Iron deficiency anaemia/dental courses

Iron deficiency anemiaIron deficiency anemia
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INDIAN DENTAL ACADEMY
Leader in continuing Dental Education

CONTENTS
• Introduction
• Prevalence
• Etiology
• Clinical features
• How to diagnose IDA
• Differential diagnosis
• Prevention , treatment & follow up .

INTRODUCTION
• Nutritional anemia is a major public health
problem , especially in developing countries
• Iron deficiency is the most common
nutritional disturbance in pediatrics and the
number one cause of anemia in this age
range .
• It results from the decrease in the number of
red blood cells, caused by a lack of sufficient
iron .

PREVALENCEPREVALENCE
• Varies widely with age ,sex ,feeding
&socioeconomic status .
• During the fetal life ,the fetus receives most
of its iron during the last trimester of
pregnancy .
• Premature infants are particularly prone to
develop iron deficiency because they start
their lives with low iron store.

• Term infants have adequate iron stores for
the first 6 months ,so IDA is rare in these.
• Adolescent girls are prone to iron
deficiency due to rapid growth , menstrual
blood loss & teenage pregnancy that
further compromise the iron status.

CLINICALFEATURESCLINICALFEATURES
• Headache ,weakness & fatigue .Headache ,weakness & fatigue .
• Decreased attention span, cognitive delays .Decreased attention span, cognitive delays .
• Pagophagia , the desire to ingest unusualPagophagia , the desire to ingest unusual
substances such as ice or dirt .substances such as ice or dirt .
• Irritability & anorexia are characteristic ofIrritability & anorexia are characteristic of
advanced cases & reflect iron deficiency in theadvanced cases & reflect iron deficiency in the
tissues.tissues.
• Pallor is the most important sign of iron deficiencyPallor is the most important sign of iron deficiency
anemiaanemia
• Tachycardia , cardiac dilatation &systolicTachycardia , cardiac dilatation &systolic
murmurs are often present .murmurs are often present .
• Recurrent infectionsRecurrent infections

ETIOLOGYETIOLOGY
intakeintake absorptionabsorption loss of bloodloss of blood

How to diagnose IDAHow to diagnose IDA??
AA . History & Physical examination. History & Physical examination :

How to diagnose IDA?
History:
• Pica suggests Iron Deficiency Anemia
• Perinatal & birth Hx
• Dietary habits : type of feeding, introduction
of cow’s milk, Inadequate Iron or protein
intake .
• History of Malabsorption (e.g. Diarrhea)
• History of GIT blood loss & Changes in stool
color (Melena or bright red blood)
• History of excessive menstrual flow
(Menorrhagia)

B. InvestigationsB. Investigations :
1. CBC: low Hg &MCV<80 Fl
RDW> 14.5
Reticulocytes are low <1.5% .
2. Blood film: shows progressive RBCs
changes as the anemia worsens .In
moderate to severe cases RBCs becomes
microcytic & hypochromic.

3.3. Iron studiesIron studies ::
• low serum iron .
• Serum ferritin level, that correlates with
bone marrow iron stores & in the absence
of inflammatory diseases , the values of
<10 ug are characteristic of iron
deficiency.
• TIBC of the serum (serum transferrin) is
high .
• Transferrin saturation is <16%

4. Free erythrocyte protoporphyrins :(FEPFree erythrocyte protoporphyrins :(FEP))
accumulates when the availability of iron
becomes rate limiting for Hg synthesis .
5. +/- Hb electrophoreses. +/- Hb electrophoreses
6. +/-+/- BM evaluationBM evaluation :is not required routinely
but if done ,it will show absent
hemosiderin in MQ

DIFFRENTIALDIAGNOSISDIFFRENTIALDIAGNOSIS
IDA must be differentiated from other
hypochromic mirocytic anemias .
1. Thalassemia
2. Anemia of Chronic Disease
3. Lead Poisoning
4. Sideroblastic Anemia

Differential diagnosisDifferential diagnosis
1.Thalassemia :
IDAIDA Alpha & beta thalassemiaAlpha & beta thalassemia
RBC count is decreased RBC count is is elevated
Hg elctrophoresis :
-High Hg F&A2 with B
thalassemia triat
-Hg Barts (3-10%) in newborn
with alpha thalassemia trait .
RDW: increased RDW & iron studies :N

2.Anemia of chronic disease :
usually normocytic, occasionally microcytic
IDAIDA Anemia ofAnemia of
chronic diseasechronic disease
Serum ironSerum iron low low
Serum ferritinSerum ferritin lowlow N or highN or high
TIBCTIBC highhigh LowLow
Transferrin satTransferrin sat low Low
..TransferrinTransferrin
receptor TfRreceptor TfR
concconc..
ElevatedElevated NN

3 .Lead poisoning3 .Lead poisoning ::
Both lead poisoning and IDA can causeBoth lead poisoning and IDA can cause
elevation of felevation of free erythrocyteree erythrocyte
protoporphyrinsprotoporphyrins
The presence of basophilic stippling of redThe presence of basophilic stippling of red
cells and high serum lead level makecells and high serum lead level make
diagnosisdiagnosis
4. Sidroblastic anemia4. Sidroblastic anemia ::
the presence of ring sidroblasts in the bonethe presence of ring sidroblasts in the bone
marrow suggests the diagnosis .marrow suggests the diagnosis .

prevention & treatmentprevention & treatmentPREVENTIONPREVENTION
• For exclusively breast fed term infants should
receive 1mg/kg /dayof supplemental iron
starting at the age of 6 months .
• Iron fortified cereal should be among the
first foods provided at time of weaning .
• For term, formula fed Infants ,use iron-
fortified formula until age 12 months.
• For Preterm Infants , start supplemental iron
(2 mg/kg/day) or iron-fortified formula no
later than age 1 month and continue to age 12
months
• Avoid cow's milk until after age 12 months.
• advice parents to supply food rich in iron &
ascorbic acid .www.indiandentalacademy.com

ManagementManagement
1.Identify if there is any source of blood
loss .
2.For treatment of an established iron
deficiency :
• oral administration of iron salts
(sulfate,gluconate,fumarate).is tolerated in young
children > adolescents and older children.
• Parenteral iron (iron dextran ) is given if there is
malabsorption .
• A daily total of 3-6mg/kg in 3 divided doses is
effective for 4 to 6 months to correct the anemia
and replenish iron stores .

ManagementManagement
3.Educate the family about the pt’s diet( to
increase iron rich foods & decrease milk if
intolerated to 500ml/day.
4.Paked RBCs & slow blood transfusion
is indicated only with severe anemia
because of associated hypervolemia
and cardiac dilatation.

Follow upFollow up
• Within 72 to 96 hr after administration ofWithin 72 to 96 hr after administration of
iron , peripheral reticulocytes is noted iniron , peripheral reticulocytes is noted in
proportion to the severity of the anemiaproportion to the severity of the anemia
• Followed by increase of Hg level as muchFollowed by increase of Hg level as much
as 0.5g/dl/24hr .as 0.5g/dl/24hr .
• Iron therapy must be continued for 8 wksIron therapy must be continued for 8 wks
after normalization of blood valuesafter normalization of blood values
• Therapeutic failure of iron medicationTherapeutic failure of iron medication
suggest, false diagnosis ,improper treatmentsuggest, false diagnosis ,improper treatment
or unrecognized blood lossor unrecognized blood loss

THANTHAN
QQ

ReferencesReferences
1. TEXT BOOK OF CLINICAL
PEDIATRICS BY: A. Elzouki,
HARB HARFI & HISHAM NAZER.
2. NELSON TEXT BOOK OF
PEDIATRICS BY : Behrman,
Kliegman & Jenson 17th
edition .

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