Iron deficiency anemia

Iron Deficiency Anemia

Mr.Abdulaziz R. Alanzi

Medical Student, Al-Imam University

Riyadh – Saudi Arabia

Objectives

1. Normal physiology & structure of Hb

2. Metabolism of iron

3. Iron Deficiency Anemia:

- Definition

- Causes & RFs

- Pathophysiology

- S & S

- Investigations

- Management

- Complications

- Prevention

- Differential Diagnosis

Normal physiology & structure of Hb

Normal physiology & structure of Hb

Globular protein contain Heme + Globin Accounts for > 95% of protein in RBC

Main functions: transportation of respiratory gases. It carries ~ 98.5% of all O2

Concentration of Hb in the Blood: Measured as g/dl (grams per deciliter, or per 100 ml)

Average values:

Male: 14-18 g/dl

Female: 12-16 g/dl

Infants: 14-20 g/dl

Haematological indices

Mean corpuscular volume (MCV): The average size of the red blood cells expressed in femtoliters (fl).

Normal value: 80-95 femtoliters (10-15 liters) abbreviated fl.

- Macrocytic anemias– larger than normal cells

- Normocytic anemia (MCV = 80-95 fl) – cells are normal in volume.

- Microcytic anemias– cells are smaller than normal.

Mean corpuscular Hb (MCH):

The average amount of hemoglobin inside a RBC expressed in picograms (pg).

Normal value: 27-33 pg (10-12 gram) - Normochromic

- Hypochromic

- Hyperchromic

Metabolism of iron

Metabolism of iron

(Adapted from Bothwell TH, Charlton RW, Cook JD, Finch CA: In Iron Metabolism in Man. Oxford, UK: Blackwell Scientific, 1979, p 24.)

Metabolism of iron

Metabolism of

iron

Source: http://emedicine.medscape.com/article/202333-overview#aw2aab6b2b3aa G

Fate of Components of Heme

Source: Dr.Ahmed Alshafei Lecture

• Iron(Fe+3) - transported in blood attached to transferrin protein - stored in liver

* attached to ferritin or hemosiderin protein

- in bone marrow, iron is used for hemoglobin synthesis

• Biliverdin (green) is converted to bilirubin (yellow) - bilirubin is secreted by liver into bile

* converted to urobilinogen then stercobilin (brown pigment in feces) by bacteria of large intestine

* if urobilinogen is reabsorbed from intestines into blood is converted to a yellow pigment, urobilin and excreted in urine

Definition of IDA

Definition of IDA

Anemia is defined as a reduction in the oxygen-carrying capacity of the blood caused by a diminished erythrocyte mass.

Iron deficiency anemia develops when body stores of iron drop too low to support normal red blood cell (RBC) production. Inadequate dietary iron, iron absorption, bleeding, or loss of body iron in the urine may be the cause.

HGB<13.5 g/dL (men) <12 (women)

HCT<41% (men) <36 (women)

a ferritin concentration of more than 100 ng/mL (100 mg/L) effectively rules out iron deficiency, and a ferritin of less than 15 ng/mL (15 mg/L) rules in iron deficiency.

More common in women as a result of menstrual losses

Causes & RFs

RFs of IDA in Pregnancy

Pregnant with more than one child

Two pregnancies close together

Vomiting a lot because of morning sickness

Teenager who is pregnant

Not enough foods that are rich in iron

Heavy periods before pregnancy

Source : http://www.webmd.com/baby/guide/anemia-in-pregnancy

Pathophysiology

Pathophysiology

Increase demands of iron

Increase iron loss

Decrease iron intake

S & S

Symptoms of anemia (eg, easy fatigability, tachycardia, palpitations and tachypnea on exertion)

Skin and mucosal changes (eg, smooth tongue, brittle nails, spooning of nails [koilonychia], and cheilosis) in severe iron deficiency

Dysphagia resulting from esophageal webs (Plummer-Vinson syndrome) may occur in severe iron deficiency

Pica (ie, craving for specific foods [eg, ice chips, lettuce] often not rich in iron) is frequent

Source: Chapter 103. Iron Deficiency and Other Hypoproliferative Anemias

Investigations

Investigations

Useful tests include the following:

Complete blood count

Peripheral blood smear

Serum iron, total iron-binding capacity (TIBC), and serum ferritin

Evaluation for hemosiderinuria, hemoglobinuria, and pulmonary hemosiderosis

Hemoglobin electrophoresis and measurement of hemoglobin A2 and fetal hemoglobin

Reticulocyte hemoglobin content

Source: http://emedicine.medscape.com/article/202333-overview

Investigations

Tests useful for establishing the etiology of iron deficiency anemia and excluding or establishing a diagnosis of another microcytic anemia include the following:

Stool testing

Incubated osmotic fragility testing

Measurement of lead in tissue

Bone marrow aspiration


Investigations

CBC results in iron deficiency anemia include the following:

Low mean corpuscular volume (MCV)

Low mean corpuscular hemoglobin concentration (MCHC)

Elevated platelet count (>450,000/µL) in many cases

Normal or elevated white blood cell count


Investigations

Peripheral smear results in iron deficiency anemia are as follows:

RBCs are microcytic and hypochromic in chronic cases

Platelets usually are increased

In contrast to thalassemia, target cells are usually not present, and anisocytosis and poikilocytosis are not marked

In contrast to hemoglobin C disorders, intraerythrocytic crystals are not seen


Investigations

Results of iron studies are as follows:

Low serum iron and ferritin levels with an elevated TIBC are diagnostic of iron deficiency

A normal serum ferritin can be seen in patients who are deficient in iron and have coexistent diseases (eg, hepatitis or anemia of chronic disorders)


Management

Management

Symptomatic elderly patients with severe iron-deficiency anemia and cardiovascular instability may require red cell transfusions.

Younger individuals can be treated more conservatively with iron replacement.

For the majority of cases of iron deficiency (pregnant women, growing children and adolescents, patients with infrequent episodes of bleeding, and those with inadequate dietary intake of iron), oral iron therapy will suffice. For patients with unusual blood loss or malabsorption, specific diagnostic tests and appropriate therapy take priority. Once the diagnosis of iron-deficiency anemia and its cause is made, There are three major therapeutic approaches.

1- RED CELL TRANSFUSION:

2- ORAL IRON THERAPY

3- PARENTERAL IRON THERAPY: saccharated ferric oxide (SFO) and cideferron (CF), for those who are not tolerated with oral iron therapy.

Source: Harrison’s Principles of Internal Medicine 17th edition

Complications

Complications

Effects of Anemia in Pregnant Women

Pregnant women with significant anemia may have an increased risk for poor pregnancy outcomes, particularly if they are anemic in the first trimester.

Complications from Anemia in Children and Adolescents

In children, severe anemia can impair growth and motor and mental development. Children may exhibit a shortened attention span and decreased alertness. Children with severe iron-deficiency anemia may also have an increased risk for stroke.

Effects of Anemia in the Elderly

Anemia is common in older people and can have significantly more severe complications than anemia in younger adults. Effects of anemia in the elderly include decreased strength and increased risk for falls. Anemia may have adverse effects on the heart and increase the severity of cardiac conditions, including reducing survival rates from heart failure and heart attacks. Even mild anemia may possibly lead to cognitive impairment or worsen existing dementia.

Iron Overload

Source: http://www.umm.edu/patiented/articles/what_symptoms_of_anemia_000057_4.htm#ixzz2P9eHzfYJ

Prevention

Prevention

Good food sources of iron include the following:

Meats--beef, pork, lamb, liver, and other organ meats

Poultry--chicken, duck, turkey, liver (especially dark meat)

Fish--shellfish, including clams, mussels, oysters, sardines, and anchovies

Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards

Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans

Yeast-leavened whole-wheat bread and rolls

Iron-enriched white bread, pasta, rice, and cereals

Source: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02428

Prevention

Vitamin supplements containing at least 400 micrograms of folic acid are now recommended for all women of childbearing age and during pregnancy. Food sources of folate include the following:

Leafy, dark green vegetables

Dried beans and peas

Citrus fruits and juices and most berries

Fortified breakfast cereals

Enriched grain products

Source: https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02428

Differential Diagnosis

Differential Diagnosis

Microcytic anemia resulting from other causes

Thalassemia Anemia of chronic disease Sideroblastic anemia Lead poisoning

Source: Quick Medical Diagnosis & Treatment Book

Thank [email protected]@AbdulazizEnazi

:// . . /http imamu academia edu AbdulazizAlanzi

http://imamu.academia.edu/AbdulazizAlanzi

Iron deficiency anemia

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