I.

DEF ANEMIA
6/1/2014
Dr mukhtar jama nour, MBBS
Amoud university for health and science institute
1
Anemia Basics
Iron def. anemia is either due to.

1. Ineffective RBC production
2. Accelerated destruction of the RBC
or
3. Increased demand or consumption
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Most common cause of anemia worldwide

Most important cause of iron deficiency anemia is
parasitic infection - hookworms, whipworms and
roundworms
IDA
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A diet containing 810mg of iron daily is necessary for
optimal nutrition

1mg of iron must be absorbed each day - Absorbed in
the proximal small intestine




GENERAL FEATURES
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Meat
Liver
Kidney
Egg-yolk
Green vegetables
Fruits
**** Cows milk- poor source of iron
Iron sources:
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Distribution of body iron: (adults)
- Hemoglobin: 2.3 gm
- Storage (ferritin / haemosiderin) : 1.0 gm
- Non-available tissue iron: 0.5 gm
- Transport iron: 3-4 mg

Iron metabolism:
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Iron absorption:
Depends upon Body stores of iron
- Rate of erythropoiesis
- Iron needs of the body
Increased absorption in presence of:
- vitamin C
- fruit juices
- lactose
- amino acids- cystine, lysine ,
histidine,
- gastric Hcl
Decreased absorption : - phytates
- tannic acid
- calcium salts
- phosphates

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Iron Metabolism:
Figure 16-8: Iron metabolism
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Increased physiological demand:
- growing children (6-24 months)
- adolescence
- women during reproductive ages
Pathological blood loss:
-chronic loss E.g GI loss
Inadequate intake of diets rich in iron:
-nutritional deficiency
-decreased absorption- gastroenterostomy/
tropical sprue/ coeliac disease

Pathogenesis of IDA:
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High Hb conc of the newborn falls during the first 2
3 mo - considerable iron is stored - usually sufficient
for blood formation in the first 69 mo of life in term



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The most important cause world-wide is
infestation with parasitic worms
(hookworms- suck 0.03- 0.2 ml of blood per
worm /day ),whipworms, roundworms
Dietary insufficiency
Malabsorption
ETIOLOGY
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Chronic blood loss - occult bleeding : peptic
ulcer, Meckel diverticulum, polyp, hemangioma,
inflammatory bowel disease, Intravascular
hemolysis and hemoglobinuria
Chronic diarrhea
Milk allergy


ETIOLOGY
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Demograpghic Eldery, Teenager, Female

Dieatary low Iron, low Vit C, excess
phytate,tea coffee,

Social and physical poverty,alcohol
abuse,GIT ds

Risk factors for IDA
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Pallor is the most important sign
Look for pallor : FACE, nails, palms, conj, mucus
membranes
Pagophagia (pica for ice) / pica
Anxiety , Poor appetite
Below 5g/dL: irritability and anorexia are prominent
Tachycardia and systolic murmurs- dyspnea ,
Palpitations





CLINICAL FEATURES
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Hair loss and lightheadedness
Fainting
Sleepiness, Tinnitus
Mouth ulcers, Glossitis ,Angular cheilitis
Constipation
Depression, Twitching muscles, Tingling,
numbness or burning sensations

CLINICAL FEATURES
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Koilonychia (spoon-shaped nails) ,
Platynychia
Weak,brittle nails
Pruritus
Dysphagia due to formation of esophageal
webs (Plummer-vinson syndrome
clubbing



CLINICAL FEATURES
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Platynychia
6/1/2014
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shows on The Medical Post [
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17
pallor
6/1/2014
Download more documents and slide
shows on The Medical Post [
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18
Koilonychia - spoon shaped nail
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Neurologic and intellectual function
Affects attention span, alertness,
Verbal learning and memory


CLINICAL FEATURES
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First:
Tissue iron stores represented by bone marrow hemosiderin
disappear
Serum ferritin decreases

Next:
Serum iron level decreases
Serum transferrin,S. iron-binding capacity of the - increases
Percent saturation (transferrin saturation) falls below normal
Response to low Hb:
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Response to low Hb:



Later:
Microcytosis, hypochromia, poikilocytosis,
and increased RBC distribution width (RDW)
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1.complete blood count (CBC)
- High RBC distribution width (RDW) -
reflecting an increased variability in the size of
red blood cells (RBCs).
- A low MCV, and MCHC
2. Hemoglobin (Hb)&hematocrit (Hct) value
low
3. Reticulocyte - normal or moderately elevated


Diagnosis - LABORATORY INVESTIGATIONS
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3.Peripheral blood smear microcytic
hypochromic anemia, target cells,
hypochromic pencil-shaped cells, and
occasionally small numbers of nucleated RBC

Diagnosis - LABORATORY INVESTIGATIONS
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4. Diagnostic tests
- Serum ferritin- low
- Serum iron - low
- Serum transferrin -elevated
- Total iron binding capacity (TIBC) - high
5.Stool for occult blood
6.Stool for - hookworm and whipworm
LABORATORY INVESTIGATIONS
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Gold standard
Bone marrow aspiration, with the marrow
stained for iron -Bone marrow is hypercellular,
with erythroid hyperplasia
Leukocytes and megakaryocytes are normal
No stainable iron in marrow reticulum cells

Diagnosis:LABORATORY INVESTIGATIONS
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Oral administration - ferrous salts (sulfate, gluconate,
fumarate) -46mg/kg of elemental iron
Consumption of milk should be limited
Blood loss from intolerance to cow's
milk proteins is reduced
The amount of iron-rich foods is
increased

TREATMENT
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Incorrect diagnosis (eg, thalassemia)
Patient is not taking the medication
Not absorbed (enteric coated?)
malabsorption syndromes
gastrectomy/celiac disease
Rapid iron loss?
Anemia of chronic disease-impairs bone
marrow response

Oral iron failure?
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Parenteral iron preparation (iron dextran) : Intolerance
to oral iron, severe gastrointestinal complaints
Packed or sedimented RBCs : with Hb values < 4g/dL
congestive heart failure: fresh-packed RBCs should be
considered

TREATMENT
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1224 hr
Replacement of intracellular iron enzymes; subjective
improvement; decreased irritability; increased Appetite
3648 hr
Initial bone marrow response; erythroid hyperplasia
4872 hr
Reticulocytosis, peaking at 57 days
430 days
Increase in hemoglobin level
13 mo
Repletion of stores
RESPONSES TO IRON THERAPY

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