Iron Anemia

8/12/2019 Iron Anemia

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I.DEF ANEMIA

6/1/2014

Dr mukhtar jama nour, MBBS

Amoud university for health and science institute

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Anemia Basics

Iron def. anemia is either due to.

1. Ineffective RBC production2. Accelerated destruction of the RBC

or

3. Increased demand or consumption

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Most common cause of anemia worldwide

Most important cause of iron deficiency anemia is

parasitic infection - hookworms, whipworms androundworms

IDA

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A diet containing 810mg of iron daily is necessary for

optimal nutrition

1mg of iron must be absorbed each day - Absorbed in

the proximal small intestine

GENERAL FEATURES

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Meat

Liver

Kidney Egg-yolk

Green vegetables

Fruits**** Cows milk- poor source of iron

Iron sources:

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Distribution of body iron: (adults)

- Hemoglobin: 2.3 gm

- Storage (ferritin / haemosiderin) : 1.0 gm- Non-available tissue iron: 0.5 gm

- Transport iron: 3-4 mg

Iron metabolism:

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Iron absorption:

Depends uponBody stores of iron

- Rate of erythropoiesis- Iron needs of the body

Increased absorption in presence of:

- vitamin C

- fruit juices- lactose

- amino acids- cystine, lysine ,

histidine,

- gastric Hcl Decreased absorption : - phytates

- tannic acid

- calcium salts

- phosphates6/1/2014 7


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Iron Metabolism:

Figure 16-8: Iron metabolism6/1/2014 8


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Increased physiological demand:

- growing children (6-24 months)

- adolescence

- women during reproductive ages

Pathological blood loss:-chronic loss E.g GI loss

Inadequate intake of diets rich in iron:

-nutritional deficiency-decreased absorption- gastroenterostomy/

tropical sprue/ coeliac disease

Pathogenesis of IDA:

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High Hb conc of the newborn falls during the first 2

3 mo - considerable iron is stored - usually sufficient

for blood formation in the first 69 mo of life in term

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The most important cause world-wide is

infestation with parasitic worms

(hookworms-suck 0.03- 0.2 ml of blood per

worm /day),whipworms, roundworms

Dietary insufficiency

Malabsorption

ETIOLOGY

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Chronic blood loss - occult bleeding : peptic

ulcer, Meckel diverticulum, polyp, hemangioma,

inflammatory bowel disease, Intravascular

hemolysis and hemoglobinuria

Chronic diarrhea

Milk allergy

ETIOLOGY

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DemograpghicEldery, Teenager, Female

Dieatarylow Iron, low Vit C, excess

phytate,tea coffee,

Social and physicalpoverty,alcohol

abuse,GIT ds

Risk factors for IDA

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Pallor is the most important sign

Look for pallor : FACE, nails, palms, conj, mucusmembranes

Pagophagia (pica for ice) / picaAnxiety , Poor appetite

Below 5g/dL: irritability and anorexia are prominent

Tachycardia and systolic murmurs-dyspnea,Palpitations

CLINICAL FEATURES

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Hair loss and lightheadedness

Fainting

Sleepiness, Tinnitus Mouth ulcers, Glossitis ,Angular cheilitis

Constipation

Depression, Twitching muscles, Tingling,numbness or burning sensations

CLINICAL FEATURES

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Koilonychia (spoon-shaped nails) ,

Platynychia

Weak,brittle nails

Pruritus

Dysphagia due to formation of esophageal

webs (Plummer-vinson syndrome

clubbing

CLINICAL FEATURES

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Platynychia

6/1/2014

Download more documents and slide

shows on The Medical Post [

www.themedicalpost.net ]

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pallor

6/1/2014

Download more documents and slide

shows on The Medical Post [

www.themedicalpost.net ]

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Koilonychia - spoon shaped nail

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Neurologic and intellectual function

Affects attention span, alertness,

Verbal learning and memory

CLINICAL FEATURES

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First: Tissue iron stores represented by bone marrow hemosiderin

disappear

Serum ferritin decreases

Next: Serum iron level decreases

Serum transferrin,S. iron-binding capacity of the - increases

Percent saturation (transferrin saturation) falls below normal

Response to low Hb:

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Response to low Hb:

Later:Microcytosis, hypochromia, poikilocytosis,and increased RBC distribution width (RDW)

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1.complete blood count (CBC)

- High RBC distribution width (RDW) -

reflecting an increased variability in the size of

red blood cells (RBCs).

- A low MCV, and MCHC

2. Hemoglobin (Hb)&hematocrit (Hct) value

low

3. Reticulocyte - normal or moderately elevated

Diagnosis - LABORATORY INVESTIGATIONS

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3.Peripheral blood smearmicrocytic

hypochromic anemia, target cells,

hypochromic pencil-shaped cells, and

occasionally small numbers of nucleated RBC

Diagnosis - LABORATORY INVESTIGATIONS

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4. Diagnostic tests

- Serum ferritin- low

- Serum iron - low- Serum transferrin -elevated

- Total iron binding capacity (TIBC) - high

5.Stool for occult blood6.Stool for - hookworm and whipworm

LABORATORY INVESTIGATIONS

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Gold standard

Bone marrow aspiration, with the marrow

stained for iron -Bone marrow is hypercellular,

with erythroid hyperplasia

Leukocytes and megakaryocytes are normal

No stainable iron in marrow reticulum cells

Diagnosis:LABORATORY INVESTIGATIONS

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Oral administration - ferrous salts (sulfate, gluconate,fumarate) -46mg/kg of elementaliron

Consumption of milk should be limited

Blood loss from intolerance to cow'smilk proteins is reduced

The amount of iron-rich foods is

increased

TREATMENT

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Incorrect diagnosis (eg, thalassemia)

Patient is not taking the medication

Not absorbed (enteric coated?)

malabsorption syndromes

gastrectomy/celiac disease

Rapid iron loss?

Anemia of chronic disease-impairs bonemarrow response

Oral iron failure?

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Parenteral iron preparation (iron dextran) : Intoleranceto oral iron, severe gastrointestinal complaints

Packed or sedimented RBCs : with Hb values < 4g/dL

congestive heart failure: fresh-packed RBCs should beconsidered

TREATMENT

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12

24 hr Replacement of intracellular iron enzymes; subjective

improvement; decreased irritability; increased Appetite

3648 hr

Initial bone marrow response; erythroid hyperplasia4872 hr

Reticulocytosis, peaking at 57 days

430 days

Increase in hemoglobin level13 mo

Repletion of stores

RESPONSES TO IRON THERAPY

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Iron Anemia

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