The measure of sincerity of a person is his devotion towards his God. A person not sincere to his creator can never be faithful to people…

BYDR. PIRAH KORAI

fcps-ii traineecmc larkana

Definition of anemiaIron metabolismEtiologyGroups at higher riskSymptomsDiagnosisTreatmentComplications

ANEMIAANEMIA

is defined as the condition in is defined as the condition in which blood lacks adequate which blood lacks adequate healthy RBCs which carry healthy RBCs which carry O2 to tissues.O2 to tissues.

NORMAL BLOOD ANEMIA

NORMAL IRON DEPLETION

IRON DEFICIENT ERYTHROGENESIS

IDA

SERUM FERRITIN 50-300 g/l

MARROW IRON STORAGE

2+ ABSENT ABSENT

SERUM IRON 50-150 g/dl NORMAL

TOTAL IRON BINDING CAPACITY

250-450 g/dl

NORMAL

% IRON SATURATION OF TRANSFERIN

25-50 25-50 <15 <10

SIDEROBLAST 40% 40% <10% <5%

RBCs MORPHOLOGY

NORMAL

NORMAL NORMAL MICROCYTIC HYPOCHROMIC

1) Blood loss a) Menorrhagia b) Chronic internal bleeding ~ A bleeding ulcer, colon, polyps, CA ~ Regular use of NSAIDs ~ Hookworm infestation ~ Severe injury or surgery

2) Decreased Iron intake

3) Decreased Iron absorption a) Intestinal disorders ~ Crohn’s disease ~ Celiac disease b) Regular use of stomach acid blockers c) certain foods like milk, tea, coffee

4) Increased Iron requirement juvenile age, pregnancy, lactation

Pregnant women

Children < 2 years

Lactating women

Severely malnourished

children< 5 years

Vegetarians

GROUPS

AT

RISK

Anemia in pregnancy is multifactoral in etiology mainly caused by deficiency of iron & folic acid.

½ of all pregnant ladies develop IDA.

The condition can increase a pregnant women’s risk for:

premature birth low birth weight Prenatal mortality Maternal death

Iron is an essential nutrition not only for growth, health & survival of children but also for the development & cognitive functioning.

IDA is significantly associated with poorer learning ability, altering motor functioning & behavioral changes.

IDA has a -ve effect on physical growth.

GENERAL & CHARACTERISTICS

CHARACTERISTICS SYMPTOMS

Glossitis, stomatitisdysphagia due to formation of esophageal webs ( Plummer-Vinson syndrome )Atrophic gastritisDry, pale skinKoilonychias Blue scleraeHair lossPICA (appetite for non food substances such as an ice, floor, clay)Restless legs syndromeSplenomegaly ( 10% )Increased platelet count

Microcytosis, Hypochromia,

Anisocytosis, Poikilocytosis

Absence of stainable iron

High cellularity

Mild to moderate erythroid hyperplasia (25-35%; N 16 – 18%)

Polychromatic and pyknotic cytoplasm of erythroblasts is vacuolated and irregular in outline (micronormoblastic erythropoiesis)

Reticulocyte count

Hematodrit

Serum Ferritin

Serum iron level

Transferin level

Total iron binding capacity(TIBC)

Hemoglobin electrophoresis

Endoscopy

Colonoscopy

Find the cause & treat it

Nutritional & dietary supplementation

Iron

Vitamin c

Epoetin

Gynecological approach

Medical & surgical procedures

ANIMAL SOURCERed meat e.g. beef, liver

Chicken, turkey, fish, shell fish, pork

Egg

PLANT SOURCESpinach, peas & other dark green leafy vegetables

Peanuts, peanut butter, almonds

Dried fruits such as raisins, apricots, peaches

MINERAL SUPPLEMENTS ORAL

iron supplements, usually with iron (II) sulfate, ferrous gluconate, or iron amino acid chelate ferrous bisglycinate, synthetic chelate NaFerredetate, EDTA .

PARANTERALiron dextran ( using a drip or hemodialysis )

FORTIFIED FOODS

CEREALS

BREAD

PASTA

Sources are:

Citrus fruits

e.g. orange, grape fruits

Vegetables

e.g. broccoli, tomatoes, potatoes, cabbage, leafy green vegetables

Blood transfusion

Surgery

COMPLICATIONS

Heart problems

Problems during pregnancy

Growth problems

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