IRON DEFICIENCY
ANEMIA(IDA)
IRON
4% of Earth’s Crust
4±1 gm total Body Iron in Adult Human
Hb2± 0.5 gm
Storage(Fe+++)
1 ± 0.5 gm
Ferritin
Haemosiderin
Essential iron: Myoglobin & Iron-Containing Enz. (e.g.cytochromes, catalases)
Plasma 4 ± 1 mg
Protein-iron complex Ferritin Haemosiderin
Solubility Water-soluble Insoluble
Molecular weight ~ 450.000 Variable
structure Apoferritin
( outer prtn.coat )
& iron-phosphate-
hydroxide core
Derived from partial
lysosomal digestion
of aggregates of
ferritin molecules
% of iron in the structure 20 37
In Perls’ - reaction
(Prussian blue-reaction)
under light microscope
Not visible
Visible
in macrophage & normoblasts
Binding ~4500 iron atoms
/molecule of apof.
Variable
Daily Iron Cycle
Enterocytes &Iron absorption
HEPCIDIN A polypeptide produced by the liver
The major hormonal regulator of
iron homeostasis It inhibits iron release from macrophages, intestinal
epithelial cells & from placental syncytiotrophoblasts
by accelerating degradation of ferroportin mRNA Iron deficiency , hypoxia & ineffective erythropoiesis
inhibits hepcidin production
iron release from pre-mentioned cells As acute phase protein,
hepcidin production is induced by inflammation via IL-6
Ancylostoma
Sequence of Events in IDA
SEQUENCE OF EVENTS IN IDA I
Hb 15 g/dL
RCC 5 million/ µL
MCH 30 pg Hct. 45 %
MCHC 33 g/dL
MCV 86 fL
Serum Iron UIBC
20 µmol/L 40 µmol/L
TIBC= 60 µmol/L
Saturation 33%
p.ferritin N. 15-300 µg/L
WBC7,500/µL
Platelet400,000/µL
SEQUENCE OF EVENTS IN IDA II
BLEEDING
40 ml/ Day
20 mgIRON
Iron Absorption
up to5
mg/Day
Net Daily Loss= 20-5 = 15 mg
1500------ = 100 Days 15
Latent Iron
Deficiency
No Clinical FeaturesNormal Blood Values
If Iron Stores= 1500 mg
1/3 of ACD are microcytic hypochromic
Causes of microcytic hypochromic anemias
The 1st step in the evaluation of microcytic anemia is to rule out IDA,HOW?