Ida
-
Upload
ashok-moses -
Category
Documents
-
view
152 -
download
0
Transcript of Ida
Classification of anemia
Causes of anemia
-Blood loss.
-Iron deficiency.
-Infection.
-RBC destruction (hemolysis) e.g. G6PD.
-B12 and Folate deficiency.
Red cells size and their indices
-Hb concentration and Hematocrit
-MCV, MCH, MCHC.
MCV
-IDA
-Thal
MCV-B12 -Folat
Normal MCV-hemolytic anemia
Iron deficiency anemia
Normal iron metabolism:-The primary function is oxygen transport.-Iron is absorbed by duodenum and jejunim-Average total body iron content 3500-4000 mg.-Approximately 2/3 found in hemoglobin, -Iron is also stored in RE cells (BM, Spleen and liver) as hemosiderin and ferratin.-Also iron found in myglobin and myeloperoxidase and in certain electron transfer.-Iron is more stable in ferric state (Fe+++) than in ferrous state (Fe++).
Iron + Hem
Iron Metabolism
Iron Absorption1-2 mg only
Plasma FeTransferrin carriers
4 mg
Body stores
1000 mg (M)
300-500 mg (F)
Myglobin300 mg
20 mg FeReturned to immature RBC
in BM
RBC2500 mg
R.E. 20 mgReleased daily
Via RE system90% extra vascular5-10% intra vascular
Loss (from GI tract)1-2 mg daily
Daily Fe++ turnover continuous process
Dietary iron:Iron is present in food as ferric hydroxides (ferric-protein complexes and hem-protein complexes).-meat, liver-vegetables, eggs.-The average diet contains 10-15mg and only 5-10% is normally absorbed.
Iron requirements:It varies depending on sex and age:Male/female 0.5-1 mg/dayPregnant female 1-2 mg/dayChildren 0.5 mg/day
Clinical features:• When ID is developing, the RE stores (hemosiderin and
ferritin) become completely depleted before anemia occurs.• At an early stage, no clinical abnormalities.• Later, patient may develops general symptoms and signs of
anemia.• In severe case of IDA ridged or spoon nails.
Causes:• Chronic blood loss
Fetomaternal Hemorrhage, inherited bleeding disorders menstrual peroid.
• Maternal iron deficiency (neonate).• Growth spurts (infants and children).• Gastrointestinal,
peptic ulcer, aspirin ingestion, carcinoma, hookworm, colitis, piles etc.
• Pregnancy• Rarely hematouria, self-inflicted blood loss, hemoglobinuria.
• Insufficient daily iron intake (poor diet).• Malabsorption.
Laboratory findings:•Red cell indices:
Low Hb conc.MCV, MCH, MCHC*
•Blood film:Hypochromic microcytic Picture.Occasional Target cells.Pencil shaped poikilocytes.Normal reticulocyte count.
•Bone marrow iron:Normal to hypercellular.RBC precursors are increased in number.Iron stain negative.
•Chemical testing on serum:Serum iron Decreased Transferrin/TIBC Normal to HighSerum ferritin Decreased (Very low)
Hypochromic Microcytic picture (IDA)
-ve BM Iron Stain +ve
Reticulocytes