Ncdurai

Technologist
Ibra hospital

IRON DEFICIENCY
ANAEMIA
WATER WATER …
EVERYWHERE BUT NO
WATER TO DRINK…

….. A sailor’s confession.

OVERVIEW
 INTRODUCTION
 ABSORPTION
 TRANSPORTATION
 STORAGE
 FUCTIONS
 DEFICIENCY
 TEST S TO MEASURE
 GIFT TO THE PARTICIPANTS.

INTRODUCTION
 IDA is not only a deficiency . but ,
Indication to remember other
diseases.
 20% world population is affected by I
D A (2005)
 As health care worker we need to
know more on absorption,
metabolism other than finding &
evaluating IDA.

Over all metabolism
IRON - HEME
Body Iron Distribution and Storage
Duodenum Dietary iron
( average , 1 - 2 mg
Utilization Utilization
per day )

Plasma ( TIBC )
transferrin
( 3 mg )
Bone
Muscle marrow
( myoglobin ) Circulating ( 300 mg )
( 300 mg ) erythrocytes
Storage
iron ( hemoglobin )
( Ferritin ) ( 1 , 800 mg )

Sloughed mucosal cells

Desquamation / Menstruation
Other blood loss
( average , 1 - 2 mg per day ) Reticuloendothelial
Liver
( 1 , 000 mg ) macrophages
Iron loss ( 600 mg )
absorption
HEME – FERRITIN
-TRANSFERRIN
Storage
functions

 Iron used in synthesis of HEME which

forms hemoglobin, myoglobin
 Transportation of O2,
 Iron in cytochorme participates in
electron transfer reactions.
 Participates in heme enzyme
activities
 Constituent of lactoferrin present in
milk & other secretions.
Gliadin Ab disturbs iron absorption
H.
P
y
l
o
r
i
 Welcome to CME & thanks for the given
opportunity.

Iron is the commonest element in the world but iron

deficiency is the commonest cause of anaemia

IRON IRON EVERY

WHERE BUT NO IRON FOR
HEMESYNTHESIS...
IRON DEFICIENT BODY’S
CONFESSION.
  IRON DEFICIENCY ANAEMIA

 Categorized under Hypo chromic
Microcytic.

 Under stood from the metabolism
Iron deficient caused by
Disturbed absorption

Blood loss

Coeliac diseases, H.pylori, Hook worm

infections.

When to think about iron
deficient?
 The characteristic sequence of events
ensues when the total body iron level
begins to fall:
 1. decreases the iron stores in the
macrophages of the liver, spleen and
bone marrow
 2. increases the amount of free
erythrocyte
 protoporphyrin (FEP)
 3. begins the production of
microcytic erythrocytes
 4. decreases the blood haemoglobin
The end result of a long period of
negative iron balance
decreased iron intake
inadequate diet, impaired absorption,
gastric surgery, celiac disease
increased iron loss
gastrointestinal bleeding
(haemorrhoids, salicylate ingestion,
peptic ulcer, neoplasm, ulcerative
colitis)
excessive menstrual flow, blood
donation, disorders of hemostasis
increased physiologic requirements for
iron
infancy, pregnancy, lactation
cause unknown (idiopathic hypochromic
anemia)
Stages in the development of iron deficiency

 Prelatent
 reduction in iron stores without reduced serum
iron levels
 Hb (N), MCV (N), iron absorption (↑),
transferin saturation (N), serum ferritin (↓),
marrow iron (↓)
 Latent
 iron stores are exhausted, but the blood
haemoglobin level remains normal
 Hb (N), MCV (N), Τ Ι Β Χ (↑), serum ferritin
(↓), transferin saturation (↓), marrow iron
(absent)
 Iron deficiency anemia
 blood haemoglobin concentration falls below
the lower limit of normal
 Hb (↓), MCV (↓), Τ Ι Β Χ (↑), serum ferritin
(↓), transferin saturation (↓), marrow iron
Symptoms of anemia

 Fatigue
 Dizziness
 Headache
 Palpitation
 Dyspnea
 Lethargy
 Disturbances in menstruation
 Impaired growth in infancy
 Symptoms of iron deficiency
 Irritability
 Poor attention span
 Lack interest in surroundings
 Poor work performance
 Behavioural disturbances
 Pica
 Defective structure and function of epithelial
tissue
 especially affected are the hair, the skin, the
nails, the tongue, the mouth, the hypopharynx
and the stomach
 Increased frequency of infection
 Pica

 The habitual ingestion of unusual

substances
 earth, clay (geophagia)
 laundry starch (amylophagia)
 ice (pagophagia)


 Usually is a manifestation of iron

deficiency and is relieved when the
deficiency is treated
Laboratory findings (1)

 Blood tests
 erythrocytes
 hemoglobin level ↓
 the volume of packed red cells (VPRC) ↓
Ρ ΒΧ ↓
 MCV and MCH ↓
 anisocytosis
 poikilocytosis
 hypochromia
 leukocytes
 normal
 platelets
 usually thrombocytosis
HYPO CHORMIC MICRO CYTIC
HYPOCHROMIC MICROCYTIC
ANAEMIA
MODERATE

  Polycythaemia rubra vera
complicated by iron deficiency

Laboratory findings (2)

 Iron metabolism tests

 serum iron concentration ↓
 total iron-binding capacity ↑
 saturation of transferrin ↓
 serum ferritin levels ↓
 sideroblasts ↓
 serum transferrin receptors ↑
 ΦΕ Π ↑

IRON – UIBC
FERRITIN
Laboratory findings (3)

 Bone marrow test

 high cellularity
 mild to moderate erythroid
hyperplasia (25-35%; N 16 – 18%)
 the cytoplasm of polychromatic and
pyknotic erythroblasts is scanty,
vacuolated and irregular in outline.
This type of erythropoiesis has
been described as
micronormoblastic
 bone marrow showing absence of
Pa p p e n h e im e r b o d ie s
•S m a lld e n se b a so p h ilic g ra n u le s
•Iro n co n ta in in g sid e ro so m e o r
m ito ch o n d ria lre m n a n t
•S id e ro b la stic a n e m ia p o st
sp le n e cto m y
GIFT TO THE CME PARTICIPANTS
TAKE HOME – (POINTS to be
remembered at all times)
 As a Technologist
 CBC should be evaluated along with RED
cell indices.
 When ever if u doubt on flags do a PS &
look for HYPO CHROMIC, MICROCYTIC
& OTHER RED CELL INCLUSIONS.
 If you find any inclusions ask your
supervisor whether to comment or
not.
 YOU CAN SUGGEST ABOUT your
findings IT MUST BE REPORTED
THROUGH PROPER CHANNEL.
THANK YOU