Hany LashenUniversity of Sheffield

Definition is based on low haemoglobin and / or haematocrite.

Age group Hb Threshold (dg/l)

Children <4.99 11

Children 5-11.99 11.5

Children 12-14.99 12

Non-pregnant women 12

Pregnant women 11

Men (> 15) 13

Classification: Blood film: microcytic hypocrhomic. Onset: Acute (haemorrhage) vs chronic. Cause:▪ Iron deficiency.▪ Vitamin B12 and folic acid deficiency.▪ Haemoglobinopathy: thalassaemia and sickle

cell.▪ Haemorrhage.

IDA is the commonest cause.

Region (countries) %

Africa (46) 40.7

Americas (38) 58

South East Asia (11) 14.9

Europe (52) 22.9

Eastern Mediterranean (21) 84.3

Western Pacific (27) 13.8

Afghanistan Kuwait Saudi Arabia

Bahrain Lebanon somalia

Djibouti Libya Sudan

Egypt Moroco Syria

Iran Oman Tunisia

Iraq Pakistan UAE

Jordan Qatar Yemen

Category of public health significance

Prevalence of anaemia (%)

Severe > 40

Moderate 20-39.9

Mild 5-19.9

Normal < 4.9

Age group % Millions

Preschool children 47.4 293

School age children 25.4 305

Non-pregnant women 41.8 56

Pregnant women 30.2 468

Men 12.7 260

Elderly 23.9 164

Most common worldwide. Need to differentiate between ID and IDA. Microcytic hypochromic. Has physiological and pathological causes.

Physiological: children and women, blood donors vegans.

Pathological: IBD, Kidney disease, Cancer, Chronic inflammatory diseases, parasitic infestation, etc.

Iron deficiency per se can have undesired effect on cognition, fatigue and immunity.

In jejunum mainly . Controls serum levels. 5-10% of dietary intake normally. Increases 3-4 fold when depleted. Two forms: haem and nonhaem. Haem absorption not affected by

elements. Nonhaem affected by inhibitors &

enhancers. ID arise when demands exceed supply.

Group Age Mean Wt.

Requirement for growth (mg/day)

Basal lossMg/day

Menstrual Loss mg/day

Males 11-14 45 0.55 0.62

15-17 64.4 0.6 0.9

18+ 75 1.05

Females 11-14 46.1 0.55 0.65

11-14 46.1 0.55 0.65 0.48

15-17 56.4 0.35 0.79 0.48

18+ 6182 0.87 0.48

Postmenopause

62 0.87

Lactating 62 1.15

Requirement

High (15%)

Intermediate (12%)

Low (10%)

v. Low (5%)

Males:

1.17 9.7 12.2 14.6 29.2

1.5 12.5 15.7 18.8 37.6

1.05 9.1 11.4 13.7 27.4

Females:

1.2 9.3 11.7 14 28

1.68 21.8 27.7 32.7 65.4

1.62 20.7 25.8 31 62

1.46 19.6 24.5 29.4 58.8

0.87 7.5 9.4 11.3 22.6

1.15 10 12.5 15 30

Estimates based on the prevalence of anaemia (WHO).

Age group Industrial world (%) Non-industrial world (%)

0-4 20.1 39

4-14 5.9 48.1

Pregnant women 22.7 52

All women 10.3 42.3

Men 4.3 30

Elderly 12 45.2

Low Hb. Microcytic hypochromic. Exclude haemoglobinopathy esp.

thalassaemia. :Check iron stores:

Low ferretin. Low transferrin saturation. High erythrocyte protoporphyrin. High serum transferrin receptor level. Bone marrow iron stain.

Establish the cause.

Who? Pregnant women. School children.

How? FBC. Ferretin.

Obstetrics: Hb <8.5 dg/l leads to poor outcome (low

birth weight, prematurity, postpartum haemorrhage, infection, slow recovery).

Gynaecology: Heavy periods (half body iron could be

lost in one year ~ 1.5 g). Oral iron unlikely to keep pace with the

loss.

Type Max dose Test dose

Ferric carboxymaltose

1000 mg No Europe, Asia, Australia

Ferumoxytol 510 No FDA

Iron isomaltoside 20 mg/kg No Europe (2009)

Dexferrum 100 Yes HMWID

InfeD 100 Yes LMWID

Ferrlecit 125 No Gluconate

Venofer 200 No Sucrose

Ganzoni formula:

Total iron dose [mg iron] = Body weight [kg] x

(Target Hb – Actual Hb) [g/dL] x 2.4 + Iron for

iron stores [mg iron].Iron for stores + 500 mg for weight

>35 kg.

IDA very prevalent world wide. ID prevalence is difficult to assess. Proper diagnosis & assess iron stores. Iron supplement should be considered

for vulnerable groups. Health economics should be in

operation. Assess the need, the cause, the time,

the efficacy of oral vs. IV iron. Patient’s compliance in certain cases.