3. Iron Deficiency Anemia
Deficiency of iron is the most common nutritional disorder in
the world.
The total body iron content is normally about 2 gm in women
and as high as 6 gm in men,
divided into functional and storage compartments .
Healthy young females have smaller stores of iron than do
males.
Iron in the body is recycled extensively between the
functional and storage pools
10. Transport form
transported in plasma by an iron-binding glycoprotein called
transferrin
synthesized in the liver.
In normal individuals, transferrin is about 1/3 saturated with iron,
yielding serum iron levels that average 120 μg/dL in men and 100
μg/dL in women.
The major function of plasma transferrin is to deliver iron to cells.
Erythroid precursors possess high-affinity receptors for transferrin,
which mediate iron import through receptor-mediated endocytosis.
12. Ferritin
Free iron is highly toxic .
Ferritin is a ubiquitous protein-iron complex that is found at
highest levels in the liver, spleen, bone marrow, and skeletal
muscles.
In the liver, most ferritin is stored within the parenchymal cells;
in spleen and the BM, it is found mainly in macrophages.
storage iron in macrophages is derived from the breakdown of
red cells.
13. ferritin
its levels correlate well with body iron stores.
In iron deficiency, serum ferritin is always below 12 μg/L,
whereas in iron overload values approaching 5000 μg/L
can be seen.
14. hemosiderin
partially degraded protein shells of ferritin aggregate into hemosiderin
granules.
Iron in hemosiderin is chemically reactive and turns blue-black when
exposed to potassium ferrocyanide, which is the basis for the Prussian
blue stain.
15. CAUSE OF IDA
Four groups
Inadequate iron intake
Defective absorption
Excessive loss of iron (5mg of iron is lost for loss of 10ml blood)
Increased requirement
In infants and children(6-18 months), iron deficiency results from poor dietary intake
In adults iron deficiency is usually secondary to chronic blood loss.
In women of reproductive age group iron deficiency is usually result of menstrual
disorders and pregnancy.
16. Inadequate dietary intake of iron
Defective absorption of iron
Subtotal gastrectomy
In partial gastrectomy-loss of gastric acidity result in impaired Fe absorption
In total gastrectomy food rapidly passes through duodenum and absorption of iron is impaired
Helicobacter pylori gastritis
Excessive loss of iron
Gastrointestinal bleeding
Peptic ulcer,
Gastritis,
Hookworm infection,
Various neoplasms especially carcinoma of colon, marathon runners;
Urinary tract bleeding
Haematuria
Haemoglobinuria
Respiratory tract bleeding
Bleeding disorders
Increased requirements for iron—Pregnancy, infancy, adolescents
17. High risk of IDA
pregnancy
Children
Elderly
Women of reproductive age
adolescents
18. Pathogenesis.
hypochromic microcytic anemia.
initially reserves are utilized.
Progressive depletion of these reserves first lowers serum iron and
transferrin saturation levels without producing anemia.
In this early stage there is increased erythroid activity in the bone marrow.
Anemia appears only when iron stores are completely depleted and is
accompanied by low serum iron, ferritin, and transferrin saturation levels.
19. Clinical Features
Fatigue, restless legs, palpitations, breathlessness.
Koilonychia: finger nail become thin, flattened, brittle & finally spoon shaped.
Angular stomatitis, glossitis: papillae of tongue making the surface smooth.
Dysphagia – difficulty in swallowing because of oesophageal web, known as
Plummer-Vinson syndrome
Most common characteristics symptoms is PICA i.e. an abnormal and intense desire
to eat strange substances such as clay, paint, cardboard, coal, etc.
20.
21.
22.
23. Stages in the deveopment of anemia
Depletion of
iron stores
Decrease in
transport iron
with reduced
availability
Normocytic
normochromic
anemia
Microcytic
anemia
MCHC ANEMIA
24. Depletion of iron stores
• Serum ferritin conc. Decrease
• Absence of stainable iron in BM
Decrease in transport iron with reduced availability of iron for
erythropoiesis
• Circulating iron level falls
• Serum iron & transferrin saturation decrease
• TIBC increase
• Free erythrocyte protoporphyrin(FEP) increases
Development Of anemia
• Normocytic normochromic anaemia
• Microcytic anaemia
• Microcytic hypochromic anaemia
STAGES IN THE DEVELOPMENT OF IDA
25.
26. Laboratory investigations of IDA
Routine RBC parameters
Hb,
RBC count
haematocrit
Red cell indices
Microscopic examination
Peripheral blood film
Grading of marrow iron stores
(Gold standard)
Serum assays
Serum ferritin
Serum iron
Serum transferrin, TIBC
Transferrin saturation
Protoporphyrin
Serum transferrin receptor
concentration
27. Hb – decreased
Reticulocyte count – normal or increased
MCV ,MCH ,MCHC – all are decreased
Peripheral smear shows – microcytic hypochromic
RBCs. tear drop cells, pencil cells and
polychromatophils
Leukocytes and platelets are normal
32. Hypercellular
Erythroid hyperplasia
Erythropoiesis is micronormoblastic
Normoblast are smaller
Late micronormoblasts demonstrate persistent basophilia
Cytoplasmic border indicate incomplete hemoglobinization.
Absence of stainable iron in the bone marrow on Perl’s Prussian blue
reaction is a specific and a reliable test for diagnosis of iron deficiency
anaemia.
BMA smear shows completely devoid of iron and iron grade is 0 (NIL).
BONE MARROW FEATURES
33.
34.
35. Serum ferritin is decreased
TIBC is increased
Serum iron is decreased
Red cell protoporphyrin is increased
36. INVESTIGATIONS FOR CHARATERIZATION OF
ANAEMIA
Haemoglobin
PCV
RBC
MCV
MCH
MCHC
RDW
TLC
Platelets
Retic count
DLC
Decreases
Decreases
Varies with severity of anemia
Decreases
Decreases
Decreases
Increases
Normal or mild decreased
Normal or increase
Normal/reduced/increase
Usually normal