Lu Ji Zhou

Prevalence
 Iron deficiency is the most common cause
of anemia throughout the world and one of
the most common medical problems that
confront the general physician.
 Geographic distribution

 Its prevalence is much higher in women

than in men.
Metabolism of Iron

Iron
 Functional iron
 Storage iron
Table: Distribution of iron in the adult
Type of Iron Concentration
men Women
Functional iron
heamoglobin 67% 31 28
myoglobin 15% 5 4
Heme enzyme 1 1
non-heme enzyme
Transferrin iron
Transferrin <1(0.2) <1(0.2)
Storage Iron 1000mg 300-400mg
Ferritin 8 4
Hemosiderin 4 2
Total 50 40
Iron Metabolism

1.Absorption
2.Transportation
3.Distribution(in the table )
4.Excretion
Abso rpti on
1 、 The source of iron
 iron in food ,diet .
2 、 The normal diet contains
approximately 15 to 30 mg of iron
each day, 1mg per day was absorbed
by the intestinal mucous.
3 、 The place of absorption of iron
 duodenum and the upper jejunum
4 、 Factors affect the absorption
Factors
influencing
the iron
absorption
Excretion
Quantity: 1mg / day
pathway: skin, urine, bile and stool.
Definition
 Iron deficiency is the state in which
the content of iron in the body is less
than normal, this state is divided into
3 stages( or phases), as the
following:
 Iron depletion （ ID ） : this is the earliest stage of
iron deficiency , in which storage iron is decreased or
absent but serum iron concentration and hemoglobin
levels are normal.
  Iron deficiency without anemia / iron deficient
erythropoiesis (IDE): this is a somewhat more
advanced stage of iron deficiency, characterized by
decreased or absent storage iron, usually low serum
iron concentration and tranferrin saturation , without
frank anemia.
 Iron deficiency anemia(IDA): this is the most
advanced stage of iron deficiency. It is characterized
by decreases or absent iron stores , low serum iron
 Etiology
1. Increases demand for iron and
inadequate iron intake, for
examples:
During the rapid growth spurts of infancy and
adolescence .
a. If the pregnant woman have iron-deficiency,
although they are rarely anemic, do have low
iron stores. These infants lack the reserves
needed for the swift growth which occurs
after birth. Iron deficiency during childhood
has a number of deleterious consequences,
such as impaired cognition.
b. During adolescent period, if the
foods have low iron content and the
need for iron is increased, the young
people may encounter the iron
deficiency anemia.
c. There is another condition may lead
to the need for iron increasing, that
is hookworm infection, it make the
added burden of blood loss.
 2.   Decreased absorption
of iron:
 Partial or total
gastrectomy
 Chronic diarrhea or
intestinal malabsorption.
 Loss of hydrochloric acid
3.   Iron loss
(1)   Physical iron loss eg.
Menstruation and pregnancy
(2)     Pathologic iron loss
a.   Gastrointestinal tract
disorders
b.   infestation eg. hookworm
c. Other Parasitic conditions eg.
 Clinical features

Patients with iron deficiency may

present
 with no signs or symptoms , coming to
medical attention only because of
abnormalities on laboratory tests;
 with the features of the underlying
disorder responsible for the development
of iron deficiency;

 1.   General manifestations , such as:
(1)      Decreased work tolerance, weakness
(2)      Shortness of breath, lassitude
(3)      Palpitations
(4)   Signs of cardiorespiratory adjustment
to anemia
exertive dyspnea
(5)      Noted pallor
2.   Special manifestation ※
(1) Signs and symptoms of gastrointestinal
tract
a.   Glossitis
b.   Angular stomatitis
c.    Gastric atrophy
d.   Postcrycoid web(Plummer-Vinson
syndrome)
(2)Pica-----one peculiar symptom is quite
characteristic of iron deficiency.
(3)Menorrhagia
(4)Others ， koilonychia is a relative
peculiar physical sign
Laboratory findings
1.   Peripheral blood
(1)   Hemoglobin decreased
(2)   Red cells are hypochromic and microcytic
MCV<80um3
MCHC<32%
2.  Bone marrow---An absence of blue staining
iron in the granule; Hypercellular BM, especially the
erythroid system
3.   Serum iron iron-deficiency anemia
serum iron ↓
serum ferritin ↓
TIBC ↑
Saturation of transferrin ↓
red cell protoprophyrin ↑
Diagnosis

1.Clinical manifestation
2.The laboratory findings
The serum ferritin is the best
figure that can reflect the quantity
of storage iron. So it is the most
sensitive and reliable figure.
Usually, we regard serum
ferritin<12ug/L as the diagnostic
index of iron deficiency.
3.Therapy with iron is effective-----
Therapeutic Trial of Iron
 Differential diagnosis
Table: The kinds of Hypochromic Anemia
With decreased body iron stores
Iron deficiency anemia
With normal or increased body iron stores
Impaired iron metabolism
Anemia of chronic diseases
Defective absorption, transport, or utilization of iron
Disorders of globin synthesis
Thalassemia
Other microcytic hemoglobinopathies
Disorders of heme synthesis: sideroblastic anemias
Hereditary
Acquired
Table: differential diagnosis of hypochronic and
microcytic anemia
IDA Thalassemia ACD Sideroblast
ic anemia

Serum Ion ↓ N ↓ ↑

TIBC ↑ N ↓ N

Serum ↓ N ↑ ↑
ferritin

Red cell ↑ N ↑ ↑ or No
proprohyrin
Therapy

1.   The etiological treatment ※

2.   Supplement iron
(1)  Oral iron
a.   Ferrous sulfate
b.   Response ： Reticulocyte
c.   The reasons of no response
 (2)      Parenteral iron
A.   Indications :
a. Malabsorption of intestine
b. There are gastrointestinal complications ,
such as peptic ulcer, vomiting of pregnancy
which can affect the absorption of oral iron.
c.  There are severe gastrointestinal reaction
even if the dosage iron has been decreased.
d.  There is severe chronic bleeding exceeding
the amount of iron which can be absorbed.
e.   At the later period of pregnancy and
complicate severe iron-deficiency anemia.
B.  Iron-dextran complex
 A formula for the dosage
 3.   Blood transfusion

 Prognosis
Key points

1. The etiology of Iron deficiency

anemia
2. The clinical manifestations of iron
deficiency anemia
3. Indications of parenteral iron