Course Name: Basic Hematology

Course Code: MLTBH-902

IRON DEFICIENCY ANEMIA

SABRINA RASHID
Senior Lecturer
M. PHIL (Immunology)
 IRON DEFICIENCY ANEMIA
Learning Objectives
• Definition Anemia

• Classification

• Pathophysiology

• Laboratory diagnosis
 IRON DEFICIENCY ANEMIA
Normal iron metabolism
• The primary function is oxygen transport

• Iron is absorbed by duodenum and jejunum

• Average total body iron stores is 600-1000 mg in male

• 200 to 300 mg in female

• Approximately 2/3 found in hemoglobin

 ANEMIA

• Anemia is defined as a reduction in Hgb, Red cell

count, and Hct
• In a given age group and gender, reduction means
deficiency of red blood cells as well as deficiency
of hemoglobin
 Classification of
anemia
Causes of anemia Red cells size and their indices

-Blood loss -Hb concentration and Hematocrit

-MCV, MCH, MCHC
-Iron deficiency
-Infection
MCV MCV
-RBC destruction -IDA Normal MCV -B12
(hemolysis) -hemolytic -Folate
-Thal anemia
-B12 and Folate
deficiency
 NORMAL IRON METABOLISM

➢Iron is also stored in RE cells (BM, Spleen and liver) as hemosiderin

and ferritin

➢Also iron found in myoglobin and myeloperoxidase

➢Iron is more stable in ferric state (Fe+++) than in ferrous state (Fe++)

➢As ferrous state is soluble state

 FERRITIN
• Iron presents a problem to living organisms
• It is essential to nearly all cells but also is quite toxic
• Its toxicity comes from its propensity to form oxygen radicals
that damage cells
• A set of iron storage proteins that shield iron and prevent it from
damaging other molecules
• Yet allow it to be released when needed
 CONT….
• Ferritins are class of iron storage proteins which usually found
in bacterial, plant and animal cells
• They form hollow, spherical particles in which 2000 to 4500
iron atoms can be stored as iron(III) (i.e. Fe+++ ions)
• Ferritin and hemosiderin are storage form of iron
 CONT….
• Ferritins are composed of 24 apoferritin monomers which
associate to form a spherical particle
• Ferritin is found not only inside cells but circulating in
plasma
• Plasma levels of ferritin have sometimes been used as an
index of iron storage deficiency
 HEMOSIDERIN
• Hemosiderin is another iron-storage complex but it is always
found within cells as opposed to circulating in blood
• The iron within deposits of hemosiderin is very poorly
available to supply iron when needed
• Readily available form is ferritin
 CONT….
• Hemosiderin is most commonly found in macrophages and is
especially abundant in situations following Hemorrhage,
suggesting that its formation may be related to phagocytosis of
red blood cells and hemoglobin
• Both hemosiderin and ferritin depletion leads towards the
clinical features of anemia
 DIETARY ASPECT OF
IRON
Iron requirements

It varies depending on sex and age:

Male/female 0.5-1 mg/day

Pregnant female 1-2 mg/day

Children 0.5 mg/day

 METABOLIC ASPECT OF IRON
Absorption of iron
• Absorption is through the mucosal cells of the duodenum and jejunum

• Present in food both inorganic (ferric and ferrous) and organic form
(Heme). Heme present in meat

• On average 10% of ingested iron is absorbed

• This absorption rate varies relative to iron stores and need

 CONT….
• On absorption ferric form is converted into the ferrous form
• Transport to the bone marrow through the circulation via
Transferrin
• Transferrin (Beta globulin) assist iron delivery to the
erythroblast
• Erythroblasts are the cells where hemoglobinisation takes
place
 CONT….
• Transferrin receptors on the pronormoblast bind iron so that
iron molecules can immediately start being incorporated
into the heme molecule during erythropoiesis

• Transferrin binds two iron atoms per molecule

• Normally transferrin is 35% saturated with iron

 IRON STORAGE
• Ferritin and hemosiderin are primary storage form of iron

• These compounds are harbored in the liver, spleen, bone

marrow and skeletal muscle

• Hemosiderin is not readily available form of iron

• Whereas ferritin is readily available form

 CONT….
➢Ferritin is a universal intracellular protein that stores iron and
releases it in a controlled fashion

➢It is the primary intracellular iron-storage protein in

both prokaryotes and eukaryotes, keeping iron in a soluble and
non-toxic form
 REGULATION OF IRON UPTAKE
• Iron absorption from the intestines into the blood
stream

• Absorption increased when iron stress are depleted or

when erythropoiesis is increased

• These condition regulate the absorption of iron

 INCORPORATION OF IRON INTO THE RED BLOOD
CELL
• Transferrin bound iron in the blood is taken up by the
mononuclear phagocytic cells that line the sinuses in the bone
marrow

• In these cells iron binds apo-ferritin and is stored as ferritin or as

granules of hemosiderin
 CONT….
• Erythrocytic blast cells gather around these phagocytic cells
and engulf small granules of hemosiderin and ferritin by a
process known as ropheocytosis

• Within developing red blood cells iron remain present in the

form of ferritin until it is delivered to the mitochondria
 CONT….
• In mitochondria iron is dissociated from the apoferritin and
incorporated into the protoporphyrin ring to form heme

• The heme binds to globin to form hemoglobin

• Hemoglobin found in cells in soluble form

 CAUSES OF IRON DEFICIENCY ANEMIA

• Blood loss
• Increase demand
• Mal absorption
• Poor diet
 BLOOD LOSS

• In adult men and in post menopausal women, bleeding is

mainly from the gastrointestinal tract.
• A chronic hemorrhage caused by gastric or duodenal ulcers,
hernia, carcinoma of the stomach.
• Bleeding may be from kidneys and bladder, resulting in
hematuria and hemoglobinuria.
 INCREASED DEMAND

Three groups of people need increased amount of iron.

• Pregnant women
• Infants and young children
• Older children and adolescent
 MAL ABSORPTION

• Ciliac disease
• Partial or need gastrectomy
• Intestinal parasites such as hookworms
 SIGN AND SYMPTOMS

• Symptoms associated with general anemia e.g. weakness,

fatigue, headaches, dizziness.
• Specific signs
• Stomitis (sores at the corners of mouth)
• Glossitis (inflammation of the tongue)
• Koilonychias ( flat or spoon shaped nails)
 CONT…..

• Esophageal webbing (lesions of esophagus)

• Dysphagia (not eating)
• Pica (craving for unusual food)
 LAB DIAGNOSIS
CBC FINDINGS:
• Hemoglobin will reduced
• PCV will be reduced
• MCV,MCH,MCHC will be reduced
• RDW may be increased
 PERIPHERAL SMEAR

• Hypochromic microcytic Picture

• Occasional Target cells

• Pencil shaped poikilocytosis

• Retics count slightly low indicating a slightly ineffective

erythropoiesis
 BONE MARROW IRON

• Erythroid hyperplasia occurs

• But the development red blood cells will be hypochromic

• Prussian blue stain for hemosiderin remains negative as all

stores have been exhausted
 IRON PROFILE

• Serum iron will be decreased

• Transferrin/TIBCwill be normal to high
• Serum ferritin will be decreased
 LEARNING OUTCOMES
• Description of iron deficiency anemia

• Categorization of iron deficiency anemia

• Mechanism involve in development of anemia

• Confirmation of anemia on the basis of laboratory tests

 REFERENCES
• Andrews SC: Iron storage in bacteria. Adv Microb Physiol
40:281-351, 1998.

• Chasteen ND, Harrison PM: Mineralization of ferritin: an

efficient means of iron storage. J Struct Biol 126:182-194, 1999.

• Harrison PM, Arosio P: The ferritins: molecular properties, iron

storage function and cellular regulation. Biochimica et
Biophysica Acta 1275:161-203, 1996.
THANK YOU