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8/12/2019 Iron Anemia
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I.DEF ANEMIA
6/1/2014
Dr mukhtar jama nour, MBBS
Amoud university for health and science institute
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Anemia Basics
Iron def. anemia is either due to.
1. Ineffective RBC production2. Accelerated destruction of the RBC
or
3. Increased demand or consumption
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Most common cause of anemia worldwide
Most important cause of iron deficiency anemia is
parasitic infection - hookworms, whipworms androundworms
IDA
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A diet containing 810mg of iron daily is necessary for
optimal nutrition
1mg of iron must be absorbed each day - Absorbed in
the proximal small intestine
GENERAL FEATURES
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Meat
Liver
Kidney Egg-yolk
Green vegetables
Fruits**** Cows milk- poor source of iron
Iron sources:
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Distribution of body iron: (adults)
- Hemoglobin: 2.3 gm
- Storage (ferritin / haemosiderin) : 1.0 gm- Non-available tissue iron: 0.5 gm
- Transport iron: 3-4 mg
Iron metabolism:
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Iron absorption:
Depends uponBody stores of iron
- Rate of erythropoiesis- Iron needs of the body
Increased absorption in presence of:
- vitamin C
- fruit juices- lactose
- amino acids- cystine, lysine ,
histidine,
- gastric Hcl Decreased absorption : - phytates
- tannic acid
- calcium salts
- phosphates6/1/2014 7
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Iron Metabolism:
Figure 16-8: Iron metabolism6/1/2014 8
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Increased physiological demand:
- growing children (6-24 months)
- adolescence
- women during reproductive ages
Pathological blood loss:-chronic loss E.g GI loss
Inadequate intake of diets rich in iron:
-nutritional deficiency-decreased absorption- gastroenterostomy/
tropical sprue/ coeliac disease
Pathogenesis of IDA:
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High Hb conc of the newborn falls during the first 2
3 mo - considerable iron is stored - usually sufficient
for blood formation in the first 69 mo of life in term
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The most important cause world-wide is
infestation with parasitic worms
(hookworms-suck 0.03- 0.2 ml of blood per
worm /day),whipworms, roundworms
Dietary insufficiency
Malabsorption
ETIOLOGY
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Chronic blood loss - occult bleeding : peptic
ulcer, Meckel diverticulum, polyp, hemangioma,
inflammatory bowel disease, Intravascular
hemolysis and hemoglobinuria
Chronic diarrhea
Milk allergy
ETIOLOGY
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DemograpghicEldery, Teenager, Female
Dieatarylow Iron, low Vit C, excess
phytate,tea coffee,
Social and physicalpoverty,alcohol
abuse,GIT ds
Risk factors for IDA
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Pallor is the most important sign
Look for pallor : FACE, nails, palms, conj, mucusmembranes
Pagophagia (pica for ice) / picaAnxiety , Poor appetite
Below 5g/dL: irritability and anorexia are prominent
Tachycardia and systolic murmurs-dyspnea,Palpitations
CLINICAL FEATURES
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Hair loss and lightheadedness
Fainting
Sleepiness, Tinnitus Mouth ulcers, Glossitis ,Angular cheilitis
Constipation
Depression, Twitching muscles, Tingling,numbness or burning sensations
CLINICAL FEATURES
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Koilonychia (spoon-shaped nails) ,
Platynychia
Weak,brittle nails
Pruritus
Dysphagia due to formation of esophageal
webs (Plummer-vinson syndrome
clubbing
CLINICAL FEATURES
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Platynychia
6/1/2014
Download more documents and slide
shows on The Medical Post [
www.themedicalpost.net ]
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pallor
6/1/2014
Download more documents and slide
shows on The Medical Post [
www.themedicalpost.net ]
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Koilonychia - spoon shaped nail
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Neurologic and intellectual function
Affects attention span, alertness,
Verbal learning and memory
CLINICAL FEATURES
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First: Tissue iron stores represented by bone marrow hemosiderin
disappear
Serum ferritin decreases
Next: Serum iron level decreases
Serum transferrin,S. iron-binding capacity of the - increases
Percent saturation (transferrin saturation) falls below normal
Response to low Hb:
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Response to low Hb:
Later:Microcytosis, hypochromia, poikilocytosis,and increased RBC distribution width (RDW)
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1.complete blood count (CBC)
- High RBC distribution width (RDW) -
reflecting an increased variability in the size of
red blood cells (RBCs).
- A low MCV, and MCHC
2. Hemoglobin (Hb)&hematocrit (Hct) value
low
3. Reticulocyte - normal or moderately elevated
Diagnosis - LABORATORY INVESTIGATIONS
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3.Peripheral blood smearmicrocytic
hypochromic anemia, target cells,
hypochromic pencil-shaped cells, and
occasionally small numbers of nucleated RBC
Diagnosis - LABORATORY INVESTIGATIONS
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4. Diagnostic tests
- Serum ferritin- low
- Serum iron - low- Serum transferrin -elevated
- Total iron binding capacity (TIBC) - high
5.Stool for occult blood6.Stool for - hookworm and whipworm
LABORATORY INVESTIGATIONS
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Gold standard
Bone marrow aspiration, with the marrow
stained for iron -Bone marrow is hypercellular,
with erythroid hyperplasia
Leukocytes and megakaryocytes are normal
No stainable iron in marrow reticulum cells
Diagnosis:LABORATORY INVESTIGATIONS
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Oral administration - ferrous salts (sulfate, gluconate,fumarate) -46mg/kg of elementaliron
Consumption of milk should be limited
Blood loss from intolerance to cow'smilk proteins is reduced
The amount of iron-rich foods is
increased
TREATMENT
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Incorrect diagnosis (eg, thalassemia)
Patient is not taking the medication
Not absorbed (enteric coated?)
malabsorption syndromes
gastrectomy/celiac disease
Rapid iron loss?
Anemia of chronic disease-impairs bonemarrow response
Oral iron failure?
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Parenteral iron preparation (iron dextran) : Intoleranceto oral iron, severe gastrointestinal complaints
Packed or sedimented RBCs : with Hb values < 4g/dL
congestive heart failure: fresh-packed RBCs should beconsidered
TREATMENT
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12
24 hr Replacement of intracellular iron enzymes; subjective
improvement; decreased irritability; increased Appetite
3648 hr
Initial bone marrow response; erythroid hyperplasia4872 hr
Reticulocytosis, peaking at 57 days
430 days
Increase in hemoglobin level13 mo
Repletion of stores
RESPONSES TO IRON THERAPY
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