Iron deficiency anemia is the most common type of anemia globally. It is caused by low iron levels which prevents adequate hemoglobin production. Common symptoms include fatigue, weakness, and pale skin. Treatment involves oral or intravenous iron supplementation to replenish iron stores depending on the severity and underlying cause of the anemia. Oral iron is usually the first line treatment but intravenous iron may be needed if oral iron is not absorbed or anemia does not improve. Both forms can cause side effects but are generally safe and effective ways to treat iron deficiency anemia.
Megaloblastic anaemia is a red blood cell disorder due to the inhibition of DNA synthesis during erythropioesis.
Mitotically, the inhibition of the DNA synthesis impaires the progression of the cell cycle development from G2 to (M) stage.
Megaloblastic anaemia is a red blood cell disorder due to the inhibition of DNA synthesis during erythropioesis.
Mitotically, the inhibition of the DNA synthesis impaires the progression of the cell cycle development from G2 to (M) stage.
Iron deficiency anemia is one of the nutritional deficiency anemia, and the most common microcytic hypochromic anemia. it is also one of the common anemia in Pakistan. Pregnant and lactating are most commonly affected.
Information about megaloblastic anemia and it's etiology and its classification.
Vitmain b12 deficiencies
Folic acid deficiencies
Signs and symptoms of megaloblastic anemia
Neural tube defects
Iron deficiency anemia is one of the nutritional deficiency anemia, and the most common microcytic hypochromic anemia. it is also one of the common anemia in Pakistan. Pregnant and lactating are most commonly affected.
Information about megaloblastic anemia and it's etiology and its classification.
Vitmain b12 deficiencies
Folic acid deficiencies
Signs and symptoms of megaloblastic anemia
Neural tube defects
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
3. Anemia
Anemia comes from the Greek word ( ναιμία)(an-haîma)
meaning "without blood”. It is a deficiency of red blood cells
(RBCs) and/or hemoglobin.
Anemia is a hematologic condition in which there is
quantitative deficiency of circulating hemoglobin
(Hb), often accompanied by a reduced number of
(erythrocytes).
• Usually associated with:
▫ decreased levels of hemoglobin or hematocrit
▫ Abnormal hemoglobin may give appearance of anemia
(methemoglobin).
Classified as:
▫ Moderate (Hb 7-10 g/dl) or
▫ Severe (Hb <7g/dl).
4. Anemia
Deficiency in the oxygen-carrying capacity of the blood
due to a diminished erythrocyte mass.
Two general forms of anemia:
• Absolute Anemia (decrease in red cell mass) and
• Relative Anemia (increased plasma volume gives
appearance of anemia).
May be due to:
Erythrocyte loss (bleeding)
Decreased Erythrocyte production
low erythropoietin
Decreased marrow response to erythropoietin
Increased Erythrocyte destruction (hemolysis)
5. Anemia
Anaemia affects roughly a third of the world's
population; half the cases are due to iron deficiency.
It is a major and global public health problem that
affects maternal and child mortality, physical
performance, and referral to health-care professionals.
Children aged 0–5 years, women of childbearing
age, and pregnant women are particularly at risk.
Several chronic diseases are frequently associated
with iron deficiency anaemia—notably:
chronic kidney disease,
chronic heart failure,
cancer, and
inflammatory bowel disease.
6. Considerations by Age, Sex, and
Other Factors
Newborns <one week old, hemoglobin : 14-22 g/dl.
By six months of age, hemoglobin :11 - 14 g/dl.
Between 1 year and 15 years of age :11-15 g/dl.
Normal adult hemoglobin depends on gender:
♀ 12-16 g/dl
♂ 14-18 g/dl
In geriatric age group, men and women have same
hemoglobin range: 12-16 g/dl.
6
7. Considerations by Age, Sex, and
Other Factors
Normal ranges do depend on patient populations.
Other factors influencing “normal” hemoglobin
include:
▫ Environment: elevation of plains Vs mountains
▫ Physical Health: e.g. lung or kidney disease
▫ Nutritional deficiencies
▫ Blood loss
▫ Bone marrow replacement
▫ Chemicals / Radiation
7
10. Special Considerations in Determining
Anemia
Acute Bleed
Drop in Hgb or Hct may not be shown until 36 to 48 hours
after acute bleed (even though patient may be
hypotensive)
Pregnancy
In third trimester, RBC and plasma volume are
expanded by 25 and 50%, respectively.
Labs will show reductions in Hgb, Hct, and RBC count,
often to anemic levels, but according to RBC mass, they
are actually polycythemic
Volume Depletion
Patient’s who are severely volume depleted may not
show anemia until after rehydrated
11. 11
Classification of Anemias
• Have a variety of ways - depending on criteria
used:
▫ Functional
▫ Morphological
▫ Clinical
▫ Quantitative
12. 12
Functional
Classification of Anemias
• Decreased RBC production (hypoproliferative)
▫ Defective hemoglobin synthesis
Fe deficiency
B12 deficiency
Folate deficiency
▫ Impaired bone marrow or stem cell function, as in
leukemia
• Increased RBC destruction, as in sickle cell
anemia or hemolytic anemia
• Combination of the two (sometimes called
“ineffective erythropoiesis”)
13. 13
Morphological
Classification of Anemias
• Morphological based on color and sizes of
RBCs
▫ Normochromic Normocytic
▫ Normochromic Microcytic
▫ Normochromic Macrocytic
▫ Hypochromic Microcytic
14. 14
Clinical
Classification of Anemias
• According to their associated causes:
▫ Blood loss
▫ Iron deficiency
▫ Hemolysis
▫ Infection
▫ Nutritional deficiency
▫ Metastatic bone marrow replacement
16. Measurements in Anemia
• Hemoglobin = grams of hemoglobin per 100 mL
of whole blood (g/dL)
• Hematocrit = percent of a sample of whole
blood occupied by intact red blood cells
• RBC = millions of RBCs per mL of whole blood
• MCV = Mean corpuscular volume
• RDW = Red cell distribution width
• RDW= (Red cell volume ÷ mean cell volume) × 100
• Normal value is 11 -15%
• If elevated, suggests large variability in sizes of RBCs
17. 17
MCV
• MCV -Mean cell volume
• MCV is average size of RBC
• MCV = Hct x 10
RBC (millions)
• If 80-100 fL, normal range, RBCs considered
normocytic
• If < 80 fL are microcytic
• If > 100 fL are macrocytic
• Not reliable when have marked anisocytosis
fL= femtoliters
18. 18
RDW
• Most automated instruments now provide an RBC
Distribution Width (RDW)
• An index of RBC size variation
• May be used to quantitate the amount of
anisocytosis on peripheral blood smear
• Normal range is 11 % to 15% for both men and
women
• Anisocytosis: RBCs of unequal size. Reflected in
increased RDW (Red cell Distribution Width.)
19. Diagnosis of Anemia
Apart from before mentioned indices: the measurement of :
serum ferritin,
transferrin saturation,
serum soluble transferrin receptors, and
serum soluble transferrin receptors–ferritin index
are more accurate than in the diagnosis of iron
deficiency anaemia.
20. Beris P, Tobler A. Schweiz Rundsch Med Prax. 1997;86:1684.
Reprinted from Lambert JF, et al. In C Beaumont, P Beris, Y Beuzard, C Brugnara, eds. Disorders of iron
homeostasis, erythrocytes, erythropoiesis. Forum service editore, Genoa, Italy, 2006 page 73 figure 1, by
permission of European School of Haemotology.
Main Causes of Anaemia
Haemolysis
17.5%
Others
9%
Iron Deficiency
29%
Chronic Disease
27%
Acute
Bleeding
17.5%
21. Iron Deficiency Anemia
• Iron deficiency anemia (IDA) is the most
common form of anemia worldwide.
• In men and postmenopausal women the
commonest cause of IDA is blood loss from
lesions in the gastrointestinal tract,
making it a common cause of referral to
gastroenterologists.
• Causes of IDA relate either to
blood loss, or
iron mal-absorption
22. Iron deficiency Anemia
• The body needs iron to produce the Hb
necessary for RBC production.
• In general, most people need just 1 milligram
of iron daily.
• Menstruating women need double the
dose
23. Iron Deficiency
Successive Stages of Iron Deficiency
• Iron-deficient erythropoiesis,
▫ or functional iron deficiency
• Depletion of iron stores
• Iron-deficiency anaemia
Grosbois B, et al. Bull Acad Natl Med. 2005;189:1649.
25. Iron Deficiency—Iron loss
• In physiologic conditions
▫ Menstruation
• In pathologic conditions
▫ Surgery, delivery
▫ Haemoglobinuria,haemoptysis
▫ Gastrointestinal tract pathology
• In therapeutic procedures
▫ Phlebotomy
• In blood donation
26.
27. Iron Deficiency Anemia
• The CVS adaptations of chronic anemia can
worsen the condition of patients with underlying
cardiovascular disease and include:
▫ Tachycardia
▫ Increased cardiac output
▫ Vasodilation
• In the absence of adequate iron, small
erythrocytes with insufficient hemoglobin are
formed, giving rise to microcytic hypochromic
anemia.
28. Iron Deficiency
Clinical Manifestations
• Fatigue
• Decreased exercise tolerance
• Tachycardia
• Dermatologic manifestations
• Decreased intellectual performance
• Dysphagia
• Depression, increased incidence of infections
• Restless legs syndrome
Hoffman, ed. Hematology: Basic Principles and Practice, 4th ed. 2005.
Trost LB, et al. J Am Acad Dermatol. 2006;54:824.
29. Management
of IDA
• Treatment of iron deficiency anemia consists of correcting the
underlying etiology and replenishing iron stores.
• Oral ferrous iron salts are the most economical and
effective form
• Ferrous sulfate is the most commonly used iron salt
• Better absorption and lower morbidity have been claimed for
other iron salts
• Toxicity is generally proportional to the amount of iron
available for absorption
• Reserve parenteral iron for patients who are either
unable to absorb oral iron or who have increasing
anemia despite adequate doses of oral iron
• Reserve transfusion of packed RBCs for patients who
are experiencing significant acute bleeding or are in
danger of hypoxia and/or coronary insufficiency
31. IRON
Total body iron in adult is 2.5-5 g (average 3.5 g).
Men (50 mg/kg) > Women (38 mg/kg).
It is distributed into:
Haemoglobin (Hb) : 66%
Iron stores as ferritin and haemosiderin : 25%
Myoglobin (in muscles) : 3%
Parenchymal iron (in enzymes, etc.) : 6%
Iron forms the nucleus of the iron-porphyrin heme ring, which
together with globin chains forms hemoglobin.
In the absence of adequate iron, small erythrocytes with
insufficient hemoglobin are formed, giving rise to microcytic
hypochromic anemia.
32. Factors facilitating iron absorption
• 1. Acid: by favoring dissolution and
reduction of ferric iron.
• 2. Reducing substances:
• ascorbic acid,
• amino acids containing SH radical(cysteine and
methionine).
• These agents reduce ferric iron and form
absorbable complexes.
• 3. Meat: by increasing HCI secretion and
providing heme iron.
33. Factors impeding iron absorption
1. Alkalies (antacids) render iron insoluble, oppose
its reduction.
2. Phosphates (rich in egg yolk)
3. Phytates (in maize, wheat)
4. Tetracyclines
5. Presence of other foods in the stomach.
Above factors 2-4 impede by complexing with
iron.
In general, bioavailability of iron from cereal based
diets is low.
34. Uses
• The only clinical use of iron preparations is the
treatment or prevention of iron deficiency
anemia.
• Available as oral or parenteral preparations.
• If GI absorption of Iron is normal, oral and parenteral
agents are equipotent.
• Parenteral iron is usually preferred in patients with
advanced chronic kidney disease who are
undergoing hemodialysis and treatment with
erythropoietin.
35. ORAL IRON THERAPY
Oral iron
1. Ferrous sulfate:
Hydrated salt 20% iron,
Dried salt 32% iron 200 mg tab
2. Ferrous gluconate (12% iron) 300 mg Tab
3. Ferrous fumarate (33% iron) 200 mg Tab
4. Ferrous succinate (35% iron)
5. Ferric citrate is an oral iron that has shown
efficacy and gained FDA approval for treatment
of iron deficiency anemia in adults with CKD
and not on dialysis.
36. A/E
Dose-related
• Nausea, vomitting, epigastric discomfort,
abdominal cramps, bloating, colic
• Constipation, and diarrhea
• Staining of teeth, metallic taste
Can be minimized with dose reduction or by
taking it with or immediately after meals.
Black stools are common, patients must be
advised not to think of it as bloody stools.
37. PARENTERAL IRON THERAPY
Should be reserved for patients with
documented iron deficiency who are:
1. Unable to tolerate or absorb oral iron
2. Patients with extensive chronic blood loss
3. Patients who cannot be maintained with oral
iron alone.
4. Non-compliance to oral iron.
38. PARENTERAL IRON THERAPY
• Various conditions include:
• Different postgastrectomy conditions
• Previous small bowel resection
• IBD involving the proximal small bowel
• Malabsorption syndromes
• Advanced chronic renal disease including
hemodialysis and treatment with erythropoietin
39. PARENTERAL IRON THERAPY
1. Iron-Dextran
2. Iron-Sucrose Complex
3. Iron-Gluconate Complex
Iron dextran is given IV or as deep IM
injection.
While the later two are given through IV route
only. They are much less likely to cause
hypersensitivity reactions.
40. A/E
• Nausea and vomiting,
• Headache, light-headedness,
• Fever, arthralgias, back pain
• Flushing, urticaria,
• Bronchospasm, and, rarely, anaphylaxis and
death.
• Some are attributed to hypersensitivity reactions to
Dextran. A test dose therefore is always given.
• Even patients who received Iron-Dextran parenteral
therapy previously are at high risk.
41. A/E
Local
• Pain at site of i.m. injection,
• pigmentation of skin,
• sterile abscess- especially in old and debilitated patient.
Systemic
• Fever, headache, joint pains, flushing,
• palpitation, chest pain, dyspnoea,
• lymph node enlargement.
42. Poisonings
Seen in infants and children (> 60 mg/kg
iron)
Precipitates as
• vomiting, abdominal pain,hematemesis,
• diarrhoea, dehydration, acidosis,
• lethargy, cyanosis,convulsions;
• finally shock, cardiovascular collapse
• and death
Antidote: Desferrioxamine (chelating agent)
43. ACUTE IRON TOXICITY
• Acute Iron toxicity is seen almost exclusively in
young children who accidentally take the iron
tablets (like chocolates); 10 iron tablets can be
lethal in young children.
• Symptoms include: necrotizing gastroenteritis,
with vomiting, abdominal pain, and bloody
diarrhea followed by shock, lethargy, and
dyspnea which may be followed by severe
metabolic acidosis, coma, and death if
untreated.
• Whole bowel irrigation and Deferoxamine
should be initiated with supportive therapy for
GI bleeding, metabolic acidosis and shock.
44. CHRONIC IRON TOXICITY
Iron overload or hemochromatosis
Excess iron is deposited in the heart, liver, pancreas,
and other organs. It can lead to organ failure and death.
It is most common in patients with inherited
hemochromatosis, a disorder characterized by excessive
iron absorption, and in patients who receive many red
cell transfusions over a long period of time (eg, patients
with thalassemia major-hemolytic anemia-
hypochromic type).
In the absence of anemia, it is most efficiently treated by
intermittent phlebotomy removing one unit of blood
every week or so until all of the excess iron is removed.
Parenteral deferoxamine is much less efficient as well as
more complicated while deferasirox (oral iron chelator )
is much more convenient.
45. BLOOD TRANSFUSION
There is no universally accepted threshold for transfusing
packed red blood cells in patients with iron deficiency anemia.
Guidelines often specify certain hemoglobin values as
indications to transfuse, but the patient’s clinical condition
and symptoms are an essential part of deciding whether to
transfuse.
Transfusion is recommended in pregnant women with
hemoglobin levels of less than 6 g per dL because of potentially
abnormal fetal oxygenation resulting in nonreassuring fetal
heart tracings, low amniotic fluid volumes, fetal cerebral
vasodilation, and fetal death.
If transfusion is performed, two units of packed red blood cells
should be given, then the clinical situation should be
reassessed to guide further treatment.