IRON DEFICIENCY ANEMIA

Endang Windiastuti Hematology Oncology Subdivision Department of Child Health University of Indonesia

 Protein Vitamin Folic Acid, B 12 Mineral : Cooper, Iron Hematopoiesis

commonest

Deficiency Anemia

TISSUE DISTRIBUTION AND FUNCTION OF IRON

Protein Tissue/cells Total body (%) 66 13 Function ofiron compound O2 transport by blood O2 transport in muscle

Hemoglobin Myoglobin

(non-enz muscle proteins)

Heme enzymes (cytochrom,
Non heme iron compounds Ferritin & Hemosiderin Transferrin

Red blood cells Muscle

All cells

oxido reductase)
All cells Liver,spleen Marrow Plasma & extra vasc fluid 5 13 0.4

O2 transport, utilization & consumption in all cells O2 transport, iron reserves in all cells Iron storage
Iron transport

DISTRIBUTION of IRON

Ferrt & Hemosd Myoglb Cytochr, transfr,Catals Hemoglobin

IRON ABSORPTION (%)

Rice Spinach corn Peanuts Fish Meat 0 5 10 15 20 25

Absoption of Food Iron

HEME

NON HEME
Vit C Sugars Amino A Meat HCl

Phytates Ca, PO4

Fiber

Three Stages of Iron Deficiency

Depletion Iron Def Iron Stores Anemia (-) Serum Ferritin Transferrin Saturation Erythrocyte Protoporphyrin Hemoglobin MCV Iron Def Anemia(+)

PREVALENCE of IRON DEFICIENCY

Age Stage I II III Total Neonates Pre-school School 1 year 7 7 1-5 years 6-13 years 21 15 36 1 13 10 24 1 34 32 67 No

ETIOLOGY of IRON DEFICIENCY ANEMIA

1. NEONATES (under 1 yr.) Iron storage 2. CHILDREN (1 - 2 yr.) low intake increase demand malabsorption 3. CHILDREN (2 - 5 yr.) low intake increase demand 4. CHILDREN 5 to pre-puberty age Blood loss or excessive output 5. PUBERTAL to ADULT age increase demand menorrhagia

Etiology of Iron Def. Anemia (pathogenesis)

1. Depletion of Iron storage Preterm baby Gemeli Pregnant mother with iron def. Anemia hemorrhage in fetus 2. Low iron intake baby doesnt consume sufficient dietary iron food with less Fe heme 3. Increase demand rapid growth acute/chronic infection 4. 5. Malabsorption diarrhea malnutrition Excessive blood loss chronic gastrointestinal bleeding menorrhagia 6. Combination

Clinical Manifestation of Iron Deficiency

Anemia Fatigue & cardiovascular symptoms (tachycardia, palpitation, dizziness, dyspnoe ) Decompensatio cordis Epithelial manifestations : nails Koilonychia Tongue & mouth : absence or flattering of papillae of the tongue Skeletal changes : retarded skeletal growth & development The most important : Psychomotor delay in infants & young children Impaired work exercise tolerance and performance in older individuals

Monoxidase norepinephrine iritable tiroksin Aldehidoxidase muscle school performance

concentration

IRON

serotonin

Cytochrome oxidase

pika

Leukocyte and Lymphocyte function

IRON

bactericide of neutrophil infection lymphocyte T

GASTROINTESTINAL
IRON Disturbances in epithelial process Tongue atrophy Stomatitis Strictura oesophagus Anemia

Patherson Kelly Syndr.

Cytochrom 45 enzim (degradation of toxic substances from intestinal lumen )

MANAGEMENT of IRON DEFICIENCY

1. Determine the underlying cause. 2. Total body iron (iron stores) must be replenished.
Oral IRON Therapy : - Effective dose for children : 1-2 mg elementary iron/kg BW Response of therapy : First hematologic response : reticulocyte (7-10 day after therapy)

PREVENTION of IRON DEFICIENCY

PRIMARY PREVENTION. Parents can prevent their infants by providing adequate sources of iron Iron supplement Health education & sanitation.
SECONDARY PREVENTION Selective screening for iron deficiency anemia

CONCLUSION

Iron deficiency anemia is associated with long lasting effects on infant development, which may not be easily reserved, even with iron therapy.