Iron Deficiency Anaemia

Iron Deficiency Anaemia

• 1.
  ANAEMIA- IRON DEFICIENCY ANAEMIA ASWATHY.A ASSISTANTPROFESSOR DEPARTMENT OF PATHOLOGY
• 2.
  DEFINITION Anaemia refer toa decrese in the total number of circulatory red cells with decrease in HB,PCV below the previously established normal values , health person of same age group ,gender race,and similar environmental conditions. Its clinical diagnosis is made from the history , physical examination ,sign and symptoms ,HB values and other procedures and findings
• 4.
  IRON DEFICIENCY ANAEMIA(IDA) Anaemia associated with inadequate absorption or excess loss of iron/blood  IDA is characterized by microcytic hypochromic red cells with MCV<80 fl and MCH <25pg.  Most common anaemia prevalence in world wide and in India  High risk group __ children , pregnant women and elderly persons prevalence of IDA in children_ 25% -45% prevalence of IDA in females_ 45%- 60%  IRON METABOLISM ABSORPTION - DUODENUM AND UPPER JEJUNUM TRANSFERRIN TRANSPORTS IRON TO THE CELLS IRON STORAGE- FERRITIN AND HEMOSYDERIN
• 5.
  DAILY REQUIREMENT OFIRON Diet should contain 10-15 mg of elementary iron and with approximately 8-10% absorbed Daily net requirement of males- 1 mg Daily net requirement of females – 1.5 mg FACTORS PROMOTING IRON ABSORPTION Hcl of stomach Ascorbic acid FACTORS HAMPERING IRON ABSORPTION Phytates of cereals Tannate of tea Phosphate of diet and drugs Milk Small loss of iron each day in urine, faeces,skin and nails and in menstruating females as blood (1-2 mg daily)
• 6.
  CAUSES 1. Decreased supply 2.Impared absorption 3. Increased demand 4. Loss 1) DECREASED SUPPLY a) Nutritional deficiency b) Malabsorption 2) IMPARED ABSORPTION Total or partial gastrectomy impairs iron absorption by decreasing Hcl and transit time through the duodenum 3)INCREASED DEMAND increased utalisation , a) pregnancy and lactation b) Growth- growing infants ,childrens and adolescents
• 7.
  4)LOSS a) chronic bloodloss - Gastro intestinal tract, urinary tract, genital tract and respiratory tract bleeding b) Intravascular hemolysis – PNH, microangiopathic and hemolytic anaemia CLINICAL FEATURES  CRACKS IN THE SIDE OF THE MOUTH  EXTREME FATIGUE (TIREDNESS)  CHEST PAIN  DIZZINESS / LIGHT HEADACHE  GLOSSITIS  Dysphagia( Plummer-Vinson syndrome)  ATROPIC GASTRITIS  PALE SKIN  SPOON SHAPED NAILS, KOILONYCHIA, 
• 8.
   HAIR LOSS BLUE SCLERAE  PICA (APETITE FOR NON FOOD SUBSTANCESSUCH AS AN ICE, CLAY)  ANGULAR STOMATITIS  IMMUNE FUNCTION  BEETURIA  SPLENOMEGALY (10%)  CONGENITAL HEART FAILURE
• 10.
  LAB DIAGNOSIS OFIDA 1) Peripheral blood findings 2) Bone marrow examination 3) Iron state PERIPHERAL BLOOD FINDINGS a)Counting HB-Decreased PCV-Decreased RBC- Normal TLC-Normal DC- Normal Platelet- Increased Red cell indices - MCV < 80fl MCH< 25pg MCHC< 27g/dl RDW -Increased Recticulocyte count-Normal or Increased
• 11.
  PERIPHERAL SMEAR EXAMINATION RBC-Microcytic hypochromic anaemia with pencil/cigar shaped cells Hypochromia- Central pallor being more than 1/3 rd WBC- Normal size and shape PLATELET- Increased in number and seen in groups Severe anaemia – Central pallor 2/3 rd -3/4 th
• 12.
  BONE MARROW EXAMINATION Bone marrow is hypercellular  Erythroid hyperplasia is present but is less as compared to the degree of anaemia .It varies from 2:1 to 1:2  Miconormoblastic reactions  Myelopoiesis and megakaryopoiesis is normal  Depletion of bone marrow iron-Prussion blue stain Iron granules present in perls prussion blue stain
• 13.
  ASSESSMENT OF IRONSTATE  S. Ferritin- <12 µg/L  S. Iron –reduced 10-15µg/dl  TIBC- reduced (350-450µg/dl)  Transferrin saturation- <16%  STRA- Increased  Red cell protoporphyrin- increased ( >200 g/dl)  Recticulocyte hemoglobin content – reduced  Erythrocyte zinc protoporphyrin – increased DIFFERENTIAL DIAGNOSIS  Thalassemia major and minor  Anemia of chronic disorders  Sideroblastic anemia  Hb E thalassemia  Lead poisoning
• 14.
  TREATMENT Before using ironmedications check if you are allergic to any drugs or food dyes or if you have,  Iron overload syndrome  Hemolytic anemia (a lack of red blood cells)  Porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system thalassemia (a genetic disorder of red blood cells)  Liver or kidney disease  If you are an alcoholic; or if you receive regular blood transfusion 1) Oral iron therapy 2) Parenternal iron therapy 3)Non pharmacological treatment
• 15.
  ORAL IRON THERAPY Oraliron treatment may require 3-6 months to replenish body iron stores.
• 17.
   Ferrous sulfateis the DOC for iron deficiency anemia.  Dosage: 325 mg, which provides 180 mg of iron daily of which 10mg is usually absorbed.  Patients who cannot tolerate iron on an empty stomach should take it with food. COMMON ADVERSE EFFECTS OF ORAL IRON THERAPY • Nausea • Epigastric discomfort • Abdominal cramps • Constipation and diarrhea. • Black stool • These effects are usually dose-related
• 18.
  PARENTERNAL IRON THERAPY Indicatesin,  Late stage of pregnancy  Post operative patients  Patients who are unable to take oral preparation  Iron Sorbitol is given as a single dose/weekly/daily  Iron Dextran -Is a stable complex of ferric hydroxide and low-molecular weight dextran containing 50mg of elemental iron per milliliter of solution . It can be given deep IM injection or IV infusion’ Adverse effect:  light-headedness, fever, arthralgias, back  pain, urticaria, bronchospasm and  hypersensitivity reaction
• 19.
  NON PHARMACOLOGICAL TREATMENT Iron-rich diet  Good sources of iron includes:  Meats - beef, pork, lamb, liver, and other organ meats  Poultry - chicken, duck, turkey, liver (especially dark meat)  Fish - shellfish, including clams, mussels, and oysters, sardines, anchovies  Leafy greens of the cabbage family, such as broccoli , kale, turnip greens, and collards  Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans