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Iron

The document discusses mineral metabolism with a focus on iron, detailing its total body content, dietary recommendations, sources, absorption mechanisms, and regulation. It highlights the importance of iron in the body, the consequences of iron deficiency anemia, and the clinical features associated with it. Additionally, it addresses iron toxicity, hemosiderosis, and treatment options for both iron deficiency and excess.

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saikiranmurali2003
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14 views31 pages

Iron

The document discusses mineral metabolism with a focus on iron, detailing its total body content, dietary recommendations, sources, absorption mechanisms, and regulation. It highlights the importance of iron in the body, the consequences of iron deficiency anemia, and the clinical features associated with it. Additionally, it addresses iron toxicity, hemosiderosis, and treatment options for both iron deficiency and excess.

Uploaded by

saikiranmurali2003
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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MINERAL METABOLISM

IRON(Fe)

Dr. SREETHU U S
KUMAR
• TOTAL BODY IRON CONTENT 3-5 GRAMS
• 75% IN THE BLOOD ( HEMOGLOBIN)
• IRON IS PRESENT IN ALMOST ALL THE
CELLS
RECOMMENDED DIETARY ALLOWANCE

• ADULT – 20MG PER DAY

• CHILDREN (ADOLESCENT) – 20 – 30 MG PER DAY

• PREGNANCY – 40 MG PER DAY


• SOURCES :
• GREEN LEAFY VEGETABLES (20MG/100GM)
• PULSES (10MG/100GM)
• CEREALS - RAGI (5MG/100GM)
• LIVER (5MG/100GM)
• MEAT (2MG/100GM)
• JAGGERY
• DATES
• COOKING IN IRON UTENSILS
• MILK IS A POOR SOURCE <0.1MG/100ML
ABSORPTION OF IRON
• IRON IS MAINLY ABSORBED IN THE UPPER PART OF
DUODENUM AND JEJUNUM.
• THE ONLY MECHANISM BY WHICH TOTAL IRON STORES
ARE REGULATED IS AT THE LEVEL OF ABSORPTION.
• IRON METABOLISM IS UNIQUE AS IT OPERATES IN A
CLOSED SYSTEM. THEREFORE IT IS KNOWN AS ONE WAY
ELEMENT.
• LUMEN  ENTEROCYTE
• FERRIREDUCTASE & DMT 1

• ENTEROCYTE
• BOUND WITH FERRITIN

• ENTEROCYTE  BLOOD
• FERROPORTIN & HEPHAESTIN

• BLOOD
• WITH TRANSFERRIN
• WHEN IRON STORES IN THE BODY ARE DEPLETED,
ABSORPTION IS ENHANCED. WHEN ADEQUATE QUANTITY
OF IRON IS STORED, ABSORPTION IS DECREASED. THIS IS
REFERRED TO AS “MUCOSAL BLOCK OF REGULATION OF
IRON ABSORPTION”. IT IS ALSO KNOWN AS GARNICK
HYPOTHESIS.
REGULATION OF ABSORPTION

MUCOSAL REGULATION
• HEPCIDIN SECRETED BY LIVER
• SYNTHESIS OF DMT& FERROPORTIN DOWN REGULATED BY
HEPCIDIN
WHEN BODY IRON RESERVE ADEQUATE
• HYPOXIA, ANEMIA  HEPCIDIN SYNTHESIS REDUCED

STORES REGULATION
• AS BODY IRON STORES FALL, MUCOSA GETS SIGNALLED TO
INCREASE ABSORPTION
• ERYTHROPOIETIC REGULATION
• IN ANEMIA, ERYTHROID CELL SIGNAL THE MUCOSA TO
INCREASE IRON ABSORPTION
ERYTHROPOIETIN IS THE SIGNAL.

• SYNTHESIS OF TRANSFERRIN RECEPTOR (TF R) AND FERRITIN


RECIPROCALLY CONTROLLED

• WHEN IRON IS LOWTFR1 SYNTHESIS INCREASES, THAT OF


FERRITIN DECLINES
REGULATION AT TRANSLATIONAL LEVEL
TRANSFERRIN
• TRANSPORT FORM OF IRON
• GLYCOPROTEIN
• SYNTHESIZED BY LIVER
• 250MG/100ML
• ONE TRANSFERRIN TWO FERRIC IONS
TOTAL IRON BINDING CAPACITY

• 400MICROGM/100ML
• PROVIDED BY TRANSFERRIN

TRANSFERRIN RECEPTORS
• PRESENT IN MOST OF THE CELLS
• IRON TRANSFERRIN RECEPTOR IS INTERNALIZED
STORAGE OF IRON

• STORAGE FORM IS FERRITIN


• SEEN IN INTESTINAL MUCOSA LIVER SPLEEN BONE
MARROW
• WHEN IRON LEVEL IS HIGH FERRITIN IS SYNTHESIZED TO
STORE IRON
• IN ID ANEMIA FERRITIN IS REDUCED
• HEMOSIDERIN CAN ALSO BE STORAGE FORM
FERRITIN:
• IRON IS STORED IN THE LIVER, SPLEEN AND BONE MARROW IN
THE FORM OF FERRITIN.
• A MOLECULE OF APOFERRITIN CAN COMBINE WITH 4,000 ATOMS
OF IRON TO FORM FERRITIN.

HEMOSIDERIN:
• HEMOSIDERIN IS ANOTHER IRON STORAGE PROTEIN.
• WHEN THE SUPPLY OF IRON IS IN EXCESS OF BODY DEMANDS IT
IS STORED AS A HEMOSIDERIN, AN INSOLUBLE FORM AND IRON
IS RELEASED SLOWLY FROM HEMOSIDERIN.
EXCRETION OF IRON

IRON IS A ONE WAY ELEMENT.

VERY LITTLE IS EXCRETED.

BLEEDING>> IRON LOSS

WOMEN UPTO MENOPAUSE : LOSS 1 MG/DAY.

MALES-0.5MG/DAY
• NO IRON IS EXCRETED THROUGH URINE.

• FECES : UNABSORBED IRON AS WELL AS IRON


TRAPPED IN THE INTESTINAL CELLS WHICH ARE
DESQUAMATED.

• 30% INTESTINAL CELL LINING REPLENISHED

• UPPER LAYER OF SKIN


IRON DEFICIENCY ANEMIA
• MOST COMMON NUTRITIONAL DEFICIENCY
DISEASE
• PERINATAL MORTALITY
• IMPAIRING LEARNING ABILITIES
• 70% TOTAL POPULATION IN INDIA
• 85% PREGNANT WOMEN
ANEMIA

• HEMOGLOBIN LESS THAN 10 MG/DL


• REDUCED AVAILABILITY OF IRON FOR HEME
SYNTHESIS LEADING TO REDUCED
HEMOGLOBIN
CAUSES OF IRON DEFICIENCY

• DIETARY DEFICIENCY
• LACK OF ABSORPTION ( GASTRECTOMY,
PHYTATES)
• HOOKWORM INFECTION
• BLOOD LOSS( WOUNDS, MENORRHAGIA)
• NEPHROSIS
• LEAD POISONING
CLINICAL FEATURES
• APATHY DUE TO LACK OF OXYGEN
• ACHLORHYDRIA
• IRRITABILITY
• POOR MEMORY
• POOR SCHOLASTIC PERFORMANCE
• KOILONYCHIA
• PLUMMER WILSON SYNDROME
LAB FINDINGS

• HEMOGLOBIN
• SE. IRON TOTAL IRON
PROFILE
• TOTAL IRON BINDING CAPACITY
• TRANSFERRIN
• FERRITIN
TREATMENT OF IRON DEFICIENCY
• TAB. IRON (FESO4) ONCE DAILY UNTIL HB> 10
• DIETARY CHANGES
• PREGNANCY : 100MG FE + 500 MICROGM FA
• CHILDREN : 20MG FE+100MICROGM FA
• ALONG WITH VIT.C IMPROVES ABSORPTION
• ORAL FE CAUSES GI IRRITATION
• IV FE (POLYMALTOSE OR BISGLYCINATE)
• BLOOD TRANSFUSION
IRON TOXICITY
• >100MG FE TAKEN ORALLY CAUSES ACUTE TOXICITY

HEMOSIDEROSIS
• IRON EXCESS
• REPEATED BLOOD TRANSFUSION
• HEMOPHILIA AND THALASSEMIA
• HEMOSIDERIN GRANULES GET DEPOSITED IN LIVER
AND SPLEEN
• PRIMARY HEMOSIDEROSIS : HEREDITARY HEMOCHROMATOSIS

ABNORMAL GENE IN THE SHORT ARM OF CHROMOSOME 6


INCREASED IRON ABSORPTION
INCREASED TRANSFERRIN LEVELS
EXCESS IRON DEPOSITS

• BANTU SIDEROSIS

BANTU TRIBES IN AFRICA


DIETARY DEFICIENCY
HEMOCHROMATOSIS

• TOTAL BODY IRON > 25-30 MG - HEMOSIDEROSIS


MANIFESTED

• BRONZE DIABETES

• HEMOSIDERIN DEPOSITS IN :
LIVER  CIRRHOSIS
PANCREAS DIABETES
SKIN YELLOW BROWN DISCOLOURATION
TREATMENT OF HEMOSIDEROSIS :

• REPEATED PHLEBOTOMY EVERY WEEK.

• IRON CHELATING AGENT : DESFERRIOXAMINE


PREVIOUS YEAR QUESTIONS

• FACTORS INFLUENCING IRON ABSORPTION 2018 2 MARKS


• ABSORPTION OF IRON 2021 4MARKS
• ABSORPTION AND TRANSPORTATION OF IRON 2020 3
MARKS
• EXPLAIN SOURCE RDA ABSORPTION TRANSPORT AND
STORAGE OF IRON 2021 8MARKS

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