1. Iron Metabolism and Anemia
KARTIKA WIDAYATI TAROENO-HARIADI
HEMATOLOGY AND MEDICAL ONCOLOGY CONSULTANT

2. INTRODUCTION
Iron deficiency and iron deficiency anemia become a global health problem and common medical condition
Top ranking cause of anemia worldwide and effects on the lives of young children and premenopausal women in both low income and developed countries
Iron is crucial for biologic function :
Respiration
Energy production
DNA synthesis
Cell proliferation

3. Human body has evolved to conserve iron : recycling iron and retention
no excretion mechanisms
Iron absorption is limited to 1-2 mg
Most of the iron needed daily (about 25 mg per day) is provided through
recycling by macrophages that phagocytose senescent erythrocytes.
Hepcidin controls the absorption and recycling
Iron deficiency refers to the reduction of iron stores
Iron-deficiency anemia is a more severe condition in which low levels of iron
are associated with anemia and the presence of microcytic hypochromic red cells.
N Engl J Med. 1999;341:1986–95 [18].

4. Regulation of iron absorption and exportation by enterocytes
Transfus Med Hemother 2014;41:213–221

5. Iron cycle – adaptation mechanisms to iron deficiency
Camaschella. N Engl J Med 2015 ; 372;

6. Causes of Iron deficiency
Camaschella. N Engl J Med 2015 ; 372;

7. Classification of Iron Deficiency (Anemia)
Mechanisms
Based on Pathophysiology
absolute iron deficiency
relative iron deficiency
Decreased iron stores
Iron deficiency in selected tissue with normal iron stores
Based on clinical data
iron deficiency
iron deficiency anemia
Decrease iron stores, without anemia
Decrease iron stores with various degree of anemia
Based on inheritance
genetic IRIDA
acquired
Constitutive excess of hepcidin production
Increased iron demands, decreased intake, blood loss,
Reduced absorption
Camaschella. Blood Review 2017;31:

8. Prevalence of anemia, ID and IDA
Lancet 2016; 387: 907–16

9. Interpretation of laboratory investigation
L. Percy et al. Best Practice & Research Clinical Obstetrics and Gynaecology

10. Hemoglobin level to diagnose anemia
L. Percy et al. Best Practice & Research Clinical Obstetrics and Gynaecology

11. Clinical Findings Dry rough skin Damaged hair Cardiac murmur
Tachycardia
Neurologic dysfunction
Angina pectoris
vertigo
Pallor
Weak
fatigue
Dyspnea
Loss of energy
headache
Painless glossitis
Dysphagia
Koilonychia
alopecia

13. Diagnosis New Test Bone marrow Perl’s staining
Erythrocyte zinc protoporphyrin
circulating sTFRC
Serum hepcidin
Old test
low ferritin level <30 ng/ml
low serum iron
low transferrin saturation <
16%
microcytic hypochromic
MCV, MCH low
increased RDW

14. TREATMENT algorithm
Lancet 2016; 387: 907–16

15. Treatment Intravenous iron Oral iron sulfat, ferrous gluconas
Liposomal iron
Treatment should be 6 months

16. oOral iron supplement preparation Amount (mg) Ferrous iron (mg)
Max daily intake (mg elemental iron/day)
Ferrous fumarate
Ferrous gluconas
Ferrous sulphate
Ferrous sulphate (dried)
200
300 65 35 60
195
105
180
L. Percy et al. Best Practice & Research Clinical Obstetrics and Gynaecology

17. Parenteral iron
L. Percy et al. Best Practice & Research Clinical Obstetrics and Gynaecology

18. SUMMARY
Clinical history, presentation, and findings include fatigue, pallor, dyspnoea on exertion, and pica.
Microcytic, hypochromic anaemia; low reticulocyte count.
Characteristics include low serum iron, increased total iron-binding capacity (TIBC), less than 16% transferrin saturation, and low serum ferritin.
The diagnosis of iron deficiency anaemia necessitates investigation of the underlying cause.
Initial treatment includes oral iron, and intravenous iron as indicated