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IRON DEFICIENCY ANAEMIA MBBSBDS IV.pptx
- 1. Iron deficiency anaemia DR ABBA AISHA MOHAMMED DEPARTMENT OF HAEMATOLOGY FACULTY OF BASIC CLINICAL SCIENCES UNIVERSITY OF MAIDUGURI 7/10/2023 1
- 2. OBJECTIVES To define iron deficiency anaemia To understand iron metabolism To identify the causes & consequences of IDA To be able to effectively diagnose and manage IDA 7/10/2023 2
- 3. OUTLINE Introduction Iron metabolism Clinical features/ consequence of iron deficiency/Stages of iron deficiency Laboratory diagnosis Treatment Prevention 7/10/2023 3
- 4. INTRODUCTION Iron deficiency is the decrease in total iron content of the body Iron deficiency anaemia occurs when iron deficiency is severe enough to decrease/ halt erythropoiesis and cause development of anaemia IDA diminishes capability of individuals to work and affects growth and learning 7/10/2023 4
- 5. CONT’D Deficiency of iron is the most common cause of anaemia globally Affects >1.5 billion people worldwide Occurs most frequently in under-developed countries It is the most important differential diagnosis of” microcytic hypochromic “anaemia (morphologic classification) 7/10/2023 5
- 6. IRON METABOLOSM o Iron requirements vary daily as it compensates for losses from the body and growth requirements o Pregnant women, menstruating females and adolescents have the highest demands 7/10/2023 6
- 7. DAILY REQUIREMENTS OF IRON Infants up to 4 months- 0.5mg Infants 5-12 months and children- 1mg Menstruating women-3mg Pregnancy- 3-4mg Adult male and postmenopausal women-1mg 7/10/2023 7
- 8. SOURCES OF IRON Animal sources- red meat, dairy products(milk is a poor source of iron) Plant sources- fruits, cereals, legumes,vegetables 7/10/2023 8
- 9. 7/10/2023 9 Distribution of body iron
- 11. IRON METABOLISM Dietary iron is present in foods in the ferric form (ferric hydroxides and ferric protein) The proportion of iron absorbed differs from one food to another; meat is the richest source of iron Depending on the type of food taken, iron is absorbed partly as haeme and partly as inorganic iron 7/10/2023 11
- 12. 7/10/2023 12 FACTORS THAT FAVOUR / IMPEDE IRON ABSORPTION
- 13. ABSORPTION OF IRON Haeme iron is absorbed directly through the duodenum to the portal circulation While inorganic iron is first converted to ferrous form (ferrireductase) and internalized with the aid of DMT1 7/10/2023 13
- 14. CONT’D Inside the cell it is either stored as ferritin or transported to the plasma Exit of iron from the duodenal enterocyte into the portal plasma is controlled by ferroportin Ferrioxidase converts ferrous to ferric iron to enable it bind to transferrin 7/10/2023 14
- 16. TRANSPORT OF IRON Transferrin; a glycoprotein produce by the liver delivers iron to tissues that have transferrin receptors e.g marrow erythroblasts, for incorporation into haemoglobin and other cells of the body. Transferrin is then re-utilized Iron in the erythroblast cytoplasm moves to the mitochondria for haeme synthesis Some iron is stored in the lysosome as ferritin (sideroblasts) 7/10/2023 16
- 17. STORAGE OF IRON Ferritin - water soluble consisting of a protein shell and iron core, contains numerous ferric oxyhydroxide molecules and is readily mobilised for haemoglobin synthesis when required 7/10/2023 17
- 18. CONT’D Haemosiderin –represents aggregation of ferritin from which most of the protein has been removed. It is stored in the RES, it is water insoluble and less readily available for haemoglobin synthesis 7/10/2023 18
- 19. REGULATION OF IRON : HEPCIDIN A 25 amino acid polypeptide hormone produced by the liver known to be the key regulator of iron metabolism It causes internalisation and degradation of ferroportin; the only iron exporter at the basolateral end of the enterocyte 7/10/2023 19
- 20. CONT’D There by inhibiting iron absorption from the GIT and release by the macrophages Hepcidin levels fall in iron deficiency , hypoxia and erythropoietic drive Plasma transferrin saturation and inflammation stimulate hepcidin synthesis 7/10/2023 20
- 21. REGULATION OF BODY IRON 7/10/2023 21
- 22. STAGES OF IRON DEFICIENCY Iron store depletion- absent iron stores Iron deficient erythropoiesis (latent iron deficiency)- absent iron stores with reduction of plasma concentration of iron Iron deficiency anaemia- the two above with blood film features of iron deficiency 7/10/2023 22
- 23. STAGES OF IRON DEFICIENCY 7/10/2023 23
- 24. CAUSES OF IRON DEFICIENCY EXCESSIVE LOSS OF IRON- 1. GI BLEEDING (oesophageal varices, hiatus hernia, peptic ulcer, gastritis, meckel’s diverticulum,Crohn’s disease, Ulcerative colitis, hookwork infestation, colorectal cancer) 7/10/2023 24
- 25. CONT’D 2. UTERINE BLEEDING (menorrhagia) 3.URINARY TRACT BLEEDING, (haematuria,haemoglobinuria) 4.RESPIRATORY TRACT BLEEDING; haemoptysis 5. BLEEDING DISORDERS 7/10/2023 25
- 26. CONT’D INADEQUATE DIETARY INTAKE DEFECTIVE ABSORPTION OF IRON- subtotal gastrectomy INCREASED REQUIREMENTS OF IRON-pregnancy, infancy, adolescents 7/10/2023 26
- 27. Clinical features GENERAL FEATURES OF ANAEMIA- Weakness, easy fatiguability, breathlessness on exertion, tachycardia and a systolic heart murmur e.t.c 7/10/2023 27
- 28. CONT’D FEATURES RELATED TO IRON DEFICIENCY- pica;abnormal intense desire to eat strange substances such as clay,,paint cardboard etc. atrophic glossitis, dysphagia,angular stomatitis and koilonychia Iron def. anaemia+ glossitis+dysphagia= Patterson Kelly (or plummer-vinson) syndrome 7/10/2023 28
- 29. Cont’d FEATURES DUE TO UNDERLYING CAUSE- bleeding from GIT,menorrhagia,alteration in bowel habit, hemoptysis e.t.c 7/10/2023 29
- 31. 7/10/2023 31 • Microcytic hypochromic cells • Pencil shaped cells • Marked anisocytosis
- 32. DIAGNOSIS 1.PERIPHERAL BLOOD FILM RED cells show Anisopoikilocytosis with microcytic hypochromic cells, pencil cells, occasional target cells PLATELETS; thrombocytosis LEUCOCYTES normal or increased (with infection or infestation) 7/10/2023 32
- 33. CONT’D NOTE: A dimorphic picture is seen if the patient has received transfusion, has coexisting folate or vit B12 deficiency or received recent iron therapy 7/10/2023 33
- 34. CONT’D 2.Red cell indices - MCV ↓ (< 80fl) MCH ↓(<27 pg) MCHC↓ RDW ↑ 3.Serum iron ↓ 4.Serum ferritin ↓ 7/10/2023 34
- 35. CONT’D 5.TIBC/ Serum transferrin receptor ↑ 6.Free red cell portopophyrin ↑ 7.Serum hepcidin ↓ 8.Bone marrow examination (GOLD STARNDARD ) stained with Prussian blue (perl’s reaction) will show absent iron in macrophages, but is not necessary except in complicated cases 7/10/2023 35
- 36. 7/10/2023 36
- 37. DIFFERENTIAL DIAGNOSIS Thalassaemia Anaemia of chronic disease Sideroblastic anaemia Lead poisoning 7/10/2023 37
- 38. 7/10/2023 38
- 39. TREATMENT 1. Identify the underlying cause and treat appropriately 2. Iron replacement therapy Aim- to correct anaemia and replenish the stores 7/10/2023 39
- 40. CONT’D Two forms of iron replacement therapy are in use 1. The oral formulations 2. The parenteral formulations 7/10/2023 40
- 41. CONT’D 1.Ferrous sulphate (BEST preparation) , contains 67mg of elemental iron in 200mg tablet. Administration is 6-8hrly on an empty stomach. Side effects include nausea, abdominal discomfort and diarrhea or constipation 2. Ferrous gluconate , contaims 37mg iron in 300mg tablet(does not deliver required iron content) ,has less side effect 3. Ferrous fumarate 7/10/2023 41
- 42. CONT’D NOTE: Therapy is given for at least 6 months to correct anaemia and replenish the stores Failure to respond to oral iron therapy- On going haemorrhage Non-compliance Wrong diagnosis Mixed deficiencies Malabsorption 7/10/2023 42
- 43. CONT’D PARENTERAL IRON THERAPY – 1. Ferric-hydroxide sucrose 2. Iron dextran 3. Ferric carboxymaltose These are calculated according to weight and degree of anaemia 7/10/2023 43
- 44. CONT’D 1 and 2 are commonly used in our centre 1 is give as an slow IV injection or infusion 2 is given as deep IM injection spread over a week 7/10/2023 44
- 45. CONT’D Indicated only – GI bleeding, severe menorrhagia, chronic haemodialysis, erythropoeitin therapy and when oral iron is ineffective Side effects of parenteral iron therapy includes- hypersensitivity reactions, muscle staining, 7/10/2023 45
- 46. CONT’D NOTE: there is no superiority in haematological response of parenteral iron over oral iron therapy 7/10/2023 46
- 47. PREVENTION Iron supplementation Food fortification Dietary modification Control of viral. Bacterial and parasitic infections 7/10/2023 47
- 48. SUMMARY Iron deficiency anaemia is a significant public health problem globally with varied aetiology ranging from loss of iron via blood loss to inadequate intake and problems of metabolism 7/10/2023 48
- 49. CONT’D Women tend to have substantially lower iron stores than men, thus are more vulnerable to iron deficiency when iron intake is lowered or need increases Diagnosis is made using PBF ,red cell indices in addition to evaluation of iron stores 7/10/2023 49
- 50. CONT’D Treatment is aimed at correcting anaemia and replenishing the stores Prevention is by nutrirional education and supplementation in diets 7/10/2023 50
- 51. THANK YOU FOR LISTENING 7/10/2023 51
- 52. REFERENCES New concepts in iron deficiency anaemia. British journal of General practice 2017 Camaschella C. New insights into iron deficiency and iron deficiency anaemia. Blood Rev.2017 Williams Hematology 9th Edition Postgraduate Haematology 7 Edition A. V. Hoffbrand 7/10/2023 52
- 53. QUIZ 5 minutes One of your senior colleagues that took part in the just concluded examination in laboratory medicine and pharmacology was excited by the outcome and invited you for an outing where you ate bread , suya and drank a cup of tea. What is wrong with such a combination? What is the pathophysiology of the attendant problem ? 7/10/2023 53