1. Iron Deficiency Anemia

2. Prevalence
NFHS-3 : 7/10 children aged 6-59 months are
anemic. (3%-severely anemic, 40%-moderate
anemic, 26%- mildly anemic)
65% in preschool children
Adolescent period -50%
Iron deficiency affects 2170 million
worldwide, and 1200 million of them anemic with
90% of affected are in developing countries

3. Total Body Iron
Full-term infants - approximately 75 mg/kg
body weight of iron
Adult males – 50 mg/kg and females – 35
mg/kg
Can be divided into functional(80%) and
storage(20%) compartments

4. Iron Balance
Mostly lost from shedding of epithelial cells in
G.I.Tract.
Total average daily loss of iron has been
estimated at ∼1.0 mg in normal adult men and
nonmenstruating women.
20% of heme iron (in contrast to 1% to 2% of
nonheme iron) is absorbable.

5. Iron balance is primarily, if not
exclusively, achieved by control
of absorption rather than by
control of excretion

6. The “Iron cycle”

7. Since plasma ferritin is derived
largely from the storage pool of
body iron, its levels correlate well
with body iron stores.

8. Nutritional Iron Balance

9. Role of Hepcidin
Synthesized and released from the liver
Inhibits iron transfer from the enterocyte to
plasma
Regulator of iron absorption
Also suppresses iron release from
macrophages
Important role in anemia of chronic diseases
and hemochromatosis

10. Very high levels of hepcidin in
Anemia of chronic diseases and
inappropriately low levels of
hepcidin in hemochromatosis

11. Etiology
Late manifestation of prolonged negative
iron balance
As a result of major blood loss
Increased physiologic need for iron

12. Diet
Body iron concentration in normal neonates averages
∼75 to 100 mg/kg weight
Premature infants are at higher risk of iron deficiency
Delayed cord clamping
The fetus is an “effective scavenger of maternal iron”
Normal term infant must acquire 135 to 200 mg of iron
during the first year of life. A premature infant may
require as much as 350 mg in the same period

13.  Iron stores in the infant are typically depleted by 4 to
6 months of age
 Iron intake of 1 mg/kg/day is recommended for full-
term infants, 2 to 4 mg/kg/day for preterm infants
 Deficiency is relatively uncommon in the first 6
months of life in infants exclusively fed breast milk
 Cow’s milk should not be given to infants <1 year of
age

14. Blood loss
• Lesions of the gastrointestinal (GI) tract - peptic
ulcer, Meckel diverticulum, polyp, hemangioma, or
inflammatory bowel disease
• Heat-labile protein in whole bovine milk
• Chronic diarrhea and rarely with pulmonary
hemosiderosis
• Parasitic infestations and H.pylori infection

16. Clinical Features
Pallor, anorexia and irritability
Hyperdynamic circulation
Skin and nail changes
Pica - 70-80% of Children

17. Koilonychia

20. Consequences of Iron Deficiency
Long term mental impairment
Impaired immune function
Poor physical performance
Febrile seizures, temper tantrums, breath
holding spells, restless leg syndrome.

22. Lab evaluation
Hemoglobin, Hematocrit
Red cell indices
Reticulocyte hemoglobin content (CHr)
Mentzer index and RDW
Serum ferritin
Serum iron, TIBC, Transferrin saturation
Stainable iron in bone marrow
Stool for occult blood

25. Treatment
 Depends on severity and associated complications
 3-6 mg/kg of elemental iron in 3 divided doses is
adequate
 Ferrous sulfate is 20% elemental iron by weight
and is ideally given between meals with juice
 Addition of folic acid and vitamin C (200
mg), vitamin B12.

26. Parenteral Iron
 Should usually be avoided
 Severe side effects on oral therapy, noncompliance or
gastrointestinal bleeding
 Total dose infusion (only in hospital)
 Iron dextran or sucrose complex - most commonly used
 Iron required=wt (kg)x 2.3x (15-patient hemoglobin)
+500-1000 mg

27. Response to Iron therapy
TIME AFTER IRON ADMINISTRATION RESPONSE
12-24 hr
Replacement of intracellular iron
enzymes; subjective improvement;
decreased irritability; increased
appetite
36-48 hr
Initial bone marrow response;
erythroid hyperplasia
48-72 hr Reticulocytosis, peaking at 5-7 days
4-30 days Increase in hemoglobin level
1-3 months Repletion of stores

28. Nonresponders to Iron therapy
 Incorrect dose or medication
 Malabsorption of administered iron
 Ongoing blood loss including gastrointestinal, menstrual, and pulmonary
 Concurrent infection or inflammatory disorder inhibiting the response to
iron
 Concurrent vitamin B12 or folate deficiency
 Diagnosis other than iron deficiency
 • Thalassemias
 • Anemia of chronic disease
 • Lead poisoning
 • Sickle thalassemias, hemoglobin SC disease
 • Rare microcytic anemias

29. Prevention
• Medicinal iron supplementation
• Dietary modification
Balance between inhibitors and promoters
Vitamin C rich foods
Fermentation and germination
• Food fortification
Double fortified salt

30. Weekly Iron and Folic acid
Supplementation (WIFS)