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Iron Deficiency Anemia
Nada Mohamed Ahmed ,MD, MT (ASCP)i
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• Definition .• Physiology of iron. • Causes of iron deficiency.• At risk group .• Stages of IDA (pathophysiology).• Symptoms (clinical presentation ).• Lab diagnosis.
LEARNING OBJECTIVES
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Definition Iron Deficiency Anemia
• Iron deficiency anemia is a condition in which hemoglobin synthesis has been defected due to reduce or lacking of iron in the body .
• Iron is an essential mineral that is needed to form hemoglobin, an oxygen carrying protein inside red blood cells.
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Physiology of iron:
• 1- distribution of iron • 2- source of iron • 3-Iron absorption • 4-Iron transport• 5-storage of iron
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) distribution (of iron Iron in human body
• Total Iron in human body averages 4 to 5 grams which is distributed as:
1. 65% in form of Hb. (Hemoglobin iron)2. 4% in form of mayoglobin. respiratory
enzymes 3. (plasma iron ) ( transport iron) 0.1% is
combined with protein transferrin in blood4. storage iron 15%−30% stored for later use,mainly
in reticuloendothelial system of bone marrow and liver parenchymal cells, principally in form of ( ferritin and hemosidirin )
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Absorption
• Ferrous, Fe2+, most soluble = most absorbable
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AbsorptionDuodenal Lumen Duodenal Mucosa Plasma
B2-microglobulin
HFE
DMT1
B3 integrin
MucinFe++
Fe++ Fe++
Fe2+
Fe3+
Mobilferritin
Heme-Protein
Heme+
Polypeptides
Heme
Biliverdin Bilirubin Bilirubin
Heme
OxigenaseCO CO
paraferritin
Fe2+ Fe2+
Fe3+
Transferritin
Ceruloplasmin
Ferroportin
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IRON ABSORPTION
Haem iron is not affected by ingestion of
other food items. The haem molecule is absorbed intact and the iron is released in the mucosal cells.
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IRON ABSORPTION (2)
The absorption of(free) non-haem iron varies greatly from 2% to 100% because it is strongly influenced by:
The iron status of the bodyThe solubility of iron saltsIntegrity of gut mucosaPresence of absorption inhibitors or
facilitators
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INHIBITORS OF IRON ABSORPTION
Food with polyphenol compoundsVegetables such as spinach and spices Beverages like tea, coffee, cocoa and wine. A single cup of tea taken with meal reduces iron absorption by up to 11%.
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IRON TRANSPORTTransferrin is the major protein responsible for transporting iron in the body.Transferrin receptors, located in almost all cells of the body, can bind two molecules of transferrin.Both transferrin concentration & transferrin receptors are important in assessing iron status.
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STORAGE OF IRONTissues with higher requirement for iron
( bone marrow, liver & placenta) contain more transferrin receptors.
Once in tissues, iron is stored as ferritin & hemosiderin compounds, which are present in the liver, RE cells & bone marrow.
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Causes of iron deficiency
Increase demands of iron
Increase iron loss
Decrease iron intake
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AT RISK GROUPSInfants
Under 5 children
Children of school age
Women of child bearing age
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• Iron deficiency anemia is the most common form of anemia and it develops over time if the body does not have enough iron to manufacture red blood cells.
• Without enough iron, the body uses up all the iron it has stored in the liver, bone marrow and other organs.
Stages of IDA (pathophysiology)
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• Once the stored iron is depleted, the body is able to make very few red blood cells.
• If erythropoietin is present without sufficient iron, there is insufficient fuel for red blood cell production
• The red blood cells that the body is able to make are abnormal and do not have a normal hemoglobin-carrying capacity, as do normal red blood cells.
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Clinical Presentation• Iron-deficiency anemia can cause:brittle nails
cracks in the sides of the mouth
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Extreme fatigue (tiredness)
chest pain
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• Pale skin
• Dizziness or lightheadedness
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Symptoms (clinical presentation ).
an enlarged spleenCold hands and feetfrequent infections.Irritabilityshortness of breathswelling or soreness of the tongue
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LAB FINDINGS IN IDA
Complete blood count(Microcytic hypochromic) anaemiaLow Hb level (< 11.0 g/dl)Low MCV, MCH, MCHCLow serum ferritin
High iron binding capacity
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