Scribd
Upload
65 views32 pages

Iron Deficiency Anaemia: LT Col Hamid Iqbal Fcps (Haem) CL Pathologist MH Rawalpindi

Iron deficiency anemia is the most common nutritional disorder worldwide, affecting over 2 billion people, many due to insufficient dietary iron intake or blood loss. Iron is essential for forming hemoglobin and myoglobin and various enzymes, with the majority stored in hemoglobin within red blood cells. Diagnosis of iron deficiency anemia involves evaluating blood counts, iron studies, and examining red blood cells and bone marrow for low iron stores.

Uploaded by

Hamid Iqbal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
65 views32 pages

Iron Deficiency Anaemia: LT Col Hamid Iqbal Fcps (Haem) CL Pathologist MH Rawalpindi

Iron deficiency anemia is the most common nutritional disorder worldwide, affecting over 2 billion people, many due to insufficient dietary iron intake or blood loss. Iron is essential for forming hemoglobin and myoglobin and various enzymes, with the majority stored in hemoglobin within red blood cells. Diagnosis of iron deficiency anemia involves evaluating blood counts, iron studies, and examining red blood cells and bone marrow for low iron stores.

Uploaded by

Hamid Iqbal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 32

IRON DEFICIENCY ANAEMIA

LT COL HAMID IQBAL


FCPS (HAEM)
CL PATHOLOGIST
MH RAWALPINDI
IRON DEFICIENCY ANAEMIA

• Most common and widespread nutritional disorder in


the world
• About 2 billion people – over 30% of the world’s
population – are anaemic, many due to iron deficiency
• In many developing countries, iron deficiency anaemia
is aggravated by worm infections, malaria and other
infectious diseases such as HIV and tuberculosis
IRON METABOLISM
• Important for formation of
• Haemoglobin
• Myoglobin
• Enzymes like cytochromes, cytochrome
oxidase, peroxidase, catalase
DISTRIBUTION OF BODY IRON
• Total quantity of Iron in the body 4-5 grams
• Haemoglobin 65%
• Myoglobin 4%
• Haem compounds 1%
• Transferrin bound 0.1%
• Storage pool 15-30%
IRON TRANSPORT & METABOLISM
Tissues
Bilirubin (excreted)
Ferritin Hemosiderin

Macrophages Heme
Degrading Hb free iron Free iron Enzymes

Transferrin-Fe .
Haemoglobin
Red cells
Plasma
Blood loss- 0.7 mg Fe Fe++ absorbed Fe excreted-0.6 mg daily
daily in menses (small intestine)
IRON ABSORPTION
IRON ABSORPTION
Factors favoring absorption Factors reducing absorption
Haem Iron Inorganic Iron
Ferrous form Fe++ Ferric form Fe+++
Acids (HCl, Vit C) Alkalis- antacids, pancreatic secretions
Solubilizing agents ( eg. aminoacids, Precipitating agents- phytates,
sugars ) phosphates, tea
Reduced serum hepcidin eg. Iron Increased serum hepcidin eg Iron excess
deficiency
Ineffective erythropoiesis Decreased erythropoiesis
Pregnancy inflammation
Hereditary haemochromatosis
CAUSES OF IRON DEFICIENCY
DIETARY: insufficient or poorly available iron, vegetarian diet
INCREASED DEMANDS: infancy, adolescence, females, pregnancy
BLOOD LOSS
UTERINE: menorrhagia, post-menopausel bleeding, parturation
GASTROINTESTINAL: oesophageal varices, hiatus hernia, peptic ulcer, aspirin ingestion,
hookworm, carcinoma of the stomach, caecum and colon, haemorrhoids
RENAL TRACT: haematuria, haemoglobinuria
PULMONARY TRACT: haemoptysis
MALABSORPTION
Gluten-induced enteropathy, gastrectomy, atrophic gastritis
DIAGNOSIS OF IRON DEFICIENCY ANAEMIA

• History and physical examination


• Blood CP
• RBC morphology & reticulocyte count
• Serum iron & TIBC
• Serum ferritin
• Haemoglobin electrophoresis
• Bone marrow examination
BLOOD CP
• Haemoglobin
• Red cell indices
• TLC
• Platelet count
RBC MORPHOLOGY
RETICULOCYTE COUNT
HAEMOGLOBIN ELECTROPHORESIS
HAEMOGLOBIN ELECTROPHORESIS

Figure 1.16 Alkaline hemoglobin (Hb)


electrophoresis. Top panel: Lane 2: Normal.
Lanes 3 and 5:β-thalassemia trait. Lane 4: HbS
disease.
BONE MARROW ASPIRATION
BONE MARROW ASPIRATE
SIDEROBLASTIC ANAEMIA
LABORATORY DIAGNOSIS OF A
HYPOCHROMIC ANAEMIA
Iron deficiency Chronic Thalassaemia Sideroblastic
Inflammation trait (α or β) anaemia
or malignancy
MCV/MCH Reduced in Normal or mild Reduced; very Usually low in
relation to reduction low for degree congenital type
severity of of anaemia
anaemia
Serum iron Reduced Reduced Normal Raised
TIBC Raised Reduced Normal Normal
Serum ferritin Reduced N or raised Normal Raised
Bone marrow Absent Present Present Present
iron stores
Erythroblast iron Absent Absent Present Ring forms
Haemoglobin Normal Hb A2 raised Normal Normal
electrophoresis in β form
MANAGEMENT
• ORAL THERAPY
Ferrous sulphate 200 mg contain 67 mg iron
Ferrous gluconate 300 mg provides 27mg iron
Adults 100-200 mg of elemental iron each day
Infants and children 3mg/kg/day
• SIDE EFFECTS such as nausea, epigastric pain, diarrhoea and constipation
• RESPONSE RATE 2g/dl rise in Hb every 3 weeks
• DURATION OF THERAPY 3-6 months
• FAILURE TO RESPOND TO ORAL IRON
• REASSESS THE DIAGNOSIS
FAILURE OF RESPONSE TO ORAL IRON
• Continuing haemorrhage
• Failure to take tablets
• Wrong diagnosis – especially thalassaemia trait, sideroblastic
anaemia
• Mixed deficiency – associated folate or vitamin B12
deficiency
• Another cause for anaemia (e.g.malignancy,inflammation)
• Malabsorption – coeliac disease, atrophic gastritis,
Helicobacter infection
• Use of slow-release preparation
MANAGEMENT
• PARENTERAL IRON THERAPY

Can not tolerate oral iron particularly if GI disease


Essential to replace body stores rapidly
Patients with CRF being treated with erythropoietin
• Ferric hydroxide-sucrose (Venofer)
• Iron dextran (CosmoFer)
• Iron sorbitol (Jectofer)
QUESTIONS???
IRON ABSORPTION
• Small intestine site of absorption
• Liver secretes apotransferrin into the bile
• Apotransferrin binds with free iron and iron
compounds hemoglobin and myoglobin from
meat tranferrin
• Transferrin taken up by enteroytes and
released into blood capillaries
DISTRIBUTION OF BODY IRON

Amount of Iron in average Male (g) Female (g) Percentage of total


adult
Haemoglobin 2.4 1.7 65
Ferritin and haemosidrin 1.0 0.3 30
Myoglobin 0.15 0.12 3.5
Haem enzymes 0.02 0.015 0.5
(cytochromes,catalase,
peroxidases, flavoproteins)
Transferrin bound Iron 0.004 0.003 0.1

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy