Iron deficiency Anaemia is the most common nutritional deficiency in the world. This presentation to learn about Iron deficiency Anaemia. Here I discuss causes, clinical features, lab diagnosis and treatment of Iron deficiency Anaemia. I think it will help those who want to know about IDA.
2. DEFINITION
Anaemia refer to a decrese in the total number of circulatory red cells with decrease in HB,PCV
below the previously established normal values , health person of same age group ,gender race,and
similar environmental conditions.
Its clinical diagnosis is made from the history , physical examination ,sign and symptoms ,HB values and
other procedures and findings
3.
4. IRON DEFICIENCY ANAEMIA(IDA)
Anaemia associated with inadequate absorption or excess loss of iron/blood
IDA is characterized by microcytic hypochromic red cells with MCV<80 fl and MCH <25pg.
Most common anaemia prevalence in world wide and in India
High risk group __ children , pregnant women and elderly persons
prevalence of IDA in children_ 25% -45%
prevalence of IDA in females_ 45%- 60%
IRON METABOLISM
ABSORPTION - DUODENUM AND UPPER JEJUNUM
TRANSFERRIN TRANSPORTS IRON TO THE CELLS
IRON STORAGE- FERRITIN AND HEMOSYDERIN
5. DAILY REQUIREMENT OF IRON
Diet should contain 10-15 mg of elementary iron and with approximately 8-10% absorbed
Daily net requirement of males- 1 mg
Daily net requirement of females – 1.5 mg
FACTORS PROMOTING IRON ABSORPTION
Hcl of stomach
Ascorbic acid
FACTORS HAMPERING IRON ABSORPTION
Phytates of cereals
Tannate of tea
Phosphate of diet and drugs
Milk
Small loss of iron each day in urine, faeces,skin and nails and in menstruating females as blood (1-2 mg daily)
6. CAUSES
1. Decreased supply
2. Impared absorption
3. Increased demand
4. Loss
1) DECREASED SUPPLY
a) Nutritional deficiency
b) Malabsorption
2) IMPARED ABSORPTION
Total or partial gastrectomy impairs iron absorption by decreasing Hcl and transit time through the
duodenum
3)INCREASED DEMAND
increased utalisation ,
a) pregnancy and lactation
b) Growth- growing infants ,childrens and adolescents
7. 4)LOSS
a) chronic blood loss - Gastro intestinal tract, urinary tract, genital tract and respiratory tract bleeding
b) Intravascular hemolysis – PNH, microangiopathic and hemolytic anaemia
CLINICAL FEATURES
CRACKS IN THE SIDE OF THE MOUTH
EXTREME FATIGUE (TIREDNESS)
CHEST PAIN
DIZZINESS / LIGHT HEADACHE
GLOSSITIS
Dysphagia( Plummer-Vinson syndrome)
ATROPIC GASTRITIS
PALE SKIN
SPOON SHAPED NAILS, KOILONYCHIA,
8. HAIR LOSS
BLUE SCLERAE
PICA (APETITE FOR NON FOOD SUBSTANCESSUCH AS AN ICE, CLAY)
ANGULAR STOMATITIS
IMMUNE FUNCTION
BEETURIA
SPLENOMEGALY (10%)
CONGENITAL HEART FAILURE
9.
10. LAB DIAGNOSIS OF IDA
1) Peripheral blood findings
2) Bone marrow examination
3) Iron state
PERIPHERAL BLOOD FINDINGS
a)Counting
HB-Decreased
PCV-Decreased
RBC- Normal
TLC-Normal
DC- Normal
Platelet- Increased
Red cell indices - MCV < 80fl
MCH< 25pg
MCHC< 27g/dl
RDW -Increased
Recticulocyte count-Normal or Increased
11. PERIPHERAL SMEAR EXAMINATION
RBC- Microcytic hypochromic anaemia with pencil/cigar shaped cells
Hypochromia- Central pallor being more than 1/3 rd
WBC- Normal size and shape
PLATELET- Increased in number and seen in groups
Severe anaemia – Central pallor 2/3 rd -3/4 th
12. BONE MARROW EXAMINATION
Bone marrow is hypercellular
Erythroid hyperplasia is present but is less as compared to the degree of anaemia .It varies from 2:1 to 1:2
Miconormoblastic reactions
Myelopoiesis and megakaryopoiesis is normal
Depletion of bone marrow iron-Prussion blue stain
Iron granules present in perls prussion blue stain
13. ASSESSMENT OF IRON STATE
S. Ferritin- <12 µg/L
S. Iron –reduced 10-15µg/dl
TIBC- reduced (350-450µg/dl)
Transferrin saturation- <16%
STRA- Increased
Red cell protoporphyrin- increased ( >200 g/dl)
Recticulocyte hemoglobin content – reduced
Erythrocyte zinc protoporphyrin – increased
DIFFERENTIAL DIAGNOSIS
Thalassemia major and minor
Anemia of chronic disorders
Sideroblastic anemia
Hb E thalassemia
Lead poisoning
14. TREATMENT
Before using iron medications check if you are allergic to any drugs or food dyes or if you have,
Iron overload syndrome
Hemolytic anemia (a lack of red blood cells)
Porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system thalassemia
(a genetic disorder of red blood cells)
Liver or kidney disease
If you are an alcoholic; or if you receive regular blood transfusion
1) Oral iron therapy
2) Parenternal iron therapy
3)Non pharmacological treatment
15. ORAL IRON THERAPY
Oral iron treatment may require 3-6 months to replenish body iron stores.
16.
17. Ferrous sulfate is the DOC for iron deficiency anemia.
Dosage: 325 mg, which provides 180 mg of iron daily of which 10mg is
usually absorbed.
Patients who cannot tolerate iron on an empty
stomach should take it with food.
COMMON ADVERSE EFFECTS OF ORAL IRON THERAPY
• Nausea
• Epigastric discomfort
• Abdominal cramps
• Constipation and diarrhea.
• Black stool
• These effects are usually dose-related
18. PARENTERNAL IRON THERAPY
Indicates in,
Late stage of pregnancy
Post operative patients
Patients who are unable to take oral preparation
Iron Sorbitol is given as a single dose/weekly/daily
Iron Dextran -Is a stable complex of ferric hydroxide and low-molecular weight dextran containing 50mg
of elemental iron per milliliter of solution . It can be given deep IM injection or IV infusion’
Adverse effect:
light-headedness, fever, arthralgias, back
pain, urticaria, bronchospasm and
hypersensitivity reaction
19. NON PHARMACOLOGICAL TREATMENT
Iron-rich diet
Good sources of iron includes:
Meats - beef, pork, lamb, liver, and other organ meats
Poultry - chicken, duck, turkey, liver (especially dark meat)
Fish - shellfish, including clams, mussels, and oysters, sardines, anchovies
Leafy greens of the cabbage family, such as broccoli , kale, turnip greens, and collards
Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas,
and canned baked beans