Download - 2..iron deficiency of anemia.2
Iron Deficiency of Anemia Iron Deficiency of Anemia
General MetabolismMorphology
Clinical Manifestations & diagnosis Treatment Prognosis
PROF: DR. RAFI AHMED GHORIPROF: DR. RAFI AHMED GHORIMedical Unit-IV Medical Unit-IV Liaquat University of Medical & Health Liaquat University of Medical & Health Sciences, JamshoroSciences, Jamshoro
Iron Deficiency AnemiaGeneral
Iron Deficiency AnemiaGeneral
Probably most common nutritional disorders world-wide.
In the U.S.A most particularly common in toddlers, adolescent girls, women of child-bearing Age.
Etiology of IDA varies a little depending on populating group
Iron Deficiency AnemiaMetabolism
Iron Deficiency AnemiaMetabolism
Total body iron contents
women: ~2gm
• women have smaller store of iron than do men even healthy
young
men: ~6gm
Functional versus storage compartments
Functional: ~80% in hemoglobin
• reminder in mayoglobin, catalase, cytochromes
Storage: ~15-20% in hemosiderin, ferritin
Iron Deficiency AnemiaMetabolism
Iron Deficiency AnemiaMetabolism
Storage Ferritin protein iron complex
particularly found in liver, spleen, bone marrow, skeletal muscles
Liver: most stored in parenchymal cells Other tissue: most stored in mononuclear
phagocytic cells Within cells, protein shells degraded, iron
aggregated into hemosiderin granules
Iron Deficiency AnemiaMetabolism
Iron Deficiency AnemiaMetabolism
Storage Ferritin (cont’d)
Only trace amounts of hemosiderin usually found
- principally in reticuloendothelial cells in BM, spleen, and liver
Very small amounts of ferritin in plasma- level is very good indicator of body iron storage
Storage iron pool important- readily mobilizable
Iron Deficiency AnemiaMetabolism
Iron Deficiency AnemiaMetabolism
Mucosal uptake
Iron Deficiency AnemiaMetabolism
Iron Deficiency AnemiaMetabolism
Transport of iron
In plasma: transferrin, usually ~33%saturated with iron
Transferrin delivers iron to cells Immature RBCs possess high-affinity receptors for
transferrin
Iron Deficiency AnemiaMetabolism
Iron Deficiency AnemiaMetabolism
Body losses of iron are limited Iron balance is maintained largely by regulation of
absorptive uptake Factors are largely unknown
• Rate and level of absorption are dependent on total body iron content and erythropoietin
activity (need of erythroid precursors) As body storages rise, % of absorbed iron falls With ineffective erythropoieses, iron absorption
increases
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
Iron requirement: 1 to 1.5 mg./day, so about 1 mg. must be absorbed /day
only 10-15% of ingested iron is absorbed
• daily iron requirement 5 to 10 mg. for men
• 7 to 20 mg. for women average deit in “Western” world 15 to 20
mg.
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
Bioavailability is imoportant heme iron is more absorbable than
inorganic iron
- absorption or inorganic iron influenced by other dietary contents
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
Dietary lack Impaired absorption increased requirement Chronic blood loss
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
Dietary lack Rare in industrialized countries with
abundant food supplies (including meat)• Elderly • Very poor• Infants• Children
More common in developing countries where food is less abundant
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
Impaired absorption Sprue Intestinal steatorrhea Chronic diarrhea Gastrectomy Food items
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
Increased requirement Growing infants and children adolescents Premenopausal (particularly pregnant)
women• economically deprived women multiple and
frequent pregnancies
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
chronic blood loss Most important cause in Western world External hemorrhage depletes iron reseves GI tract
ulcers, gastritis, carcinoma, hemorrhoids, parasitic diseases
Urinary tract Tumors
Genital tract Menorrhagia, uterine cancer
Iron Deficiency Anemia Etiology
Iron Deficiency Anemia Etiology
Iron deficiency in adult men and postmenopausal women in the “Western” world
GI blood loss should be top differential, unless proven otherwise
Iron Deficiency AnemiaClinical and laboratory Iron Deficiency AnemiaClinical and laboratory
Hypochromic, microcytic anemia Other changes (in long-standing deficiency)
Koilonychia Alopecia
Atrophic changes in tongue and gastric mucosa
Intestinal malabsorbtion
Iron Deficiency AnemiaClinical and laboratoryIron Deficiency AnemiaClinical and laboratory
Plummer-Vinson syndrome
(AKS Paterson-Brown-kelly syndrome) Microcytic hypochromic anemia Atrophic glossitis
Esophageal webs
Iron Deficiency AnemiaClinical and laboratory Iron Deficiency AnemiaClinical and laboratory
In early stages of blood loss (of negative iron balance), reserves usually adequate to maintain normal Hgb/Hct,serum iron, transferrin saturation
Depletion of reserves eventually lowers serum iron, transferrin saturation
Bone marrow attempts to keep up with increase erythroid activity
Iron Deficiency AnemiaClinical and laboratory Iron Deficiency AnemiaClinical and laboratory
anemia appears when all iron stores are depleted
low serum iron, low transferrin saturation,
low serum ferritin
Iron Deficiency of Anemia Morphology
Iron Deficiency of Anemia Morphology
Bone marrow Mild to doderate increase in erythropoietic activity
• Increased normoblasts Stainable iron disappears
Peripheral blood smear red cells are small (microcytic) pale (hypochromic)
HYPOCHROMIC, MICROCYTIC PICTURE OF
R.B.Cs
HYPOCHROMIC, MICROCYTIC PICTURE OF
R.B.Cs
Iron deficiency Anemia Clinical and Laboratory Iron deficiency Anemia Clinical and Laboratory
Dominating signs often related to underlying cause fe anemia
Diagnosis rests on laboratory studies Decreased Hgb/Hct
Hypothermia, microcytosis, poikilocytosisSerum iron, serum ferritin lowTotal plasma iron-binding capacity high Decreased transferrin saturation
Laboratory Findings Laboratory Findings
Lab Testing Algorithm for Lab Testing Algorithm for Iron Deficiency Anemia (IDA)Iron Deficiency Anemia (IDA)
Iron deficiency Anemia
Differentials Diagnosis
Iron deficiency Anemia
Differentials Diagnosis
Spherocytosis, hereditary Thalassemia, Alpha Thalasseamia, Beta Anemia of chronic disorders Hemoglobin CC disease Hemoglobin DD disease Lead poisoning Microcytic anemias Sideroblastic anemias
Iron deficiency Anemia Treatment
Iron deficiency Anemia Treatment
Medical Care:• Iron deficiency should be treated with oral or
injectable iron.
• Diet
• underlying etiology should be corrected so the deficiency does not recur.
Surgical Care:• Surgical treatment consists of stopping hemorrhage
and correcting the underlying defect.
Iron deficiency Anemia Prognosis
Iron deficiency Anemia Prognosis
Iron deficiency anemia is an easily treated disorder with an excellent outcome; however, it may be caused by an underlying condition with a poor prognosis, such as neoplasia. Similarly, the prognosis may be altered by a comorbid condition such as coronary artery disease.