About iron Deficiency Anaemia

1. IRON DEFICIENCY ANAEMIA
AND MEGALOBLASTIC
ANAEMIA
Presented by Dr Donna June Syngkli

2. INTRODUCTION
• What is anemia ??
Anemia refers to a decrease in the total number of circulating red cells with
decrease in hemoglobin when compared with normal for that age group and sex.
WHO (1968) criteria for anaemia are as follows:
Adult males Hb < 13 g/dl
Adult females Hb < I2 g/dl
Infants and children up to 12 years Hb < 11 g/dl
Pregnant women Hb < 11 g/dl

3. CLASSIFICATION OF ANAEMIA
• Morphological classification
- Microcytic anaemia — MCV < 80fl
- Normocytic anaemia — MCV 81— 99fl
- Macrocytic anaemia — MCV > 100fl
• Etiological classification
- Anemias due to impaired red cell production .
- Hemolytic anemias due to increased red cell destruction .

5. IRON DEFICIENCY ANEMIAS
• This group of anemias occur due to deficiency of substances which are
essentially required by the bone marrow for development of red cells.
• The important substances include iron, folic acid, vitamin B12, pyridoxine,
vitamin c copper and zinc.
• In India, the major cause of anemia Is nutritional deficiency of iron,
minerals and vitamins.
• Iron is crucial for various biological functions like DNA synthesis, cell
proliferation and cell respiration .

6. • Iron deficiency anemia (IDA) is characterized by microcytic
hypochromic red cells with mcv <80 Fl and MCH < 25 pg.
• Morphologic changes of red cells appear as the iron stores get
depleted and iron is not available in adequate amounts for heme
synthesis .
• In IDA, marrow is not very hyperplastic and is one of the
hypo-proliferative anemias, since reticulocyte index is < 2.5.

7. • PREVALENCE
• Iron deficiency is the most widespread form of malnutrition affecting
nearly two billion people the world over .
• It is the most common anemia prevalent in India .
• Its frequency is higher in females more so in pregnancy when the
prevalence rate of IDA is as high as 45%-60% .

8. • IRON METABOLISM & ITS ROLE IN HOMEOSTASIS
• Iron is present in hemoglobin, myoglobin and iron containing enzymes of
cytochrome system.
• Iron is essential for DNA, RNA and protein synthesis. It is also essential for myelin
synthesis and for heme and non-heme enzymes.
• Clinical consequences of iron deficiency are - CNS dysfunction, impaired work
performance, reduced immunity, impaired temperature regulation and effects
of reduced oxygen carrying capacity of blood, resulting in hypoxia to various
tissues.

11. PATHOGENESIS OF IDA
• The four factors responsible for pathogenesis of anemia are:
1) Impaired Hb synthesis
2. Impaired cellular proliferation
3. Diminished iron containing proteins
4. Reduced red cell survival when anemia is severe

12. CLINICAL FEATURES
• Can frequently be asymptomatic
• Anaemia symptoms:
• Fatigue
• Altered behaviour , irritability
• Exertional dyspnoea
• Can lead to decreased cognitive performance and delay mental and motor development in
children
• Headache
• Sleep disturbance
• Decrease cognitive function and impaired memory
• Palpitations
• Muscle and joint pain

13. • Features of iron deficiency:
• Glossitis, angular cheilitis
• Craving for ice or clay (pica or pagophagia), especially in pregnant women Dysphagia
with solid foods
• Koilonychia and brittle nails
• Restless legs syndrome (Willis-Ekbom disease)
• Severe IDA in pregnancy is associated with an increased risk of preterm labour,
low neonatal weight and increased new-born and maternal mortality .

14. DIAGNOSIS
LABORATORY
• Complete blood count
• Low hemoglobin (Hb) and hematocrit (Hct)
• Low mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration
(MCHC)
• Increased red cell distribution width (RDW)
• Decreased reticulocyte index
• Low serum iron and ferritin levels (best initial test)
• Low iron saturation
• Elevated total iron binding capacity (TIBC) or transferrin
• Reticulocyte hemoglobin content value is a strong predictor of the early measurement of
functional iron deficiency

15. • In adult men, postmenopausal women or younger women with severe anemia,
tests to determine the reason for iron deficiency should be performed:
• Fecal occult blood test
• Upper and lower endoscopy
• Test for hematuria or hemoglobinuria
• Gynecologic evaluation in women
• Bone marrow examinations
• urine and stool examinations

16. TREATMENT
• Dietary supplementation
• Iron therapy:
• Oral iron for mild to moderate symptoms
• Parenteral iron: unable to absorb oral iron or anaemia worsening despite oral iron
therapy
• RBC transfusions in patients with acute bleeding or in severe symptoms of anaemia
or coronary insufficiency

17. Microscopic (histologic) description
• Peripheral blood smear:
• Microcytic and hypochromic RBCs with marked anisopoikilocytosis in chronic cases
of iron deficiency anemia
• Platelets may be increased (reactive thrombocytosis) Target cells are absent, unlike in
thalassemia
• In more acute cases, dimorphic population of RBCs with increased RDW is the
earliest evidence of iron deficient erythropoiesis
• Normocytic cells produced before bleeding and microcytic cells produced after bleeding

18. Microcytic and hypochromic RBCs
scooping of nails
Koilonychia
Atrophic glossitis

19. Eerythroid hyperplasia