anemia is preventable........

1. Dr. Rabi Narayan Satpathy
Asst. professor
Dept. of Obst. & gynaecology
SCB MEDICAL College, Cuttack
Mob-09861281510

2. Major Public Health Problem
Most Preventable Cause
Still the Leading Cause

3. Developing Countries:
World
9 out of 11 pt are anemic.
population: 5-6 billion
Every second preg. Woman
2 billion anemic
4 out of 10 pre school
MAGNITUDE OF THE PROBLEM
India:
Highest prevalence
87% preg women
10% severe anemia
1 in 5 maternal deaths

4. ANNUAL MATERNAL DEATHS -
GLOBALLY TOTAL 500,000
India South Asia
Rest
South Asia Rest India
75% : Hemorrhage ; Abortion ; Eclampsia ;
Sepsis ; Obs. Labour.
ANAEMIA : Direct cause contributes 20%
Indirect cause further 20%

5. Fe++ Fe++
Fe++
Iron Metabolism – Fe++ Fe++
The Concept
Fe++
Fe++
Fe++
Is it Very Confusing !!!

6. EXTERNAL IRON EXCHANGE
Non-haem Iron Haem Iron
Inorganic Organic
Inhibitors
•Phytates.
Fascilitators Efficient
•Tannin. independent of
•Ascorbate
•Antacid duodenal pH
•Gastric pH •P-pump inhibitors
•Citrate
Competitors
•AA •Pb.
•Mn.
•Zn.
C
Luminal Cell of Duodenum & C
Fe++
Jejunum
Ferrous
More soluble Ferritin
Acidic duodenal pH
PLASMA TRANSFERIN

7. Normal men 1 mg/day
Menstruating females 2 mg/day
Pregnant women 4.8 mg/day
Adolescent 1-2 mg/day

8. INTERNAL IRON EXCHANGE
(IRON CYCLE)
Bone marrow erythroid cells
RBC
Transferrin –
120 days
Iron Complex
R-E system
Transferrin Haemosiderin
receptor (Stable) can’t be
mobilized
Gut Liver
Ferritin

10.  Demand by fetus
 Net utilisation is 800 mg
 Twin.
Iron
Absorption
Increase << 

Bioavailability of iron is
decreased.
Inadequate calorie
intake < 2,000 Kcal/day.
 Increase in plasma &
RBC volume.

11.  Age group < 20 yrs.
 Low SE status.
 Literacy.
 Parity > 2.
 Sparing 2 yrs.
 Malnutrition.
 Vegetarian diet – mostly cereal & pulse.
 Worm infestation.
 Unemployment of women, poverty.

12. Nutritional Blood loss
 Fe.  Acute.
 Folic.  Abortion.
 B12.  Ectopic.
 Combined.  Molar.
 Abruptio
 Previa.
 Coagulopathies.
 Chronic.
 Hookworm.

13. Causes Contd…..
Hemolytic anemias Aplastic Anemias/
Hypoplastic
 Congenital.  Chronic systemic
 Hemoglobinopathies. disease.
 Thalassemia.  Bone marrow
 Sickle cell anemia. depression.
 Acquired.  Renal disease.
 Malaria.  Endocrine disorder.
 Autoimmune disease.
 Malignancy.
 Viral infection.

14. Reliable, Cost effective,
Easy Indicator of Anemia
WHO standardisation of Anemia
g/dl g/l PCV
Mild < 11 < 110
Moderate 6.5-8 70-109 24-37
Severe < 6.5 40-69 13-23
Very severe <4 < 40 < 13

15. Decrease Hb Anemia
Story Behind
Negative Iron Balance.
Iron deficient erythropoiesis.
Iron Deficiency Anemia (IDA).

16. Normal Negative Iron deficient Iron deficiency
iron balance erythropoiesis anemia
BM Iron
Stores
Hb%
S. Ferritin
50-200
( g/l) <15
TIBC
300-360 > 400
( g/dl)
S. Iron
50-150 N
( g/dl)
Saturation
30-50 N
(%)
RBC
N
protophyrin
RBC Microcytic
N N
morphology hypochromatic

17. Degree of Symptoms
Anemia
Mild Mod Irritabilit
y
Fatigue
Severe
Weaknes
Dizziness s

19. Vulnerable Groups Problems
Maximum Iron required
Infant (4-24m)
equivalent to adult dose
Worm infestation, UTI,
Growing girl child epistaxis, pelvic infection,
chronic malaria, tuberculosis
Puberty menorrhagia,
Adolescent girl
infection, malnutrition

20. Diet.
Fortification.
Social factors.
Infection control.

21. Non-haem Iron
Haem Iron Egg
Organ meats. Diary products.
Poultry. Dried beans, peas.
Fish. Dark green leafy
Oysters. vegetables
Beef. (spinach, mustard
Pork. greens).
 People who are iron deficientsesame seeds
Nuts & absorbs 10
times more than normal subjects.
 Vit. C → Citrus fruits, lemon, tomatoes.
 Cooking in cast iron pans & utensils.

22.  Iron fortification of:
 Cereals.
 Bread.
 Pasta.
 Double fortification of salt.
 Iodine & Iron.
 Food vehicles.

23. Respect to girl child.
Education of girl child.
Equal rights.
Mid-day meal programmes.
Personal hygiene.
Marriage after 18.
Safe abortion.
Worm infestation.
Malaria.

24. National Nutritional Anemia Prophylaxis
Programme (NNAPP)
Aims at
Universal Oral Iron Supplementation of
All Pregnant Women
60 mg/ 100 mg/ 120 mg
As Recommended by WHO & implemented by GOI
100 mg of Iron x 100 days

25. 1st trimester 2nd trimester 3rd trimester
< 11 g/dl 9 – 11 g/dl
200 mg 200 mg
Elemental Iron Elemental Iron
Reassessment Monitoring
on 2nd & 3rd Maintenance
Therapy
< 9 g/dl
Lab. Test: CBC (PS), Iron Studies, BM studies,
Opinion of Hematologist
IDA: 200 mg Elemental Iron
Monitoring

26. IUGR CCF
PIH INFECTION
IUD IUH
Medical PRETERM
Disorder LABOUR

27. Supplement Forms
Elemental Iron
 Ferrous salts 60 mg
(Sulphate, Ascorbate, Citrate,
Lactate, Carbonate)
 Ferrous fumarate 65 mg
 Ferrous gluconate 36 mg
 Sustained release 105 mg
 Polysaccharide iron complex
 Carbonyl iron

28. Iron & Ascorbic Acid.
Vit. C enhances the absorption of iron.
Fewer side effects.
Better tolerated.
Good bioavailability.

29. Small Iron Particles - 5 m
Ferric hydroxide
polymaltose complex. Slow absorption.
Expensive. Good bioavailability
Bioavailability Least GI side effect
controversial. Environment stability.
Seems to be promising in
rise of Hb status.

30. PROBLEMS WITH
ORAL IRON Gastric
irritation
Diarrhea
Constipation
Free Radical
Generation

31. If a child consumes 3 adult iron tablets,
acute fatal iron poisoning can occur.

32. Highly controversial.
High side effects & adverse reaction.
Should have hematology consultation.
I.V. (TDI) / I.M.
Iron Dextran (Imferon)
 Recent:
 IV Sodium ferric gluconate.
 Iron sucrose.
 Used with recombinant erythropoietin therapy.

33. ??? to raise Hb in last trimester
 Acute blood loss.
 Preparation of cesarean.
 Obstetric complications.

34.  Requirement: 400 g/day
 Rich source:
 Megaloblastic anemia.
 Diary products.
 S. folate.
 RBC folate  Animal products.
 Macrocytosis.  Egg.
 Rich in:  Fish oil.
 Bananas, fruits, green leafy  RDA – 2.4 g/day.
vegetable, yeast.
 Periconception, pregnancy,
lactation.

35. It is paradoxical but true,
that anaemia is
preventable condition,
however due to its
multifactoral origin we
could not conquer it and
even today it remains one
of the major cause of
maternal mortality.

36. DREAMING
PREGNANT WOMAN
FREE OF
NUTRITIONAL ANEMIA
Keep the lamp of knowledge burning to achieve
the vision. Only the vision will ignite the billion
souls. Ignited soul is the most powerful resource
making dream to reality.
A. P. J. Abdul Kalam