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Iron Deficiency

Anaemia

IDA
Characterized by microcytic
,hypochromic red cells with MCV < 80fl
and MCH <25pg
Morphologic changes appear as the
iron stores get depleted and
unadequate for haem synthesis
F>M
High in children, pregnant woman, and
elderly

Babies are born with about 500mg of


iron
Total body iron in adult is about 5gm
Children need to absorb about 1mg iron
per day to meet growth requirement
10% of dietary iron is absorbed daily
Breast-fed infants have an advantage
because they absorb iron 2-3 times
more efficiently than infants fed bovine
milk.

Etiology of Iron Deficiency


Anaemia
In Infants :
Most iron in neonates is in circulating
hemoglobin.
High hb conc falls in first 2-3m of life
Iron is usually reclaimed and stored
This is enough for hb formation in first 6-9m of
life
Anaemia due to dietary deficiency presents
between 9-24m of life
In pre-term and LBW infants, iron stores are
depleted earlier

Etiology of Iron Deficiency


Anaemia
1.Dietary deficiency of iron
2.Impaired absorbtion of iron
3.Increased blood loss
4.Increased iron demand

Dietary deficiency of iron


Commonest cause of IDA
More in socioeconomically low
Impaired absorbtion of iron
Total/partial gastrectomy (loss of
gastric acidity results in impaired Fe
absorbtion)
In total gastrectomy ,absobtion if iron
is impaired

Increased blood loss


One of the common cause of IDA
5mg of iron is lost for loss of about
10ml of blood
Any haemorrhagic lesion in intestine/GI
tract
Some causes :
-hookwoom infestation
-multiple pregnancies
-gastric mucosal haemorrhages
-haematuria

Increased iron demand


There is increased physiological
demand in
-infancy
-pregnancy
-lactation

Clinical Features
Symptoms:
-Weakness, fatigue, or lack of stamina
-Shortness of breath
-Headache frontal
-Difficulty concentrating
-Irritability, apathy
-Dizziness
-Pallor
-Craving substances that are not food (pica)
-The desire to ingest ice (pagophagia)

Signs:

-Rapid heart beat


-Brittle nails (also spoon nailskoilonychia)
-Cracked lips (angular stomatitis)
-Smooth sore tongue (glossitis)
-Decreased appetite (especially in
children)
-Decreased rate of growth
-Delay in skills like Blue
walking , talking ..
and relatively latersclera

Diagnosis
1. Peripheral blood findings
2. Bone marrow morphology and iron
stores
3. Iron status

Peripheral blood findings


Hb (Reduced)
Hct (Reduced)
Absolute values (MCV < 80fl and MCH
<25pg)
Microcytic hypochromic red cells in peripheral
smear
(anisopoikilocytosis,microcytic,hypochromic)
Reticulocyte count (Normal or slight
increased)
White cells (Normal)
Platelets (Increased)

Bone marrow morphology and iron stores


Hypercellular
Erythroid hyperplasia
Micronormoblastic reaction :
Normoblasts are smaller
Myelopoiesis is normal
Megakaryopoiesis is normal

Microcytic hypochromic red cells


smaller than the lymphocyte
show a large central pallor
surrounded by a rim of
haemoglobin at the periphery of
red cell
Micronormoblastic
erythropoiesis in iron deficiency
anaemia.Erythroblasts are
smaller,demonstrate fraying of
cytoplasmic borders and
persistent basophilia in late
micronormoblasts
Perls stain.Marrow
fragment shows lack of
iron granules

Assessment of Iron status


Serum ferritin
Serum Iron
Serum transferrin receptor assay
Red cell protoporphyrin
Reticulocyte haemoglobin

Differential diagnosis

Thalassemia major
Anaemia of chronic disorder
Thalassemia minor
Lead poisoning

Prevention
Breast-feeding should be encouraged
Addition of iron-fortified cereals after 4-6 mo
of age.
Infants who are not breast-fed should only
receive iron-fortified formula (12 mg of iron
per liter) for the first year
Bovine milk should be limited to < 20-24 oz
daily.
Encourages the ingestion of foods richer in
iron

Principle of treatment
Oral iron therapy
-Ferrous gluconate
-Ferrous fumarate
-Ferrous succinate
Dose of elemental iron for IDA : 36mg/kg/day
Given in empty stomach

Parenteral iron
-Iron dextran
-Iron gluconate
-Iron sucrose
Indications
Oral iron is poorly tolerated
Rapid replacement of iron stores needed
GI absorbtion of iron is compromised
Erythropoietin therapy needed

RESPONSES TO IRON THERAPY IN IDA


TIME AFTER IRON
ADMINISTRATION

RESPONSE

12-24 hr

Replacement of intracellular iron


enzymes,subjective
Improvement ,decreased
irritability ,increased appetite

36-48 hr

Initial bone marrow response


,erythroid hyperplasia

48-72 hr

Reticulocytosis, peaking at 5-7


days

4-30 days

Increase in hemoglobin level

1-3 mo

Repletion of stores

Failure of iron therapy


Non compliance
Continuing loss
Insufficient duration of therapy
High gastric acid pH
Inhibitors of iron absorbtion
Incorrect diagnosis

Indications of blood transfusion


Severe anaemia
Superimposed infection
Follow up
Hb concentration increased about 1g per
week until normal values restored
Continues therapy for 3 months to
ensure replenishment of iron stores