Iron metabolism - PowerPoint PPT Presentation

Loading...

PPT – Iron metabolism PowerPoint presentation | free to download - id: 6ca3e5-MTA2M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Iron metabolism

Description:

Iron metabolism And Anemia in chronic kidney disease Chittima Sirijerachai Iron distribution Intracellular ferrous iron Heme iron compound : Hb, myoglobin Iron ... – PowerPoint PPT presentation

Number of Views:29
Avg rating:3.0/5.0
Slides: 38
Provided by: Own122
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Iron metabolism


1
Iron metabolism And Anemia in chronic kidney
disease
Chittima Sirijerachai
2
Iron distribution
  • Intracellular iron
  • Intracellular ferrous iron
  • Heme iron compound Hb, myoglobin
  • Iron containing enzyme
  • Intracellular ferric iron
  • RE cell, heart, epithelial cell of small intestine
  • Extracellular iron

- Ferric-transferrin
3
Dietary iron 1-2 mg/day
Slough mucosal cell 1-2 mg/day
4
Iron absorption
  • Promote absorption
  • Fructose
  • Vitamin C
  • Heme iron
  • Amino acid

Fe
HCl
Fe
  • Inhibit absorption
  • Phosphate
  • Phytate
  • Tannin
  • Soil clay

Fe
Fe
ferritin
Fe - transferrin
5
Iron absorption
6
Regulation of iron absorption
  • Dietary iron mucosal block
  • Iron stores store regulator
  • Erythropoitic regulator

7
Iron utilization
8
Iron deficiency anemia
Dietary iron 1-2 mg/day
Slough mucosal cell 1-2 mg/day
9
inflammation
Anemia of chronic disease
Plasma Fe-Tf
10
Iron study
  • Serum iron
  • Total iron binding capacity (TIBC)
  • Transferrin saturation (Tf sat)
  • Ferritin

11
Iron depletion
normal
functional
absolute
erythrocyte
Iron stores
12
(No Transcript)
13
Causes of anemia in ESRD
  • Decrease erythropoietin
  • Iron deficiency
  • Nutritional deficiency
  • Decrease red cell survival
  • Bone marrow suppression by uremia
  • Osteitis fibrosa cystica
  • Inflammation
  • Aluminum toxicity

14
Work-up for a diagnosis of anemia in CKD
Hb
Adult male lt 13.5 g/dl
Adult female lt12.5 g/dl
15
Diagnosis of renal anemia
  • Significant impairment of renal function

GFR lt 30 cc/min, Cr gt 2 mg/dl
  • No other causes of anemia
  • Iron deficiency anemia
  • Nutritional deficiency anemia

16
Diagnosis of renal anemia
  • History taking

- Dietary intake
- Chronic blood loss
  • Physical examination

17
(No Transcript)
18
Investigation
  • CBC
  • Red cell indices
  • Iron study, ferritin

19
CBC and RBC indices
20
(No Transcript)
21
Iron study, ferritin
TSAT lt 20 Ferritin lt 100 ng/ml
Iron deficiency anemia
22
Treatment of renal anemia
23
Benefit of anemia control in ESRD
  • Increased survival
  • Decreased cardiac complication
  • Improved quality of life
  • Increased exercise capacity
  • Decreased hospitalization

24
Target for anemia treatment
Hb gt 11 g/dl Hct gt 33
Within 4 months
Ferritin 200-500 ng/ml TSAT 30-40
25
Treatment of renal anemia
26
(No Transcript)
27
Iron therapy
Improved response to EPO
Reduced dose of EPO
28
Iron therapy
VS
29
Iron therapy
- Ferrous sulfate 1 x 3
- Iron sucrose 25-150 mg/wk
Monitor- serum ferritin, TSAT q 1-3 months
30
Iron therapy in CKD
Serum ferritin
lt 100 ng/ml - iron deficiency
gt 800 ng/ml - stop iron Rx
Transferrin saturation
lt 20 - iron deficiency
gt 50 - stop iron Rx
31
Side effects of iron therapy
  • GI irritation
  • Diarrhea
  • Constipation

Oral iron
  • anaphylactoid
  • hypotension
  • muscle cramp

IV iron
32
Erythropoietin
Erythropoietin a
Erythropoietin b
Recormon
33
Erythropoietin
80-120 U/kg/wk SC
120-180 U/kg/wk IV
34
Erythropoietin
Side effects
- hypertension
- headache
- PRCA
- Thrombosis
35
Inadequate erythropoietin response
Patient fail to attain the target Hb while
receiving- EPO 300 U/kg/wk SC EPO 450 U/kg/wk
IV
4-6 months
36
Inadequate erythropoietin response
  • Iron deficiency anemia
  • Chronic blood loss
  • Chronic inflammation
  • Inadequate dialysis
  • hyperparathyroidism

37
(No Transcript)
About PowerShow.com