Screening for Iron Deficiency

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Screening for Iron Deficiency

• Prepared by Maan I.Mesmeh,M.D.
• Moderated by Dr. Yousef Abu-Osba

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Screening for Iron Deficiency

• Definitions
• Epidemiology
• Pathogenesis
• Clinical Aspects
• Making the Diagnosis
• Laboratory Parameters
• Diet
• Prevention

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Screening for Iron Deficiency

• Introduction
• why it is an important health problem ?
• Its serious sequelae
• Its prevalence
• Still seen frequently

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Screening for Iron Deficiency

• Anemia
• Definition
• Causes
• Categorizing
• Iron
• Depletion
• Deficiency
• Iron deficiency anemia

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Screening for Iron Deficiency

• Epidemiology
• WHO estimates most of the worlds population
  are iron deficient , one third have anemia .
• High prevalence in the late 1960s led to the
  introduction of preventive programs .
• WIC act
• Iron deficiency remains common in the developed
  countries sever cases still occur .

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Screening for Iron Deficiency

• Attributable factors are different in the
  developing countries from developed countries .
• Some sectors of the population are more
  susceptible .
• The difference between the infants toddlers in
  regard to fortification of formula , diet cow
  milk ingestion .
• The difference between the male the female .
• In the first months of life no role for iron
  deficiency .

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Screening for Iron Deficiency

• Pathogenesis
• Site
• Role
• Absorption
• heme nonheme
• inhibitors of iron absorption
• enhanced absorption
• absorbability difference between human milk
  (50) , cow milk (10) , fortified formula (5) .
  

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Screening for Iron Deficiency

• Transport
• Source Storage developing fetus , depletion
  of 50 occurs in the first 4 months , depletion
  of the stores occur at 2-3 months in the preterm
• Loss occur in GIT , urine skin .
• Daily needs ( o.8 mg/d 0.6 growth , 0.2 for
  ongoing losses

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Screening for Iron Deficiency

• Clinical Aspects
• SS depends on the degree of deficiency on the
  rate of development of the deficiency
• The most frequent sign is pallor
• 10-15 splenomegally
• Irritability anorexia in infants toddlers
• 45 of sever cases were asymptomatic
• Developmental delay ? irreversibility

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Screening for Iron Deficiency

• Clinical Aspects
• Other SS
• poor growth , blue sclerae , koilonychia ,
  angular stomatitis , increased susceptibility to
  infections , GIT symptoms , increased lead
  absorption , pica plumbism .

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Screening for Iron Deficiency

• Making the Diagnosis
• DDx narrows once classified as microcytic
• IDA
• Thalassemia
• Lead poisoning
• Chronic disease
• Sideroblastic anemia

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Screening for Iron Deficiency

• Making the Diagnosis
• The gold standard for identifying iron
  deficiency is bone marrow biopsy with Prussian
  blue staining .
• Otherwise no single best test to diagnose iron
  deficiency
• Hematological biochemical tests are based on
  RBCs features iron metabolism
• Biochemical tests detect early iron deficiency
• CHr is a new test

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Screening for Iron Deficiency

• Laboratory Parameters
• 1) Hematological Markers
• The changes through the spectrum from normal
  to IDA in
• Hgb MCV are late markers less
  specific
• RDW is highly sensitive but has low
  specificity
• Reticulocytes for assessing response
  to Rx .
• CHr is the best predictor of iron
  deficiency among Hgb , MCV , s.iron , RDW
  transferrin saturation .

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Screening for Iron Deficiency
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Screening for Iron Deficiency

• Laboratory Parameters
• 2) Biochemical Markers
• S.ferritin is the earliest marker of iron
  deficiency with high specificity
• S.iron is not accurate because it is
  affected by iron absorption , infection ,
  inflammation diurnal variation .
• TIBC measures iron-binding sites but
  affected by malnutrition , inflammation , chromic
  infection cancer .
• Transferrin saturation () s.iron TIBC

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Screening for Iron Deficiency

• Laboratory Parameters
• 2) Biochemical Markers
• TfR by immunoassay . It presents in
  immature reticulocytes . It is early marker can
  differentiate between IDA chronic illness
• ZPP/heme is an early marker but not specific

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Screening for Iron Deficiency
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Screening for Iron Deficiency

• Diet
• The dietary history is suggestive
• IDA in one study defined as
• 1) lt 5 servings per week
• 2) gt 16 oz milk per day
• 3) Daily fatty snacks , sweets gt 16 oz soda.
• In this case the history was 71 sensitive , 79
  specific , 97 negative predictive value

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Screening for Iron Deficiency

• Prevention
• Primary
• Secondary
• AAP recommendation Hgb Hct once between 9-12
  months again after 6 months ( consider risk
  factor prevalence in the population ) also all
  adolscence once between 11-21 years in addition
  to all mensruating females annually

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Screening for Iron Deficiency
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Screening for Iron Deficiency

• Treatment
• oral iron salts
• parenteral iron
• PRBCs
• Follow up increase of 10 g /L after one month
  of Rx confirms the diagnosis

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