Iron Metabolism

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Iron Metabolism Hypochromic Anemia

• Yuttana Mundee?
• MYuttana_at_netscape.net

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Objectives

• Iron Metabolism
• Iron Deficiency Anemia
• Sideroblastic Anemia
• Lead Poisoning
• Anemia of Chronic Disease
• Hemochromatosis
• Porphyrias

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Iron Metabolism

• Iron Distribution
• Iron Absorption
• Iron Transportation
• Iron Storage
• Iron Requirement

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Abnormal Iron Metabolism

• Abnormal Hemoglobin Production
• Abnormal Cytoplasmic Maturation
• Microcytic Hypochromic Anemia
• Abnormal Heme Synthesis
• Abnormal Porphyrin Metabolism

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Iron Deficiency Anemia (Sideropenic Anemia)

• Low Iron Intake,
• Malabsorption of Iron
• Increased Iron Loss

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Sideroachrestic Anemia(Iron Overload)

• Over Iron Absorption
• Abnormal Iron Insertion
• Abnormal Porphyrin Synthesis
• Sideroblastic Anemia
• Abnormal Iron Reuse
• Anemia of Chronic Disease

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Iron Functions

• Oxidative Metabolism
• Cell Growth
• Cell Proliferation
• Oxygen Transport

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Iron Toxicity

• Inorganic Iron
• Ionized Iron

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Iron Distribution

• Functional Forms
• Hemoglobin
• Myoglobin
• Cytochromes

• Storage Forms
• Apoferritin
• Ferritin
• Hemosiderin

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Iron Absorption

• Mucosal cells
• Duodenum
• Absorptive Surface
• Time
• Types of Iron

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Types of Iron

• Non-Heme Iron
• Plant Iron
• Ferric-iron (Fe) Complex
• Gastric HCl, Lactic Ascorbic Acids
• Reduced to Ferrous (Fe)
• Sugar, Amino Acids Amines (ve)
• Carbonates, Oxalates, Phosphates, Phytates
  Tannates (-ve)

• Heme Iron
• Animal Iron
• Phosphate ascorbic acid has no effect.
• Heme Dissociation
• Direct Absorption
• Heme Oxigenase
• Oxidized to Fe in Plasma
• Transferrin Binding

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Transferrin receptor (TfR)

• Transmembrane Glycoprotein
• Homodimer
• 2 Transferrin Binding Sites
• 4 Atoms of Fe in Total
• Equal Affinity (apotransferrin, monoferric or
  diferric transferrin)
• Ropheocytosis

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Iron Storage

• Apoferritin
• Isoferritin
• Ferritin
• Hemosiderin

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Iron Requirement

• Adult males 1 mg/day
• Adult females 2 mg/day
• Pregnancy women 3.4 mg/day
• Infants Children

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Iron Deficiency Anemia

• Chronic Blood Loss
• (Intestinal Parasites)
• Malnutrition
• Malabsorption
• Reduced Iron Store

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chronic blood loss

• Hypermenstruation
• Pica Syndromes
• (Geophagia)
• (Amylophagia)
• (Phagophagia)
• PNH
• G6PD deficiency

• Peptic Ulcers
• Alcoholic Gastritis
• Salicylic Acid (Aspirin)
• Parasites
• Hemorrhoid
• Malignancy

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Laboratory findings in IDA

• Complete Blood Count (CBC)
• Zinc Protoporphyrin (ZPP)
• Iron Studies
• Serum Transferrin Receptor (STfR)
• Bone Marrow (BM)

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Sideroblastic Anemia

• Laboratory findings in SA
• CBC
• Iron Studies
• BM

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Anemia of Chronic Disease

• Chronic Infections
• Inflammatory Disorders
• Neoplastic Disorders
• etc.

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Anemia of Chronic Disease(ethiology)

• Release of cytokines
• (IL-1)
• (TNF)
• (Etc.)
• Low Erythropoietin (Epo) Production

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Hemochromatosis

• Iron Overload
• Increased Iron Absorption
• Chronic Transfusion
• Iron Deposit
• Hepatocytes, Cardiac Muscle, Endocrine

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Porphyrias

• Abnormal Enzymes in Porphyrin Metabolism
• Photosensitive
• Abdominal Pain
• Neuropathy
• (motor dysfunction)
• (loss of sensory)
• (mental disturbances)

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References

• Harmening, D.H., et al., Clinical hematology and
  fundamental of hemostasis, 3rd Ed, F.A. Davis
  Company, Philadelphia, 1997.
• McKenzie, S.B., et al., Text book of hematology,
  2nd Ed, Williams Wilkins, A Waverly Company,
  Baltimore,1995.