Iron deficiency anemia is the most common type of anemia worldwide. It occurs when iron levels in the body are low, preventing adequate hemoglobin production. Common causes include deficient diet, blood loss from menstruation or gastrointestinal issues, and increased needs during pregnancy or lactation. Symptoms include fatigue, palpitations, and pale skin. Diagnosis involves blood tests showing low ferritin, increased total iron-binding capacity, and transferrin saturation below 16%. Treatment focuses on oral iron supplementation, but parenteral iron may be used if oral iron is not tolerated or absorption is impaired.

1. IRON DEFICIENCY ANEMIA
Dr. Syed Muhammad Ali Shah
RMO/PGR
Dept. of Medicine, ABSTH/NSMC

2. ANEMIA
• Anemia refers to a state in which the level of
haemoglobin in the blood is below the
reference range appropriate for age and sex.
• Anemia is present in adults if the hematocrit is
< 41% (hemoglobin < 13.5 g/dL) in males or <
36% (hemoglobin < 12 g/dL) in females.

3. CLASSIFICATION OF ANEMIA
1. According to pathophysiology
2. According to RBC size/MCV

4. ACCORDING TO PATHOPHYSIOLOGY
• Decreased red blood cell production (relative or
absolute reticulocytopenia)
– Hemoglobin synthesis lesion: iron deficiency, thalassemia,
anemia of chronic disease, hypoerythropoietinemia
– DNA synthesis lesion: megaloblastic anemia, DNA synthesis
inhibitor drugs
– Hematopoietic stem cell lesion: aplastic anemia, leukemia
– Bone marrow infiltration: carcinoma, lymphoma, fibrosis,
sarcoidosis, Gaucher disease, others
– Immune-mediated inhibition: aplastic anemia, pure red
cell aplasia

5. • Increased red blood cell destruction or
accelerated red blood cell loss (reticulocytosis)
– Acute blood loss
– Hemolysis (intrinsic)
• Membrane lesion: hereditary spherocytosis, elliptocytosis
• Hemoglobin lesion: sickle cell, unstable hemoglobin
• Glycolysis abnormality: pyruvate kinase deficiency
• Oxidation lesion: glucose-6-phosphate dehydrogenase
deficiency
– Hemolysis (extrinsic)
• Immune: warm antibody, cold antibody
• Microangiopathic: thrombotic thrombocytopenic purpura,
hemolytic-uremic syndrome, mechanical cardiac
valve,paravalvular leak
– Infection:
• Clostridium perfringens
• malaria
– Hypersplenism

6. ACCORDING TO SIZE/MCV
• Microcytic (< 76 fL)
– Iron deficiency
– Thalassemia
– Anemia of chronic disease
– Lead toxicity
– Zinc deficiency
• Macrocytic (Megaloblastic) >98
– Vitamin B12 deficiency
– Folate deficiency
– DNA synthesis inhibitors
• Macrocytic (Nonmegaloblastic)
– Myelodysplasia
– Liver disease
– Reticulocytosis
– Hypothyroidism
– Bone marrow failure state (eg,
aplastic anemia, marrow
infiltrative disorder, etc.)
– Hypocupremia
• Normocytic (76–98 fL)
– Kidney disease
– Non-thyroid endocrine gland
failure
– Hypocupremia
– Mild form of most acquired
etiologies of anemia

8. IRON DEFICIENCY ANEMIA
• Most common cause of anemia worldwide.
• Iron metabolism is balanced between
absorption of 1 mg/d and loss of 1 mg/d.
• Pregnancy and lactation – requirements
increase to 2–5 mg of iron per day.

10. Causes of Iron Deficiency
• Deficient diet
• Decreased absorption
– Celiac sprue
– Zinc deficiency
• Increased
requirements
– Pregnancy
– Lactation
• Blood loss (chronic)
– Gastrointestinal
– Menstrual
– Blood donation
• Hemoglobinuria
• Iron sequestration
– Pulmonary
hemosiderosis
• Idiopathic

12. CLINICAL ASSESSMENT
HISTORY
• Gastrointestinal history is important
• Menorrhagia is a common cause of anaemia in pre-
menopausal females
• Dietary history should assess the intake of iron and folate
• Past medical history resection of the stomach or small bowel
• Family history and ethnic background may raise suspicion of
haemolytic anaemias
• Drug history may reveal the ingestion of drugs which cause
blood loss (e.g. aspirin and antiinflammatory drugs

13. Symptoms & Signs
• Easy fatigability
• Tachycardia
• Palpitations
• Dyspnea on exertion
• Pallor
• Smooth tongue
• Brittle nails
• Spooning of nails
(koilonychia)
• Cheilosis

15. • A ferritin value < 12 ng/mL (< 27 pmol/L)
• TIBC will be increased
• Levels of soluble plasma transferrin receptor
increase
• A transferrin saturation (i.e. iron/TIBC × 100)
of less than 16% is consistent with iron
deficiency but is less specific than a ferritin
measurement

16. TREATMENT
ORAL IRON
• Ferrous sulfate, 325 mg three times daily on an
empty stomach
• Ferrous gluconate 300 mg twice daily
• Iron therapy should continue for 3–6 months
after restoration of normal hematologic values to
replenish iron stores.
• The haemoglobin should rise by around 10 g/L
every 7–10 days and a reticulocyte response will
be evident within a week.

17. Parenteral Iron
• The indications are:
– Intolerance to oral iron
– Refractoriness to oral iron
– Gastrointestinal disease (usually inflammatory
bowel disease) precluding the use of oral iron
– Continued blood loss that cannot be corrected,
such as chronic hemodialysis