HEMOGLOBIN CONCENTRATION STATE OF CONSTRICTION DILATATION OF PERIPHERAL VESSELS

PIGMENTATION AND SCT FLUID

 REDUCTION IN RED CELL MASS REDUCTION IN BLOOD HEMOGLOBIN

CONCENTRATION

TO DELIVER AND RELEASE ADEQUATE QUANTITIES OF OXYGEN TO THE TISSUES TO MEET THEIR METABOLIC DEMANDS

AGE Hgb(g/dl) Hct (%) 6-23 MOS < 10 < 31 2-5 YRS < 11 <34 6-12 YRS < 12 < 37

Hgb ( g ) 9 11 57 6 .0 3.0 2 - 2.5

SYMPTOMS little to no dysfunction exertional dyspnea some weakness dyspnea at rest cardiac failure

HISTORY
PHYSICAL EXAMINATION LABORATORY TESTS CBC RBC INDICES RETICULOCYTE COUNT EXAMINATION OF THE PERIPHERAL SMEAR

MCV = VOLUME OF PRC (hct) ___________________ X 1000 RBC COUNT

NV = 80 - 100 fl

MCH = Hgb -------RBC COUNT NV = 27 34 pg

MCHC =

Hgb --------VOLUME OF PRC

NV = 32 36 %

ACTUAL HCT X ----------------------DESIRED HCT NV = 1 1.5 %

OBSERVED RC ( % )

ACUTE BLOOD LOSS

HEMOLYTIC ANEMIA
AFTER A THERAPEUTIC TRIAL OF IRON

BONE MARROW FAILURE APLASTIC ANEMIA

LEUKEMIA

HYPOCHROMIA , MICROCYTOSIS , ANISOPOIKILOCYTOSIS , TARGET CELLS , THROMBOCYTOSIS , THROMBOCYTOPENIA

DECREASED SERUM IRON INCREASED TOTAL IRON BINDING CAPACITY TRANSFERRIN SATURATION IS BELOW 15 % SERUM IRON BELOW 5O ug / dl

1.DISORDERS OF EFFECTIVE RC PRODUCTION

2. DISORDERS WITH RAPID ERYTHROCYTE DESTRUCTION OR RC LOSS

 DEPRESSED NET RATE OF RC

PRODUCTION DISORDERS OF ERYTHROCYTE MATURATION INEFFECTUAL ERYTHROPOIESIS ABSOLUTE FAILURE OF ERYTHROPOIESIS

ANEMIA
INITIAL SCREENING and PRESUMPTIVE DIAGNOSIS

RED CELL INDICES MCV, MCHC, MCH, RDW, HDW

PERIPHERAL SMEAR RETICULOCYTE COUNT AND INDICES

HISTORY PHYSICEL EXAMINATION NON-HEMATOLOGICAL DISEASES: (Renal, Thyroid, Metabolic, Others) Indirect bilirubin LDH, Heptogloblin, Serum B12 Serum, RBC Folate Serum ferritin, iron, TIBC Circulating transferrin Receptor Serum Lead and RBC ZPP RBC Enzyme Panel Membrane protein studies

CONFIRMATO RY STUDIRS

DIRECT ANTI GLOBULIN TEST G6PD screening test Osmotic fragility Hb ISOELECTROFOCUSIN G & OTHER TESTS FOR RARE Hb VARIANTS

Hb ELECTROPHORE SIS
Bone Marrow Aspirate/Blopsy Test for unstable Hbs CYTOGENETIC STUDIES

ADDITION AL STUDIES

MOST COMMON CAUSE OF ANEMIA COMMON IN AGES 6 24 MONTHS

FERROUS ( Fe 2+ ) FERRIC ( Fe 3+ )

DESFERRIOXAMINE

TRANSFRRRIN

AVERAGE ADULT -

3- 5g

( BALANCE

= DIETARY UPTAKE AND LOSS )

LOSSES :

SKIN - 1 mg/ day MENSTRUATION - 2 mg /day

A. INADEQUATE SUPPLY OF IRON 1 . LACK OF IRON STORES AT BIRTH ( LBW ,PT , TWIN OR MULTIPLE BIRTHS , SEVERE IDA IN MOTHER , FETAL BLD LOSS , BLEEDING FROM THE 1ST FEW DAYS OF LIFE ) 2. INADEQUATE INTAKE-DEFICIENT DIETARY IRON

B . IMPAIRED ABSORPTION 1. CHRONIC OR RECURRENT DIARRHEA 2. MALABSORPTON SYNDROME 3 . GASTROINTESTINAL ABNORMALITIES

C. EXCESSIVE DEMANDS FOR IRON FOR GROWTH AS SEEN IN PT , LBW , INFANTS , ADOLESCENT AND PREGNANCY

D . BLOOD LOSS
1. ACUTE OR CHRONIC HEMORRHAGE 2 . PARASITIC INFECTION (HOOKWORM TRICHURIS trichiura )

PHYSICAL STATE ( BIOAVAILABILITY ) HEME > Fe 2+ > Fe 3 + INHIBITORS PHYTATES , TANNINS , SOIL , LAUNDRY STARCH , IRON OVERLOAD COMPETITORS COBALT, LEAD , STRONTIUM FACILITATORS ASCORBATE, CITRATE , AMINO ACIDS

DNA SYNTHESIS HOST OF METABOLIC PROCESSESS

1. ANEMIA 2 . GROWTH AND DEVELOPMENTAL RETARDATION 3 . EPITHELIAL CHANGES 4 . MISCELLANEOUS

.

1 . PRELATENT IRON DEFICIENCY 2. LATENT IRON DEFICIENCY

3.

FRANK IRON DEFICIENCY

PRELATENT IRON DEFICIENCY

DEPLETED STORES WITHOUT A CHANGE IN HCT OR SERUM IRON LEVELS RARELY DETECTED

LATENT IRON DEFICIENCY DECREASED SERUM IRON LEVEL TOTAL IRON - BINDING CAPACITY INCREASES WITHOUT A CHANGE IN THE HCT DECREASED TRANSFERRIN SATURATION

IRON DEFICIENCY ANEMIA

ASSOCIATED WITH ERYTHROCYTE

MICROCYTOSIS AND HYPOCHROMIA

ANEMIA

GROWTH AND DEVELOPMENTAL RETARDATION

EPITHELIAL CHANGES MISCELLANEOUS

ANEMIA IMPAIRS TISSUE OXYGEN WEAKNESS , FATIGUE , PALPITATIONS AND LIGHTHEADEDNESS REACTIVE THROMBOCYTOSIS

GROWTH AND DEVELOPMENT GROWTH AND DEVELOPMENTAL ABNORMALITIES IMPAIRS NEUROLOGIC FUNCTIONS ( BEHAVIORAL ABNORMALITIES , MOTOR INCOORDINATION AND SEIZURE )

EPITHELIAL CHANGES ANGULAR STOMATITIS ,GLOSSITIS , FLATTENED AND ATROPHIC LINGUAL PAPILLAE , PLUMMER- VINSON ( FORMATION OF POSTCRICOID ESOPHAGEAL WEB ) , KOILONYCHIA OR SPOONING OF THE FINGERNAILS

MISCELLANEOUS PICA ( CONSUME LAUNDRY STARCH, ICE AND SOIL CLAY ) MASSIVE HEPATOSPLENOMEGALY , POOR WOUND HEALING AND BLEEDING DIATHESIS ZINC DEFICIENCY LEAD INTOXICATION PSEUDOTUMOR CEREBRI

IN INFANTS :

HIGH INDEX OF SUSPICION 1. PREMATURITY 2 . BLOOD LOSS 3 . FED EXCLUSIVELY ON MILK 4 . CHRONIC DIARRHEA

1. ADMINISTRATION OF IRON TO EXPECTANT MOTHERS 2. EARLY INTRODUCTION OF SOLID FOOD 3 . SUPPLEMENTAL IRON : 1O 15 MG OF ELEMENTAL IRON / DAY ( 6 -8 WKS OF AGE )

DETERMINE THE CAUSE

CORRECT THE ABNORMALITY

1. ORAL SUPPLEMENTATION 2. PARENTHERAL IRON REPLACE MENT

 ORAL FERROUS SULFATE : 6 MG / KG / DAY ( 6 8 WKS AFTER NORMAL HGB VALUE

IS ATTAINRD ) OLDER CHILDREN : 1OO 2OO MG / DAY OF ELEMENTAL IRON

 NONCOMPLIANCE ONGOING BLOOD LOSS

INSUFFICIENT DURATION OF THERAPY

HIGH GASTRIC pH INHIBITORS OF IRON ABSORPTION /

UTILIZATION INCORRECT DIAGNOSIS

LEAD INTOXICATION

ALUMINUM INTOXICATION (HEMODIALYSIS )

CHRONIC INFLAMMATION NEOPLASIA

INDICATIONS
1. POORLY TOLERATED ORAL IRON 2 RAPID REPLACEMENT IRON STORES

3. GI IRON ABSORPTION IS COMPROMISED

ADMINISTERED BY IM OR IV ROUTE Z- TRACK INJECTION TO MINIMIZE SC LEAK 10 -15 % - TRANSIENT ARTHRALGIA RETICULOCYTOSIS IN IO DAYS COMPLETE CORRECTION IN 3 -4 WKS

INDICATION :

SEVERE ANEMIA
DEBILITATED FROM INFECTION SIGNS OF CARDIAC DECOMPENSATION

 MATERNAL IRON STATUS DETERMINES THE IRON STORES OF THE NEONATE .

ANEMIA OF CHRONIC INFLAMMATION :

1. INEFFECTIVE IRON UTILIZATION

2. LOW PLASMA ERYTHROPOIETIN LEVELS

1.
2.

HEART
LIVER

3. ENDOCRINE