Iron deficiency Anemia

Hypochromic anemia

Defective Hb synthesis

Hypochromic anemia

Fe deficiency 20% of women in child bearing age

group Adult males 2% Microcytic Hypochromic anemia All indices are reduced

Other causes of hypochromic anemia

1. Sideroblastic anemia

2. Thalassemia

3. Anemia of chronic disorders

Loss of Fe from the body

Males 1 mg /day Females 1.5 – 2 mg/ day

Pregnancy 750 mg of Fe is lost from the mother

1. 400 mg for fetus

2. 200 mg for blood loss and lactation

3. 150 mg for placenta

Source of Fe

1. Food leafy vegetables , beans , meat , liver

2. Recycling from old red cells

Average western diet contains 10 – 15 mg Fe

Absorption 5 – 10% In pregnancy and Fe deficiency 20

– 30% abs, Absorption duodenum and proximal

jejenum

Haem is better absorbed than Non haem

Absorption non heme

Inc

1. Vit C

2. Citric acid

3. Aminoacids

4. Sugars

5. Gastric secretions

6. Hcl

Dec

1. Antacids

2. Milk

3. Tannates

4. Phytates

5. Pancreatic secretions

6. EDTA

7. Phosphates

Transport to transferrin is by two vehicle transporter

1. Ferroportin

2. Hephaestin Actual mechanism of Haem Fe is not

known

Transport

Beta globulin Transferrin synthesised in liver

Erythroblasts have transferrin receptors

Transferrin – Fe is not deposited mononuclear – phagocytic cells

These cells get Fe deposits from the phagocytosis of old RBC

Storage forms of Fe in REcells

1. Ferritin

2. Hemosiderin Normally not functional Mobilised in response to demand

Excretion

Lost 0.5 – 1 mg / day Menstruating women – 1- 2 mg / day Pregnancy loss 750 mg

1. Foetus – 400 mg

2. Blood loss and lactation 200 mg

3. Placenta 100mg

Loss

1. Desquamtion of epithelial cells from GIT

2. Urine

3. Sweat

4. Hair and nails

5. Feces

C/F

Anemia – pica may develop Epithelial tissue change

1. Koilonychia

2. Atrophic glossitis

3. Angular stomatitis

4. Esophageal web

Stages of anemia

1. Fe store depletion

2. Fe deficiency erythropoiesis

3. Frank Fe deficiency anemia

Lab diagnosis

1. Blood picture and Red cell indices

2. Bone Marrow findings

3. Biochemical findings

Blood picture and indices

Hb – reduced Red cells –

1. count reduced

2. Hypochromic

3. Mcrocytic

4. Anisocytosis

5. poikilocytosis

Red cells

Target cells Elliptical forms Polychromatic cells

Reticulocyte count

Normal / reduced After haemorrhage slightly raised i.e. 2 – 5 %

Red cell indices

All reduced

WBC count and platelets

Normal After haemorrhage – neutrophil count

may inc Normal plt count --, inc if recent

haemorrhage

Bone marrow findings

Marrow cellularity inc (dec M:E ratio) Eryothropoiesis Micronormoblasts Other cells normal Marrow Fe dec RE iron stores & red.

siderotic fe granules in normobasts

Cytoplasmic maturation lags behind Late normoblasts have pyknotic

nucleus + persisting polychromatic cytoplasm

Biochemical findings

Decreased

1. Serum Fe

2. Serum Ferritin

3. Red cell protoporphyrin

Increased

1. Total Fe binding capacity

2. Serum Transferrin receptor protein

Treatment

Correction of disorder Correction of Fe deficiency