Anemia
prevention and
treatment

35. I- Iron In Children
2014
214 pages
177 comparisons
33 trials
13114 children (49% females)
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38. II. Iron Fortified
food and Children
2017
118 pages
55 comparisons
13 trials
5810 children (50% females)
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40. III. Iron and Young
adults
2019
133 pages
57 comparisons
25 trials
10996 women
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43. IV. Iron and
Pregnancy
• 2015
• 387 pages
• 352 comparisons
• 44 trials
• 43,274 women
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44. Maternal
outcome
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45. Fetal outcome
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46. V. Iron And
Postpartum anemia
• 2015
• 121 pages
• 108 comparisons
• 22 trials
• 2858 women
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Very deficient research in this area and No conclusions were drawn

47. A successful intervention
Iron supplementation would increase the mean
blood haemoglobin concentration by
8.0 g/L (95% CI: 5.0—11.0) in children.
10.2 g/L (95% CI: 6.1—14.2) in pregnant women.
8.6 g/L (95% CI: 3.9—13.4) in non-pregnant women
Iron supplementation can:
Cure 42% of anaemia in children.
Cure 50% of anaemia in women.
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48. I. Iron
Vs D.
Iron
The Great challenge
=
Reduce Adverse Effects
Iron
Vs
None

49. iron
Traditional
Iron salts
Modified iron
salts
Enteric coated
Sustained release
Microencapsulation
1:1
Amino acid
chelated
iron
1:2
Amino acid
chelated
iron
Development of Iron as an oral
therapy
17th century 21st century
1960s
Micronized
Iron for food
fortification
Compliance...Safety…Luxury…Efficacy
95%
Absorption
99%
Absorption

50. Parenteral
Iron
Therapy
Failure of oral therapy
Iron intolerance or with low iron levels
that are refractory to treatment Need for
quick recovery
Substitution for blood transfusions when
not accepted by patient for religious
reasons
Use of erythropoiesis-stimulating agents
in chronic kidney disease
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52. A changing paradigm and practice
From…..
• Womb-oriented
• Anemia oriented
• Detection of IDA (CBC)
• Treating IDA
• Waiting too late
• Elemental Iron
• Traditional iron salts.
To….
• XX-oriented
• Iron deficiency oriented
• Detection of ID (Ferritin)
• Treating iron deficiency
• Starting too early
• C.S.L.E. Iron
• Newer 2:1 chelated iron.
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53. Thank You
For
Your Kind Attention