Acute IDA, Presented by Dr yousef quda , Master degree of pediatrics

1. IRON DEFICIENCY ANEMIAIRON DEFICIENCY ANEMIA
Dr.
Yousef Mohamed Quda
MSC. Pediatrics
dryousefquda@yahoo.com

2. IRON IN NATUREIRON IN NATURE
Iron is among the abundant minerals on earth.
Of the 87 elements in the earth’s crust, Iron
constitutes 5.6% and ranks fourth behind
Oxygen (46.4%), Silicon (28.4%) and Aluminum
(8.3%).
 In soil, Iron is 100 times more than Ca, Na & Mg
and1000 times more than Zinc and 100,000
times more than Iodine.

3. ROLE OF IRON IN THE BODYROLE OF IRON IN THE BODY
Iron have several vital functions
Carrier of oxygen from lung to tissues
Transport of electrons within cells
Co-factor of essential enzymatic reactions:
Neurotransmission
Synthesis of steroid hormones
Synthesis of bile salts
Detoxification processes in the liver

4. IRON DEFICIENCYIRON DEFICIENCY
Iron deficiency is the most common
micronutrient deficiency in the world
affecting 1.3 billion people i.e. 24% of the
world population.
In comparison only 275 million are iodine
deficient and 45 million children below age
5 years are Vitamin A deficient.

5. IRON DEFICIENCYIRON DEFICIENCY
Iron deficiency can range from sub-clinical
state to severe iron deficiency anemia.
Different stages are identified by clinical
findings & lab tests.
Most studies showed this cutoff point to be
around 11 g/dl (-2SD below the mean).

6. AT RISK GROUPSAT RISK GROUPS
Infants
Under 5 children
Children of school age
Women of child bearing age

7. ETIOLOGYETIOLOGY
i- Decrease intake: Common in ages 6-24 months due to:
- Prolonged breast feeding without supplementation (delayed weaning)
- Cow milk feeders (↓ iron, ↓ lactoferrin, heat labile protein may induce
occult blood loss).
ii- Decrease iron absorption:
- Malabsorption syndrome.
- Excess tea, phytate & antiacids.

8. ETIOLOGYETIOLOGY
iii- Decrease iron stores:
- Iron deficient pregnant.
- Perinatal blood loss( e.g. feto maternal transfusion)
- Preterm.
iv- Increase requirements due to:
- Rapid rate of growth in twins, preterm, infants, adolescence.
- Congenital cyanotic heart diseases

9. ETIOLOGYETIOLOGY
v- Increase loss: Common in ages > 2 years.
1- Overt blood loss :
- Hematuria.
- Hemodialysis.
- Hemosidrinuria →PNH, paroxysmal cold hemoglobinuria,
- Pulmonary → Epistaxis, Good Pasteur syndrome.

10. ETIOLOGYETIOLOGY
2- Occult blood loss due to
- Ankylostoma.
- Peptic ulcer, polyps, GERD
- Cow milk protein allergy or heat labile protein which
induce exudative enteropathy ( leaky gut syndrome)
- Meckle’s diverticulum.
- Pulmonary heomsiderosis→ unrecognized bleeding in
lungs→ recurrent iron deficiency anemia.

11. INHIBITORS OF IRON ABSORPTIONINHIBITORS OF IRON ABSORPTION
Food with polyphenol compounds
Cereals like sorghum & oats
Vegetables such as spinach and spices
Beverages like tea, coffee, cocoa and
wine.
A single cup of tea taken with meal
reduces iron absorption by up to 11%.

12. OTHER INHIBITORSOTHER INHIBITORS
Food containing phytic acid i.e. Bran,
cereals like wheat, rice, maize & barely.
Legumes like soya beans, black beans
& peas.
Cow’s milk due to its high calcium &
casein contents.

13. INHIBITION-HOW?INHIBITION-HOW?
The dietary phenols & phytic acids
compounds bind with iron decreasing
free iron in the gut & forming
complexes that are not absorbed.
Cereal milling to remove bran reduces
its phytic acid content by 50%.

14. Promoters of Iron AbsorptionPromoters of Iron Absorption
Foods containing ascorbic acid like citrus fruits,
broccoli & other dark green vegetables because
ascorbic acid reduces iron from ferric to ferrous
forms, which increases its absorption.
Foods containing muscle protein enhance iron
absorption due to the effect of cysteine
containing peptides released from partially
digested meat, which reduces ferric to ferrous
salts and form soluble iron complexes.

15. IRON ABSORPTION (3)IRON ABSORPTION (3)
Some fruits inhibit the absorption of
iron although they are rich in ascorbic
acid because of their high phenol
content e.g strawberry , banana and
melon.
Food fermentation aids iron absorption
by reducing the phytate content of diet

16. IRON TRANSPORTIRON TRANSPORT
Transferrin is the major protein
responsible for transporting iron in the
body.
Transferrin receptors, located in almost all
cells of the body, can bind two molecules
of transferrin.
Both transferrin concentration & transferrin
receptors are important in assessing iron
status.

17. STORAGE OF IRONSTORAGE OF IRON
Tissues with higher requirement for iron
( bone marrow, liver & placenta) contain more
transferrin receptors.
Once in tissues, iron is stored as ferritin &
hemosiderin compounds, which are present in
the liver, RE cells & bone marrow.
The amount of iron in the storage compartment
depends on iron balance (positive or negative).
Ferritin level reflects amount of stored iron in the
body & is important in assessing ID.

18. IRON CYCLE IN THE BODYIRON CYCLE IN THE BODY

19. Clinical pictureClinical picture
I. Features of anemia:
1- Mild anemia is asymptomatic
2- Pallor (the most important clue to iron deficiency).
3- Manifestations of anemia (easy fatigability,…..)
vary with severity of iron deficiency.
4- Irritability, and anorexia (occur when hemoglobin
is < 5 gm/dl).

20. Clinical pictureClinical picture
II. Features of tissue iron deficiency
1.Neurological and intellectual dysfunction
- Decreased alertness, learning & concentration span .
- Pica (Geophagia) desire to ingest unusual substances e.g. dirts.
- ↑ Incidence of breath holding attacks.
- Pseudotumor cerebri.
2- Spleen is palpable in 10-15% of cases.
3- Osseous changes similar to chronic hemolytic anemia in long
standing cases.
4- Epithelial tissue changes:
- Nails ⇒ longitudinal ridges, flattening and spooning (koilonychia).
- Atrophic glossitis (pale & smooth).
- Blue sclera are common.

21. 1. Is it anemia ?
CBC : - ↓ Hb% and ↓ RBCs count.
2. Is it microcytic hypochromic ?
CBC: - Hypochromic → MCH < 27 Pg , MCHC < 30%.
- Microcytic → MCV < 70 FL.
3- Is it iron deficiency ?
i.CBC : - Thrombocytosis (600.000-1 million) is common.
- Wide RDW (> 14.5 ) + low MCV is a good screening test for
iron deficiency.
Investigations:Investigations:

22. ii. Iron indices:
Investigations:Investigations:
Index Iron deficiency Normal (age dependent(
-Serum Iron.
• Transferrin saturation.
• Serum transferrin
receptors(STfR).
• Total iron binding
capacity (TIBC).
>30µg / dl
>15%
increased
>350µg / dl
60-120µg / dl
33%
250-350µg / dl

23. Investigations:Investigations:
4- Search for a cause ?
- Stool analysis for parasites
- Gauiac test for occult blood in stool → should be
repeated 5 times before considered negative.
- GIT barium study, endoscopy and Meckles scan.

24. LAB FINDINGS IN IDALAB FINDINGS IN IDA
Microcytic hypochromic anaemia
Low Hb level (< 11.0 g/dl)
Low MCV, MCH, MCHC
Low serum ferritin
High RWD
High iron binding capacity
High erythrocyte protoporphyrin

25. Normal Blood FilmNormal Blood Film

26. MICROCYTESMICROCYTES

27. HYPOCHROMIAHYPOCHROMIA

28. MANAGEMENT OF IDAMANAGEMENT OF IDA
i- Prophylaxis: Oral iron given at 4th
– 6th
months (2mg/kg/d) .
ii- Curative:
1- Treat the cause.
2- Diet → ↑ Rich in vitamin C, meat,
fish ,apple .
→ limit amount of cow milk & tea.

29. MANAGEMENT OF IDAMANAGEMENT OF IDA
3- Iron preparation:
Oral Iron:
- Dose: 6 mg/kg/d. elemental iron inbetween
meals.
- Ferrous fumarate , sulphate, or gluconate.
- For: 6- 8 weeks after blood values are
normalized.
- Side effects: GIT upset & dark stool.

30. MANAGEMENT OF IDAMANAGEMENT OF IDA
Parentral Iron
- For malabsorption or Intolerance to oral iron or
chronic hemorrhage.
- Intravenous:1-4 mg/kg/week.
R/ Sodium ferric gluconate (Ferrlecit)or iron
hydroxide sucrose complex(Venofer).
- Intramuscular: R/ Iron dextran.
- Side effect → staining, abscess, allergy.

31. MANAGEMENT OF IDAMANAGEMENT OF IDA
4- Packed red cell transfusion in:
- Severe anemia (Hb < 4gm/dl).
- Infection interfering with iron therapy.
- Anemic heart failure (blood is given very slowly,
in small amounts; 2-3 ml/kg packed RBCs and
repeated every few hours ).

32. Failure of iron therapyFailure of iron therapy
1- Non compliance, inadequate dose,
or preparation.
2- Impaired GIT absorption.
3- Continuing blood loss.
4- Continuing use of cow milk.