Download - Iron deficiency
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Iron Deficiency
Presenter :Purushottam Singh
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Objectives•Introduction•Sources and Functions of Iron•Causes of Iron Deficiency•Effects of Iron Deficiency•Lab Findings in Iron Deficiency•Treatment of Iron Deficiency
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Why a matter of concern? Anemia prevalence in Nepal In children under 5 years of age : In 1998 – 78% In 2011 – 46% Among these about 70% are under 2 years of age. In women of reproductive age group : In 1998 – 67% In 2011 – 35% Among these about 48% were pregnant women. (source: Annual health report 2011/012)
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•Majority of cases are due to deficiency of IRON.• Can be prevented. So, What do they need?
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Functions
1. O2 carrier – Haemoglobin Myoglobin
2. Energy production- Cytochromes (P450), Kreb’s cycle enzymes 3. Immunity- Peroxidases, Catalases
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Iron is an essential trace element.
Sources Meat, fish, green leafy vegetables, cereals, pulses. Mother’s milk is a poor source.
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Recommended dietary allowance (RDA)• Infants(upto 12 months)- 79 micro grams/kg• Children(1 to 3yrs)- 12mg• Children (4 to 9 yrs)- 22mg• 10 to12 yrs - 34mg(boys) 19mg(girls)• 13 to 15 yrs - 41mg(boys) 28mg(girls)• 16 to 18 yrs - 50 mg(boys) 30mg(girls)
Source: Essential Pediatrics – O.P. Ghai
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Causes Of Iron Deficiency In Infants-• Low birth weight ( preterm)• Early cord clamping ( as much as 80-100ml of
blood may remain in placenta)• If there’s hemorrhage from the cord, placenta• Later: poor intake( malnutrition), parasitic
infestation• Cow’s milk – poor source and allergy may cause
occult g.i bleeding
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In ChildrenDecreased intake - Malnutrition, poor source food
Decreased iron absorption
- High conc. of phytates, ca salts and rich fiber diet - Celiac disease and malabsorption syndrome - Achlorhydria
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Increased iron demand- Premature and LBW infants-grow rapidly
Error of iron metabolism - congenital transferrin def ( iron not utilised for
erythropoiesis but is stored in tissues.)
Increased iron loss -Hookworm infestation -Gastrointestinal bleeding - Haemorrhage -Ulcerative colitis - dysentry
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Effects of iron deficiencyFeatures of anemia:
• Pallor• Easily fatigued, breathlessness• Frequent infections
• Nails – thin brittle and flat, Koilonychia
• Pica
• Spleen enlargment (15% cases)
• Severe anaemia – cardiac enlargement, systolic and even diastolic flow murmurs, congestive cardiac failure
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Reduced weight gain and growth velocityLow endurance, decreased work capabilityPoor attentiveness, poor memoryPoor academic performanceReduced leucocyte defence capacity
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Lab Investigation
• Blood hemoglobin level
- will be decreased than normal range.
Male - <13 mg/dl Female - <12 mg/dl
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Red cell Indices Normal range Anemia•Mean cell Volume(fl) 82-96 •Mean cell hb (pg) 27-33•Mean cell hb conc.(gm/dl) 33-37•Red cell distribution width(%) 11.5-14.5 Provides an estimate of the size differences in RBCs. Low RDW – RBCs are uniform in size High RDW – marked variation in size of RBCs
RDW = SD of RBC volume x 100 mean cell voume
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•Peripheral Smear -Microcytic hypochromic anemia, decreased/normal reticulocyte count
•Plasma ferritin – decreased (<15 mcg/L)
•Serum Iron – reduced ( <30mcg/dL)
•TIBC – increased ( >350 mcg/dL)
•Transferrin saturation- markedly reduced ( <15%)
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Mentzer IndexUsed to differentiate iron deficiency anemia from beta thalassemia. Mentzer index = MCV/RBC count in millions If, >13 – iron deficiency anemia is more likely <13 – beta thalassemia is more likely
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PERIPHERAL BLOOD SMEAR
Severe iron-deficiency anemia. Microcytic and hypochromic red cells smaller than the nucleus of a lymphocyte associated with marked variation in size(anisocytosis) and shape (poikilocytosis).
Normal
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TREATMENT• Underlying cause to be treated.• Oral Iron therapy
• Commercially available preparations• Anhydrous ferrous sulphate(37%)• Exsiccated ferrous sulphate(30%)• Ferrous fumarate(33%)• Ferrous succinate(23%)
3-6mg of elemental iron/ kg body weight orally in three divided doses
-continued for at least 3 to 6 mths to replenish iron stores.
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Parenteral iron:Iron requirements are calculated from the equation:
• 2.3 x body wt(kg) x (15- observed hb in g/dl) + 500mg( for repleting iron stores)
• Given in divided doses 1-3 mg in 150ml normal saline over 30-90min.
Blood transfusion: Considered in emergency- urgent surgery, hemorrhage,severe anaemia with congestive cardiac failure.
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Prevention• Deworming• change in dietary habits• wearing shoes
• National Nutrition Program Goal is to reduce prevalence of anemia among children to less than 40% by 2017. 1)Iron tablet supplementation to pregnant and breastfeeding. 2)Multiple micronutrient powder distribution to children. 3)Deworming tablets distribution bi-annually to children.
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SUMMARY• Iron is essential for ……..
• What will happen, if deficient?
• Who are at more risks?
• What do we do? Prevention and Treatment
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References• Essential Pediatrics- O.P.Ghai 8th edition
• Pathologic Basis of Disease- Robbins and Cotran 8th edition
• Harper’s Biochmistry 25th edition