Nada Mohamed Ahmed, MD, MT (ASCP)i

Definition. Physiology of iron. Causes of iron deficiency. At risk group. Stages of IDA (pathophysiology). Symptoms (clinical presentation ). Lab diagnosis. LEARNING OBJECTIVES

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). Iron is vital for all living organisms because it is essential for multiple metabolic processes, including oxygen transport, DNA synthesis, and electron transport

Physiology of iron: 1- distribution of iron 2- source of iron 3-Iron absorption 4-Iron transport 5-storage of iron

) Distribution (of iron in human body Distribution: Synthesis hemoglobin 64% Synthesis myoglobin 3.2% Ferritin 32% Hemosiderin (stored in bone marrow,liver, spleen.) The iron-containing Enzymes 0.4% Transferring 0.4%

Absorption Iron Taken up as ionic iron or haem iron Ferrous, Fe 2+, most soluble = most absorbable 10% of the 10 to 20 mg of dietary iron is absorbed each day to balance the 1 to 2 mg daily loss. Iron is absorbed in Duodenum& Jejunum. Stored as Ferritin & Hemosiderin.

INHIBITORS OF IRON ABSORPTION  Food with polyphenol compounds Vegetables 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%.

IRON TRANSPORT Red cells As haemoglobin Cannot be exchanged Plasma Bound to Transferrin Carries iron between body locations e.g between gut, liver, bone marrow, macrophages Iron taken up into cells by transferrin receptors

STORAGE OF IRON Tissues 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 & bone marrow.

Causes of iron deficiency 1-I ncreased blood loss – hemorrhage (menorrhagia, chronic gastrointestinal blood loss) 2-Increased requirements pregnancy, children (growth) 3-Poor dietary intake ( Malabsorption)

AT RISK GROUPS  Infants  Under 5 children  Children of school age  Women of child bearing age

1-Iron deficiency anemia is the most common form of anemia and it develops over time if the body does not have enough iron to synthesize red blood cells. 2-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 )

3-Once the stored iron is depleted, the body is able to make very few red blood cells. 4-If erythropoietin is present without sufficient iron, there is insufficient fuel for red blood cell production 5-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.

Clinical Presentation( Symptoms ) Iron-deficiency anemia can cause:  brittle nails  cracks in the sides of the mouth

 Extreme fatigue (tiredness)  chest pain

Pale skin Dizziness or lightheadedness

Fast heart rate Headache

General Symptoms (clinical presentation ).  an enlarged spleen  Cold hands and feet  frequent infections.  Irritability  shortness of breath  swelling or soreness of the tongue

Lab Diagnosis in IDA Complete blood count (Microcytic hypochromic) anaemia Low Hb level (< 11.0 g/dl) Low MCV, MCH, MCHC Low serum ferritin High Transferrin (Iron Binding Capacity)

Iron Deficiency Anemia

Normal blood film