iron defiecinecy anemia

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ANEMIAS

• DR.W.C.LWABBY (RESIDENT IM)

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Introduction

• Anemia is defined as
• Deficiency in the oxygen-carrying capacity of the
  blood due to a diminished erythrocyte mass.
• According to the World Health Organization (WHO)
• Anemia is defined as hemoglobin (Hb) levels
  lt12.0 g/dL in women and lt13.0 g/dL in men.
• However, normal Hb distribution varies not only
  with sex but also with ethnicity and
  physiological status.

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Introduction.

• The function of the RBC is to deliver
• Oxygen from the lungs to the tissues
• Carbon dioxide from the tissues to the lungs.
• This is accomplished by using hemoglobin (Hb).
• In anemia
• a decrease in the number of RBCs impairs the
  bodys ability for gas exchange.

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Introduction.

• The decrease of RBCs mass may result from
• Blood loss
• Results in to Iron deficiency Anaemias
• Increased destruction of RBCs
• Results in to Haemolytic anaemias
• Decreased production of RBCs.
• Results in to Hypoproliferative anaemias

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Classification of Anaemias

• Aetiological (underlying mechanism)
• Blood loss (bleeding).
• Decreased RBC production.
• Increased RBC destruction.
• Morphological
• Normocytic MCV 80-100fL
• Macrocytic MCV gt 100 fL
• Microcytic MCV lt 80 fL

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IRON DEFFICIENCY ANEMIAS(IDA)
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• IDA
• Develops when body stores of iron drop too low to
  support normal red blood cell (RBC) production.
• The cause of depleted iron stores may include
•  Inadequate dietary iron
• Impaired iron absorption
• Bleeding
• Loss of body iron in the urine.

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• Iron equilibrium in the body normally is
  regulated carefully to ensure that
• -sufficient iron is absorbed in order to
  compensate for body losses of iron.

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STAGES OF IRON DEFICIENCY
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Epidemiology

• Iron deficiency is one of the most prevalent
  forms of malnutrition.
• Globally, 50 of anemia is attributable to iron
  deficiency.
• It accounts for approximately 841,000 deaths
  annually worldwide.
• Africa and parts of Asia bear 71 of the global
  mortality burden.

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Causes of Iron deficiency anemia

• Blood loss. 
• Conditions associated with blood loss include
• Menorrhagia (excessive menstruation).
• GI chronic blood loss(bleeding peptic ulcer, a
  hiatal hernia, a colon polyp or colorectal
  cancer,Inflammatory Bowel Disease).
• GIT bleeding can result from regular use of
• - some over-the-counter pain relievers,
  especially aspirin.

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Causes of Iron deficiency anemia.

• Parasitic infection (hookworm)
• Ancylostoma duodenale and Necator americanus
• Release of coagulases causes ongoing blood loss
• Necator worm results in the loss of 0.03 to 0.05
  ml of blood/day
• Ancylostoma worm results in the loss of 0.15 ml
  of blood/day
• Bleeding from most orifices (Very rarely)
• Hematuria due to S.haematobium,Bladder cancer
  e.t.c
• Hematemesis due to esophagial varices, peptic
  ulcer
• Hemoptysis due toPTB,Pulmonary CAs,etc.

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Causes of Iron deficiency anemia.

• NOTE
• Gastrointestinal blood loss
• The most common explanation ( men and
  postmenopausal women)
• Hookworm and schistosomiasis
• The most common causes of gut blood loss world
  wide.

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Causes of Iron deficiency anemia.

• A lack or inadequate iron in the diet. 
• Body regularly gets iron from the foods we eat.
• If the diet contains too little iron, over time
  the body becomes iron deficient.
• Examples of iron-rich foods include meat, eggs,
  leafy green vegetables and iron-fortified foods.
• Vegetarians are more likely to develop Iron
  deficiency.

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Causes of Iron deficiency anemia.

• Malabsorption
• Gastric acid is required to
• Release iron from food
• Keep iron in the soluble ferrous state.
• Achlorhydria may contribute to the lack of iron
  availability from the diet.
• Previous gastric surgery may also cause.

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Causes of Iron deficiency anemia.

• Pregnancy. 
• Iron deficiency anemia occurs in many pregnant
  women because iron stores need to serve
• Their own increased blood volume .
• a source of hemoglobin for the growing fetus.

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Clinical Presentation

• Symptoms
• Patients with iron deficiency anemia may report
  the following
• Fatigue and diminished capability to perform hard
  labor
• Leg cramps on climbing stairs
• Craving ice (in some cases, cold celery or other
  cold vegetables) to suck or chew
• Poor scholastic performance
• Dizzness(light headedness)

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Clinical Presentation

• Reduced resistance to infection
• Altered behavior (eg confusion)
• Worsened symptoms of co-morbid cardiac or
  pulmonary disease.

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Clinical Presentation..

•  Pica may also develop. 
• Pagophagia has been suggested to be "the most
  specific for iron deficiency.
• Other possible symptoms and signs of
  iron-deficiency anemia include
• Irritability
• Angina
• Palpitations
• Breathlessness
• Tingling, numbness, or burning sensations

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Signs

• Findings on physical examination may include the
  following
• Pallor of the mucous membranes (a nonspecific
  finding)
• Spoon-shaped nails (koilonychia)
• A glossy tongue, with atrophy of the lingual
  papillae
• Fissures at the corners of the mouth (angular
  stomatitis)
• Angular cheilitis (inflammatory lesions at the
  mouth's corners)

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Signs.

• koilonychia

• angular stomatitis

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Signs

• Angular cheilitis

• glossy tongue

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Diagnosis

• Patient history
• Description of symptoms
• Dietary History
• Medication
• Physical exam
• Signs of specific for IDA
• Koilonychia
• Angular stomatitis
• Lab investigation
• FBP
• Serum Iron
• TIBC

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Investigations

• Used for
• Confirmation of iron deficiency
• Looking the possible cause of Iron deficiency

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Investigations for Confirmation of iron deficiency

• Complete Blood Count
• Documents the severity of the anemia
• In chronic iron deficiency anemia
• - The cellular indices show a microcytic and
  hypochromic erythropoiesis
• Mean corpuscular volume (MCV)
• and
• Mean corpuscular hemoglobin concentration
  (MCHC)
• have values below the normal range for the
  laboratory performing the test.

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Investigations..

• Reference range values for MCV and MCHC are
• 83-97 fL and 32-36 g/dL, respectively.
• Often, the platelet count is elevated
  (gt450,000/µL)
• -This elevation normalizes after iron
  therapy.

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Investigations..

• Plasma ferritin
• Is a measure of iron stores in tissues
• Is the best single test to confirm iron
  deficiency.
• It is a very specific test.
• A subnormal level is due to iron deficiency
• normal value
• -Adult males and females averaging 100 and
  30 µg/L respectively
• lt15 µg/L Iron stores are depleted

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Investigations..

• Plasma iron and total iron binding capacity
  (TIBC)
• Are measures of iron availability.
• They are affected by many factors besides iron
  stores.
• Becomes very low during an acute phase response.
• Is raised in liver disease and haemolysis.

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Investigations..

• Levels of transferrin are lowered by
• Malnutrition
• Liver disease
• Acute phase response
• Nephrotic syndrome
• They are raised by
• Pregnancy and
• Oral contraceptive pill.

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Investigations..

• A transferrin saturation (i.e. iron/TIBC 100)
• Of less than 16 is consistent with iron
  deficiency.
• The normal range for the serum iron is 50150
  µg/dL
• The normal range for TIBC is 300360 µg/dL
• Transferrin saturation is normally 2550
• serum iron 100 TIBC

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Investigation of the cause

• This will depend upon
• The age and sex of the patient.
• The history and clinical findings.
• e.g
• In men and in postmenopausal women with a
  normal diet
• The upper and lower gastrointestinal tract
  should be investigated by endoscopy or
  radiological studies.
• In the tropics
• Stool and Urine should be examined for parasites.

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Other Tests

• Fecal occult blood test
• Microscopic urine examination

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Treatment

• Treatment of iron deficiency anemia consists of
• Correcting the underlying etiology
• Replenishing iron stores.

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Replenishing iron stores

• Iron therapy is as follows
• Oral Ferrous sulphate
• 200mg 3times daily
• Should be continued for 36 months to replete
  iron stores.
• The haemoglobin should rise by around 10 g/L
  every 710 days
• Reticulocyte response will be evident within a
  week.

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Replenishing iron stores.

• A failure to respond adequately may be due to
• Noncompliance
• Continued blood loss
• Malabsorption
• Incorrect diagnosis

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Replenishing iron stores.

• Parenteral iron therapy
• Patients with malabsorption or chronic gut
  disease may need parenteral iron therapy.
• Previously Iron dextran or Iron sucrose
  was used.
• Currently new preparations of iron
  isomaltose and iron carboxymaltose are
  available.
• -They have fewer allergic effects and
  hence are preferred.

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Replenishing iron stores.

• Blood transfusion is necessary if patient has
• Angina
• Heart failure
• Evidence of cerebral hypoxia
• Respiratory distress

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