Diagnosis of iron deficiency anemia

1. DIAGNOSIS OF IRON
DEFICIENCY ANEMIA
DR. GOVIND KENDRE
SETH G.S. MEDICAL COLLEGE& KEM HOSPITAL,
PAREL, MUMBAI

2. HISTORY
• Age
• Sex
• Socioeconomic strata
• Diet & personal history
• Developmental history
• History pointing towards probable etiology
• Treatment history & compliance

3. SYMPTOMS & SIGNS
• General symptoms
• Characteristic symptoms

4. CLINICAL EXAMINATION

5. CBC
• Hb & Hct
• RBC count
• MCV (<80fL/cell)
• MCH (<27pg/cell)
• MCHC(<33%)
• RDW(>15)
• TLC & differential (unchanged)
• Platelet count (>4.5lakh)
• Reticulocyte count

6. RBC COUNT
• Measured by laser light scatter methodology
• In IDA decreased in proportion with MCV
• MCV÷RBC >13

7. MCV
• Mean on histogram of RBC size distribution
• <80fl

8. RDW
• Coefficient of variation or SD of size distribution
• Quantifies degree of anisocytosis
• Normally <15%
• Increase with decrease in IDA & normal in thal & ACD

9. PERIPHERAL SMEAR
 Hypochromic microcytic picture
 Anisocytosis
 Pencil shaped poikilocytes
 Occasional Target cells

10. BONE MARROW EXAMINATION
 Cellularity variable
 RBC precursors increased
 Absent sideroblasts &
macrophage hemosiderin
by iron stain

11. INDICATORS OF IRON STATUS
• Sr. iron
• TIBC
• % saturation
• Sr. ferritin
• BM stainable iron

12. Sr iron
• Diurnal variation
• 50-150mcg/dl
• Always interpreted in combination with TIBC & Tr saturation

13. TIBC
• Indirect measure of transferrin concentration
• 200-400mg/dl

14. Tr Saturation
• Sr iron÷TIBC
• N Range 20-45%
• <20% suggest IDA
• >45% in Hemochromatosis

15. FERRITIN
• High molecular weight protein consists of 20% iron
• Serves as iron reserve in RE cells & hepatocytes
• Small amount present in serum reflect iron stores
• 45-340ng/dl
• In setting of inflammation value <100 suggest depleted iron stores
• <10 in severe IDA

16. NEWER MARKERS
• CHr
• sTfR
• Hepcidin
• ZPP

17. CHr
Realtime snapshot of iron directly available for Hb synthesis
By flow cytometry light scatter
N range (26-32pg)
<26 in iron deficient erythropoiesis
Response to EPO can be assesed
Little affected by inflammation

18. sTfR
Present on external surface of plasma membrane
Iron-transferrin complex binds to receptor
complex internalised & iron released
Proteolytic cleavage releases truncated sTfR
• Inverse relation to iron status
• Not an acute phase reactant
• N range 1.8-4.6 mg/L

19. HEPCIDIN
• Regulator of iron metabolism
• Binds to ferroportin & degrade it leading to decreased iron absorption
& export
• Decrease in IDA

20. DEVELOPMENTAL STAGES OF IRON
DEFICIENCY
• Iron depletion
• Iron deficiency
• IDA

21. IRON STATUS

22. ACD VS IDA

23. LAB PARAMETERS
Hb, Hct
MCV,MCH
Sr.iron,Ferritin,Transferrin sat.
Retic count
RDW
Platelet count
TIBC
TfR
FEP

24. IRIDA
• AR
• TMPRSS6 gene on chromosome 22 encoding serine protease
Metriptase2
• Metriptase 2 is a negative regulator of hepcidin
• Mutation leads to decreased activity of metriptase 2 with subsequent
increase in hepcidin which decrease iron absorption

25. Thank you