Iron deficiency anemia

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Iron deficiency anemia

  1. 1. IRON DEFICIENCY ANEMIA (IDA)
  2. 2. IRON 4 % of Earth’s Crust 4 ±1 gm total Body Iron in Adult Human Hb 2± 0.5 gm Storage (Fe+++) 1 ± 0.5 gm Ferritin Haemosiderin Essential iron: Myoglobin & Iron-Containing Enz. (e.g.cytochromes, catalases) Plasma 4 ± 1 mg
  3. 3. Variable ~ 450.000 Molecular weight 37 20 % of iron in the structure Variable ~4500 iron atoms /molecule of apof. Binding Visible in macrophage & normoblasts Not visible In Perls’ - reaction (Prussian blue-reaction) under light microscope Derived from partial lysosomal digestion of aggregates of ferritin molecules Apoferritin ( outer prtn.coat ) & iron-phosphate- hydroxide core structure Insoluble Water-soluble Solubility Haemosiderin Ferritin Protein-iron complex
  4. 4. Daily Iron Cycle
  5. 5. Enterocytes &Iron absorption
  6. 6. HEPCIDIN <ul><li>A polypeptide produced by the liver </li></ul><ul><li>The major hormonal regulator of </li></ul><ul><li>iron homeostasis </li></ul><ul><li>It inhibits iron release from macrophages, intestinal epithelial cells & from placental syncytiotrophoblasts </li></ul><ul><li>by accelerating degradation of ferroportin mRNA </li></ul><ul><li>Iron deficiency , hypoxia & ineffective erythropoiesis </li></ul><ul><li>inhibits hepcidin production </li></ul><ul><li>iron release from pre-mentioned cells </li></ul><ul><li>As acute phase protein, </li></ul><ul><li>hepcidin production is induced by inflammation via IL-6 </li></ul>
  7. 9. Ancylostoma
  8. 10. Sequence of Events in IDA
  9. 11. SEQUENCE OF EVENTS IN IDA I Hb 15 g/dL RCC 5 million/ µL MCH 30 pg Hct. 45 % MCHC 33 g/dL MCV 86 fL Serum Iron UIBC 20 µmol/L 40 µmol/L TIBC= 60 µmol/L Saturation 33% p.ferritin N. 15-300 µg/L WBC 7,500/µL Platelet 400,000/µL
  10. 12. SEQUENCE OF EVENTS IN IDA II BLEEDING 40 ml/ Day 20 mg IRON Iron Absorption up to 5 mg/Day Net Daily Loss= 20-5 = 15 mg 1500 ------ = 100 Days 15 Latent Iron Deficiency No Clinical Features Normal Blood Values If Iron Stores= 1500 mg
  11. 18. 1/3 of ACD are microcytic hypochromic Causes of microcytic hypochromic anemias The 1 st step in the evaluation of microcytic anemia is to rule out IDA, HOW ?

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