Iron deficiency anemia
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Iron deficiency anemia is one of the nutritional deficiency anemia, and the most common microcytic hypochromic anemia. it is also one of the common anemia in Pakistan. Pregnant and lactating are most commonly affected.
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Iron deficiency anemia
- 2. Iron deficiency anemia Muhammad Asif Zeb Lecturer Hematology Khyber Medical university Peshawar
- 3. Anemia is a medical condition in which the hemoglobin concentration is less than normal (for the age and sex of the individual)
- 4. Mild anemia With hemoglobin level 9-12 g/dl Moderate anemia With hemoglobin level 6-9g/dl Severe anemia With hemoglobin level <6g/dl Severity
- 5. Iron deficiency anemia is the most common form of anemia caused from too little iron in the body About 20% of women, 90% of pregnant women, and 3% of men do not have enough iron in their body.
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- 7. Most body iron is present in haemoglobin in circulating red cells The macrophages of the reticuloendotelial system store iron released from haemoglobin as ferritin and hemosiderin Small loss of iron each day in urine, faeces, skin and nails and in menstruating females as blood (1-2 mg daily) Body Iron Distribution
- 9. an adult male ingest about 15 mg of iron of which only 10% will be absorbed, giving him 1.5 mg/day of iron that can be used for red cell production or stored in the reticuloendothelial system (RES) Iron Metabolism
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- 11. iron ingestion duodenum 10% if ingested iron is absorbed conversion of iron from the Fe3 (ferric) to the Fe2(ferrous) transportation of iron from GI tract to bone marrow via transferrin(mono ferricdi ferric)
- 12. 1 gram of transferrin binds 1.4 mg of iron (total iron binding capacity) iron in bone marrow for the developing normoblast for use of hemoglobin synthesis erythrocytes macrophages reticuloendothelial system
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- 16. Iron is stored mainly in the liver in reticuloendothelial system as Hemosiderin Ferritin Hemosiderin is the major long term storage form of iron ; release slowly, Ferritin is the primary storage form of soluble iron ;release readily at time of need. Iron Storage
- 17. Ferritin Iron storage protein In humans, it acts as a buffer against iron deficiency and iron overload Consists of: Apoferritin – protein component Core- ferric, hydroxyl ions and oxygen Largest amount of ferritin-bound iron is found in: Liver hepatocytes (majority of the stores) BM Spleen Excess dietary iron induces increased ferritin production Partially digested ferritin= HAEMOSIDERIN- insoluble and can be detected in tissues (hepatocytes) using Perl’s Prussian blue stain
- 18. Water insoluble protien iron complex Visible by light microscope It has higher iron to protein ration up to 37% than ferritin up to 20% Formed by partial digestion of ferritin aggregates by lysosomal enzymes. Hemosidrin is present predominately in macrophages rather than hepatocytes. Hemosidrin
- 19. Transferrin (Tf) Transports iron from palsma to erythroblast Mainly synthesized in the liver Fe3+ (ferric) couples to Tf Apotransferrin = Tf without iron Contains sites for max 2 iron molecules Synthesis is inversely proportional to iron store
- 20. Iron deficiency anaemia develops in three stages iron depletion Iron deficient erythropoiesis iron deficiency anaemia Pathophysiology of IDA
- 21. Iron stores are exhausted as indicated by decreased serum ferritin, serum iron normal No anaemia Erythrocyte morphology is normal Iron Depletion
- 22. There is insufficient iron to insert into the protoporphyrin ring to form heme, Serum iron is also depleted. Anaemia and hypochromia are still not detectable Erythrocytes may became slightly microcytic Iron Deficient Erythropoiesis
- 23. Long standing negative flow leads to IDA Blood loss significantly shorten this stage Classic microcytosis and hypochromia The situation represents advanced stage of severely deficient body iron Iron Deficiency Anemia
- 24. Blood Loss Gastrointestinal Tract Menstrual Blood Loss Urinary Blood Loss (Rare) Blood in Sputum (Rarer) Increased Iron Utilization Pregnancy Infancy Adolescence Polycythemia Vera Causes of Iron Deficiency Anemia
- 25. Malabsorption Tropical Sprue Gastrectomy Chronic atrophic gastritis Dietary inadequacy Parasitic infection Hook worm
- 26. • Fatigability • Dizziness • Headache • Irritability • Dry, pale skin • Spoon shaped nails, Koilonychias • Pica (Appetite for non food substances such as clay) • Splenomegaly (10%) • Increased platelet count Sign and Symptoms
- 28. Rbc count normal-decrease Hemoglobin decreased Wbc conut normal Palatelets normal-increase(in chronic bleeding) RDW increased (is the first sign to appear even before microcytosis of the cell occurs in the iron depletion stage of anemia ) Complete Blood Count
- 29. Red cell Indices PCV decreased MCV decreased MCH decreased MCHC decreased
- 30. DLC normal-increase(in chronic infections) RBC morphology Anisocytosis microcytosis Hypochormia Poikilicytosis Tear drop cells Elliptocytes Target cells Peripheral Film
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- 35. Serum iron low Serum ferritin low TIBC(total iron binding capacity) inreased Tansferrin saturation % low Iron Profile
- 36. Bone marrow is hyper cellular with polychromatic normoblast predominance Erythroid series is small and have tiny projection from the cytoplasm Iron stain; Negative Bone Marrow
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- 41. Feaces examination for parasites LFT in case if liver damage Investigations Occasionally Required
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- 43. Iron is released from the hemosidrine molecules by treating the slide with weak acid solution .the free iron combines with potassium ferrocynide to produce ferric Ferro cyanide. Free iron will appear greenish blue Prussian-blue Stain
- 44. Procedure Air dry film Fix with methanol 10-20min Place slide in solution of 10g /l potassium Ferro cyanide in 0.1 mol/l HCL for 30 min Wash in running tap water for 1 min Rinse in distilled water Counter stain with neutral red for10-15 sec
- 46. Thank You