IDA Presented by: Awatif K. Al-Mutairi Hind K. Bin-Drees Sarah N. Al-Gubaisi Supervised by: Dr....
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Transcript of IDA Presented by: Awatif K. Al-Mutairi Hind K. Bin-Drees Sarah N. Al-Gubaisi Supervised by: Dr....
IDA
Presented by:Awatif K. Al-MutairiHind K. Bin-Drees
Sarah N. Al-Gubaisi
Supervised by:Dr. Al-Johara Al- Quaiz
IDA
Red Eye
Iron deficiencyAnaemia
acne
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RED EYEOutlines:• What is red eye?• Red eye in PHC.• DDx.• How to deal with pt. with red eye?
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Anaemia
What is Anaemia ?
It is a Greek word = “ Bloodlessness”
It is a ↓ in the level of Hb in the blood below the reference range for the age and sex of the individual .
Usually there is reduction RCC and PCV
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Normal Blood indices
Hb (g/dl)♂ 13 - 18
♀ 12 - 16
PCV (Hct) (%)♂ 42 - 52
♀ 37 - 47
RCC (1012/ L)♂ 4.7 – 6.1
♀ 4.2 – 5.5
MCV (fL)80 – 94
MCH (Pg)27 – 32
MCHC ( g/dl)32 – 36
RDW (%) 11.5 – 14.5
ESR (mm/hr)0 – 10
Reticulocytes (%)0.2 – 2.0
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Cut Offs for WHO definition of Anaemia
Age or sex groupHeamoglobin
Below (g/dl)
Heamatocrit
Below (%)
Children 0 – 60 months11.033
Childern 5 – 11 years11.534
Children 12 – 15 years12.036
Non-pregnant women12.036
Pregnant women11.033
Men 13.039
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Iron Metabolism
Absorption of iron occur primarily in the duodenum in the form of ferrous(Fe+2) , in a rate of 1-2mg/ dayIn serum Fe is bound to transferrin , & ⅓ is saturated Fe is stored as ferritin and haemosidrin in hepatocyte , Sk. Ms. , reticuloendothelial macrophages 1mg/day is lost through skin , mucosal cells , sweat, urine , faeces and menses
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Daily requirements
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Men 1 mg
Adolescence 2-3 mg
Women (reproductive age)
2-3 mg
Pregnancy 3-4 mg
Infancy 1 mg
Maximum bioavailability from normal diet about 4 mg
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Prevalence of IDA
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Iron deficiency is the most common and widespread nutritional disorder in the world
The World Health Organization estimated that about 40% of the world’s population (more than 2 billion individuals) suffer from anaemia, and that approximately 50% of all anaemia can be attributed to iron deficiency
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Prevalence in Saudi arabia
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Prevalence among women ranged from 20 -50%
in a study of 1,210 primary school girls aged 7-14, in Riyadh, Saudi Arabia, an anaemia level of 55.4% was found. The highest level (71.4%) was found among 14 year-old girls
Anaemia was reported among 20.5% of school students in general
And it is about 36-37% in preschool children
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Epidemiology
Age : very young (6-24m), preschool children , during puberty and in old ages
Gender : adolescent females are more prone than males
Physiology : pregnant & lactating women
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Etiology and Risk factors
Chronic blood loss Uterine Gastrointestinal : peptic ulcer, esophageal varices , aspirin or NSAID ingestion , partial gastictomy , GIT Ca, Hookworm , angiodysplasia , colitis… Heamosidrenosis , self induced blood lossIncrease demand Prematurity Growth Pregnancy
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Malabsorption
Celiac disease , gluten-induced enteropathy , atrophic gastritis ,gasterctomy , chronic diarrhea , IBD
Poor diet
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Clinical Features
Symptoms
Fatigue , feeling tired
Faintness
Breathlessness
Angina pectoris , palpitation
Intermittent claudication
Decreased attention span , behavioral & developmental problems
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Signs
Pale skin & mucus membranes
Spoon nails ( Koilonychias )
Painless glossitis
Angular stomatitis
Brittle hair & nails
Dietary craving (Pica)
Dysphagia
Tachycardia
Systolic flow murmur
Cardiac failure signs
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Investigations & DDx
CBC & indices RBC MCV MCH MCHC RDW
Reduced in relation to severity Of anaemia
Increased
RDW = SD of RBC volume (fL) / MCV x 100
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Iron profile
serum ferritin ( reflects stores )is lowlow
serum iron is lowlow
total iron binding capacity (TIBC) is HighHigh
transferrin saturation < 19%
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Deferential Diagnosis
MCV < 80 fL ( Microcytic )
Anaemia of chronic disease
Thalassaemia
Sideroblastic Anaemia
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Consequences of IDA
Iron deficiency adversely affects the cognitive performance, behaviour, and physical growth , language of infants, preschool and school-aged children; the immune status and morbidity from infections of all age groups; and the use of energy sources by muscles and thus the physical capacity and work performance of adolescents and adults of all age groups.
Specifically, iron deficiency anaemia during pregnancy increases perinatal risks for mothers and neonates; and increases overall infant mortality.
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Management of IDA
Find and treat the underlying cause
Oral iron
ferrous sulfate 200 mg/3/day/6m →
↑ reticulocytes count , then
↑ Hb 1 g/ dl / week
Others ferrous fumarate, gluconate
Liquid preparation → infants & children
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Parentral iron IM or IV (iron dextran) → rarely used , when the patient cannot tolerate oral iron , OR poor response to oral e.g. sever malabsorption
Blood transfusion ( Hb < 3mg/dl )
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Possible side-effects associated with iron medication Epigastric discomfort, nausea, diarrhoea, or constipation may appear with a daily dose of 60 mg or more. If these symptoms occur, supplement should be taken with meals. Faeces may turn black, which is not harmful. Treatment should continue. All iron preparations inhibit the absorption of tetracyclines, sulphonamides, and trimethoprim. Thus, iron should not be given together with these agents.
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Referral
When ?
Sever anaemia with
pregnancy beyond 36 weeks
respiratory distress + cardiac abnormalities
no improvement or worsening with Rx
Blood in stool or melena
Evidence of chronic disease (TB , hepatosplenomegaly )
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Prevention
Supplementation with medical iron
Education and associated measures to increase dietary iron intake
Control of infections
Fortification of food with iron
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Preventive measures is given mostly to pregnant women and young children
Others : schoolchildren, adolescent , and non-pregnant women( WHEN?)
The best way to prevent IDA is . . . .?
Iron is found in meat , liver , cereals , raw green vegetables, fortified food .
It is best to eat food that contain vit. C with non-meat source of iron
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For more information about IDA
WHO
http://www.who.int/ar/index.html
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Case 1
Nora is a 25 years Saudi lady , a mother of 2 children aged 1.5 years , 3 monthsShe came to the clinic complaining of decrease of her energy , weakness , and headacheshe is breast feeding her baby and there is no history of nausea ,vomiting , diarrhea or blood in her stoolReview of other systems was not significant
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on examination she was underweight with
BP 120/70
Pulse 92 / min
Temperature 37.0 C
Pale mucus membranes,
And no other significant findings
What is your next step?
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Nora’s lab results were: RBC 4*10.012/L Hb 77 g/dl Hct 25.5% MCV 61.1 fLMCH 18.5 pgMCHC 303 g/lRDW 20.1 %
What is her diagnosis ? And how would you manage Nora ?
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Case 2
Waleed is a 22 years old Saudi gentleman , a student Waleed is complaining of mild fatigue that gradually worsen over the last 6 months , he also noticed a decrease in his studying & working toleranceThere is no Hx of change of sleep , mood ,appetite , concentration No diarrhea , vomiting , blood in the stool .
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On his examination he was pale and had a
BP 110/85Pulse 82/ min Temp 37.1 COther systems were normal
What else you will do ?
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Waleed’s lab results were
RBC 3.8 *10.012/L
Hb 110 g/ l
Hct 37%
MCV 75 fL
MCH 30 pg
MCHC 321 g/L
RDW 13.4 %
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• After 2 weeks • There was no improvement in his
condition • His iron profile was Ferritin level was normal 200 ng/ml Serum iron , normal 60ng/ml TIBC , normal 320 ng/dl
What is next ?
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Acknowledgment
I am grateful to all the Haematology Lab team who provided me with the materials that I need for my presentation , especially Dr. Laila Al-Quaiz .
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References
INACG 1998 .Guidelines for the use of iron supplement to prevent and treat IDA. WHO, GENEVA 1989 .Preventing and controlling IDA through primary health care , a guide for health administrators and programme managers . Cook J.D.Defining optimal body iron . Proceeding of the Nutrition Society 1999 ; 58,489-495Al-Quaiz J.M. IDA : a Study of risk factors. Saudi Med J 2001; vol. 22 (6):490-496WHO 2001.IDA assessment , prevention , and control : a guide for programme managersGuidelines and Protocol Advisory Committee 2004 . Investigations and Management of IDUNICEF/ WHO Regional Consultation 1999 . Prevention and Control of IDA in Women and ChildrenWHO 2004 .Focusing on anaemia , Towards an integrated approach for effective anaemia control
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