Iron Deficiency Anaemia

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Iron Deficiency Anaemia

• By
• Dr OLUSAYO.O.ALAO FWACP(LAB MED)
• SENIOR LECTURERCONSULTANT HAEMATOLOGIST
• BENUE STATE UNIVERSITY/TEACHING HOSPITAL
• MAKURDI

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Outline

• Introduction
• Iron metabolism
• Causes of IDA
• Clinical features
• Diagnosis
• Differential diagnosis
• Management
• Conclusion
• References

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Introduction

• Anaemia is a reduced oxygen carrying capacity of
  blood due to reduced Hb concentration below the
  reference range for age, gender, geographical
  location and race of an individual
• Iron deficiency anaemia arises from deficient
  iron supplies to bone marrows
• Leading cause of microcytic anaemia (50) with
  women more affected
• More than 1 billion affected

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Iron distribution

• Iron conc in the body 50mg/kg-male
  40mg/kg-female,distributed into 5 compartments
• Haemoglobin-65
• Body stores-30
• Myoglobin-3.5
• Enzymes-0.5
• Plasma iron(transferin iron)-0.1

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Intra cellular iron homeostasis

• IRP /IRE response system
• IRP1 and IRP2
• Transferin receptor mRNA ?3IREs _at_3 end
• Ferritin ? 1IRE _at_5 end.
• Binding produce opposing effect in the 2 proteins
• Erythroid dALA ?1IRE_at_5end unlike housekeeping.
• Mitochndrial acornitase, ferroportin and DMT too
• hepcidin

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Normal iron balance

• Birth circumstance determine neonatal iron store
• Nil iron store from 6month -2years
• Male iron store- 1g, female -300mg
• Rapid growth, menstration, pregnancy and
  lactation causes increased demands
• Daily loss usually due to desquamation

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Factors affecting iron absorption

• Dietary
• Haeme,Animal,Ferrous/ferric
• Luminal
• ph, chelates, ligands in meat
• Systemic
• Iron status, erythropoetic, physiology, pathplogy
• Hepcidin, hemojuvelin are regulators

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• Iron incorporated into cells requiring iron
• Binds transferin receptor
• Endocytosis

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Sequence of events

• Depletion of iron stores
• Iron deficient erythropoeisis
• Iron defiency anaemia

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Causes

• Blood loss
• Increased physiological demand
• Diet
• malabsorption

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Clinical features

• Palour
• Fatigue and exercise intolerance
• Cardiac decompensation
• Koilonychia
• Angular stomatitis
• Glossitis
• Pharyngeal web
• Partial villous atrophy with malabsorption of fat
  and xylose in infants
• Learning and behavioural abnormality in children
• Hair loss

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Clinical features contd

• Atrophic gastritis
• Pica
• Diminished cell mediated immunity and neutrophil
  killing
• Premature labour
• Mental retardation
• Impaired work performation

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Diagnosis

• Lab tests are often not specific
• Iron storage
• Serum ferritin
• Bone marrow aspiration
• Iron supply to tissues
• Serum iron/iron binding capacity
• Serum transferin receptors
• Red cell protoporphyrin
• Red cell ferritin
• Blood film
• Microcytosis, hypochromia, cigar shape,
  anysiotosis, pokilocytosis, target cells,
  leptocytes, low retic, ?platelet
• Hb content of reticulocyte

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Differential diagnosis

• Thalasaemias
• Sideroblastic anaemia
• Anaemia of chronic diseases
• Lead poisoning

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Management

• Identification of cause of deficiency
• Oral iron avoid enteric coated preparations
• Ferrous sulphate 200mg (67mg)
• Ferrous gluconate 300mg(36mg)
• Ferrous fumarate 300mg(99mg)
• Carbonyl iron and polysacharide iron
• Therapeutic aim is 150-200mg or 3mg/kg
• Some preparations contain vitamin and amino acids
• Drug interactions
• Side effect

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• Parenteral iron
• Iron sorbitol- deep im, 50-100mg daily
• Iron dextran- phenol containing and phenol free
• Body wt x 2.3 x (15-Hb) 500mg dose
• Iron sucrose complex iv
• Sodium ferrous gluconate- iv
• Blood transfusion

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Poor response

• Poor patient compliance
• Continued bleeding
• Inflammation
• Wrong diagnosis
• Renal failure
• Liver disease
• Malignancy
• Coexisting anaemia of other cause

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Conclusion

• Iron deficiency anaemia is one of the commonest
  medical condition in tropical medical practice.
  Knowledge of the physiology of iron metabolism,
  clinical feature and haematological features is
  necessary to adequately diagnose and manage it.

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References

• Embury SH, Vichinsky, EP (2000) Sickle cell
  disease. In Hematology Basic Principles and
  Practice (R Hoffman, EJ Benz Jr, SJ Shattil et
  al. eds), 3rd edn. Churchill Livingstone,
  Philadelphia.
• Hoffbrand VA, Catovsky D, Tuddenham E (2005)
  Postgraduate Haematology, 5th edition, Blackwell
  publishing, Massachussette
• Robert S. Hilman, Ault K. A., Rinder H. M (2005)
  Haematology in Clinical Practice, 4th edition, Mc
  Graw Hill
• www.wikipedia.com