Iron Deficiency Anemia F I R S T Y E A R H E M A T O L O G Y M O D U L E

Transcription

1 Iron Deficiency Anemia F I R S T Y E A R H E M A T O L O G Y M O D U L E

2 Objectives By The end of this lecture, the student will be able to: describe briefly iron metabolism in human body. mention briefly the importance of iron for human being. define the term anemia. enumerate the causes of iron deficiency anemia. describe briefly the effect of iron deficiency anemia on health. describe briefly the diagnosis and treatment of iron deficiency anemia.

3 Clinical scenario A 20 year old female college student presented with 3 months history 0f becoming pale, easy fatigability and difficulty in concentration. She had also palpitation on exertion. Clinical examination revealed that she was pale and she had a smooth tongue. What is the most likely diagnosis?

4 Iron-an essential nutrient Iron is among the abundant minerals on earth. In human body, it is needed for: Reversible binding of O 2 : hemoglobin myoglobin Enzymes: Immunity: cytochromes Others free radicals to destroy microbes

5 Daily Iron Demands *Male *Adolescent *Women in reproductive age *Pregnant Total amount of body iron 1 mg 2-3 mg 2-3 mg 3-4 mg 3-5 g

6 DIETARY IRON There are 2 types of iron in the diet; haem iron and non-haem iron Haem iron is present in Hb containing animal food like meat, liver & spleen Non-haem iron is obtained from cereals, vegetables & beans Milk is a poor source of iron, hence breastfed babies need iron supplements

7 Iron Absorption 1. Heme iron (meats) is absorbed better than non-heme iron (grains). 2. Gastric acid keeps Fe reduced to Fe ++ form that is absorbable. 3. Absorption occurs in proximal small bowel. 4. Increases with: - increased erythropoiesis. 5. Inhibited by inflammation, tea cosumption.

8 Fe from intestine (1 mg/day) Erythroid precursors in bone marrow produce hemoglobin (18 mg Fe/day) Transferrin in plasma carries Fe back to bone marrow (17 mg/day) Losses (1 mg Fe/day) Macrophages in spleen remove and break down senescent RBCs (18 mg Fe/day)

9 Anemia DEFINITION: Reduction in the number of erythrocytes, or hemoglobin concentration,or packed cell volume (PCV) value below lower normal limit for age and sex. *Anemia is not a disease, it is rather a manifestation of different diseases.

10 IRON DEFICIENCY Iron deficiency is the most common micronutrient deficiency in the world affecting 1.3 billion people i.e. 24% of the world population.

11 Causes of iron deficiency Increased demand mainly in children and pregnants. Chronic blood loss mainly in adults. Malabsorbtion of iron. Inadequate iron intake. Intravascular hemolysis: loss in urine. Combinations

12 Exercise Who are the people at risk of developing iron deficiency? Please you have 3 minutes to discuss with your colleagues and write your answer.

13 AT RISK GROUPS Infants Under 5 children Children of school age Women of child bearing age

14 CLINICAL FEATURES OF IDA symptoms : fatigue, dizziness, palpitations,blurred vision,loss of concentration.. signs : pallor, smooth tongue, Koilonychia, & dysphagia in elderly women. Heart failure :in elderly with severe IDA + cardiovascular diseases.

15 Pallor

16 Smooth Tongue

17 Koilonychia

18 Laboratory Diagnosis 1-Low hemoglobin level. 2-Low packed cell volume(pcv). 3-Low mean cell volume(mcv) and low mean cell hemoglobin(mch) of red blood cells(rbc). 4-Hypochromia and microcytosis of RBC on blood film. 5-Low serum iron and high total serum iron binding capacity. 6-Low serum ferritin.

19 Normal Blood Film

20 Hypochromia and Microcytosis

21 Treatment Replace iron : oral as tablets,capsules or serup or by injection. Oral route is preferred for replacement. Treat underlying disease ie blood loss. Hb response to treatment returns to normal by 2-4 months Replacement therapy is prolonged for 3-6 months to reload stores of iron. Blood transfusion is rarely needed

22 Conclusions Iron is an important element for human being specially for hemoglobin synthesis. Iron deficiency is fairly common worldwide and is the commonest cause of anemia. The commonest cause of iron deficiency is increased demand in children and blood loss in adults. Diagnosis depends on clinical features and laboratory evidence of iron deficiency. Treatment depends on correction of the cause and iron replacement. Further Reading: Davidson's Principles and Practice of Medicine

23 THANK YOU