2. IRON IN HEALTH AND DISEASE

3. Surah 57. Al-Hadid (The Iron) Aya: 25

4. We have indeed sent Our messengers with clear evidences and sent down with them the Scripture and the balance that the people may maintain (their affairs) in justice. And we sent down iron, where in is great military might and benefits for the people, and so that Allah may make evident those who support Him and His messengers unseen. Indeed, Allah is powerful and Exalted in Might.

5. Surah 57. Al-Hadid (The Iron) Aya: 25

6. Learning Objectives Distribution Daily Requirements Dietary sources
Important functions
Absorption & Metabolism
Deficiency diseases

7. Introduction It is a well establish fact now that:
deficiency or over exposure to various elements has noticeable effects on human health.
Element’s effect is determined by many factors, including absorption, metabolism, and its interaction with other processes.
Iron is an essential element for almost all living organisms.
It participates in a wide variety of metabolic processes, including O2 and CO2 transport, DNA synthesis, and electron transport.

8. However,
Iron can form free radicals, its concentration in body tissues must be tightly regulated .
In excessive amounts, it can lead to tissue damage.
Disorders of iron metabolism are among the most common diseases of humans and encompass a broad spectrum of diseases with diverse clinical manifestations.
Ranging from anemia to iron overload, and possibly to neurodegenerative diseases.

9. IRON Called by Egyptians as “Heavenly metal”.
Used as medicine around 1500 B.C. for the treatment of parasitic infection and a variety of other ailments.
Quran describes it as a means of power.
One of the most plentiful elements on earth.
5% of earth crust, still its deficiency a common health problem

10. IRON
18th Century: presence was demonstrated in animal tissues and blood.
20th Century: Much learnt about iron & its interaction with other elements.

11. At. No. 26 IRON At. Mass 56

12. IRON ( Al-Hadeed) Fe Aya No. 25 Sura No. 57

13. DISTRIBUTION 4 grams of Fe ,on an average in human body
3 grams in active or functional form and
1 gram in storage or transport form.

14. Distribution of Iron in human body
Hemoglobin 66%
Myoglobin %
Other body cells 05%
Enzymes 01%
Ferritin (store) 25%

15. Recommended Dietary Allowance
Infants 0 – 0.5 = 10 mg
0.5 – = 15 mg
Children 1 – 3 = 15 mg
4 – 6 = 10 mg
7 – 10 = 10 mg

16. Iron RDA Age Male Female 11 – 14 18 mg 15 – 18 19 – 22 10 mg 23 – 50
51 +

17. Major Dietary sources Red meat, Liver and Eggs
Green Vegetables and , Cereals
Apple, Nuts, Peaches and Dry fruits
Iron from cooking utensils, made of iron

18. FUNCTIONS Essential elements in the daily diet.
Vital role in O2 transport and energy production.
Exclusively involved in the uptake and release of O2 at cellular level.

19. FUNCTIONS
Active part is mostly in Porphyrin and forms an integral part of Hb and Myoglobin,
In RBCs enzymes cytochrome, oxidase, catalase and peroxidases .

20. FUNCTIONS
Myoglobin works on similar principle but performs in muscles only.

21. FUNCTIONS Shuttles O2 from lungs to all other tissues and
CO2 back from tissues to lungs.
Ability of Hb molecule to take up O2 and release CO2, is dependent on presence of Fe in Hb.
Without Fe, the Hb. molecule cannot perform this function.
The cytochrome enzyme system functions in energy production.

22. Absorption and Metabolism

23. METABOLISM
Fe++ is absorbed from intestinal lumen into the cells of intestinal mucosa.
Here Fe++ is oxidized to Fe+++
Combines with proteins Apoferritin.
Iron – protein complex, Ferritin and stored.

24. EXCRETION Iron is unique among mineral elements.
There is no physiologic mechanism for regulating its increase or decrease excretion.
Balance is mainly controlled at the site of intestinal absorption.

26. that increase or decrease the availability of iron for absorption.
Iron Absorption
Absorption is influenced by the amount already present in the diet / food
that increase or decrease the availability of iron for absorption.
Primary regulator of iron homeostasis
1-50% of iron is absorbed.
If body needs more iron, it increases amount of “transferrin” an iron carrying protein.
Iron can also be stored in another protein called “ferritin”

27. Iron Absorption

30. Enterocyte Gut ABSORPTION OF IRON Fe+++ Ferritin Fe++ Tf-Fe+++ Fe++
Haem Tf

31. BODY IRON CYCLING

32. Absorption Heme iron is better absorbed than non heme iron
During states of iron balance, about 10% of dietary iron is absorbed
Figure can increase by 2 or 3 times, during periods of iron deficiency

33. METABOLISM
When iron is needed by the body, Ferritin gives up its iron to the blood stream.
Fe+++ iron is reduced within the mucosal cell to Fe++ form and released.
The apoferritin in the mucosal cell can then combine with dietary iron absorbed in the intestine.
If all the mucosal cells are saturated, no further absorption.

34. METABOLISM
Most of iron in blood stream is utilized by bone marrow to synthesize Hb.
Some is used by other tissue in the formation of enzyme

35. Factors affecting Iron Absorption
Absorbed through intestinal mucosa, only when needed
Ferrous (Fe++) is better absorbed than Fe+++ (Ferric)
Better absorbed in Acidic medium, by virtue of conversion of ferric to ferrous state.

36. Absorption Absorption increase with need:
Period of rapid growth in infancy.
Childhood and adolescence
During pregnancy,
As a result of blood loss and
At high attitude.

37. Factors
Absorption is more efficient in presence of Vit C, and other reducing substances
Vitamin C and fructose forms soluble complexes with iron and therefore better absorbed.

38. High fiber in diet – decrease iron absorption
Tea can also inhibit the absorption of non heme iron
Phosphate, Oxalates, Phytates forms insoluble complexes with iron, preventing absorption.

39. IRON DEFICIENCY Hypo chromic anemia:
No of RBCs are either normal or reduced
Amount of circulating Hb is reduced
In each RBC the Hb. content fall
Hb low, oxygen carrying capacity is reduced

40. IRON REQUIREMENTS
Due to efficient conservation and reutilization in the body daily physiologic requirement is small.
Healthy man loses about mg/day iron, while women lose about mg/day
10% of average available dietary iron is absorbed which comes to 5-10 mg/day required for men and mg/day required for women

41. IRON REQUIREMENTS Pregnancy increase iron daily need by 3.5 mg/day
To be taken as iron supplement and not diet – 60 mg/day
Lactation iron losses are 0.5 – 1.0 mg/day
Continuous Supplementation needed for 2 – 3 month after delivery

42. IRON DEFICIENCY Commonest cause of anaemia worldwide
Cause of chronic ill health
May indicate the presence of important underlying disease eg. blood loss from tumour

43. CLINICAL FEATURES (Symptoms)
Dizziness
Headache
Weakness
Fatigue

44. CLINICAL FEATURES (signs)
Pallor
Glossitis
Angular cheilosis and
koilonychia.
Koilonychia
Glossitis

45. CLINICAL FEATURES OF IRON DEFICIENCY Angular Cheilosis or Stomatitis
                                        

46. Hypochromic microcytic red cells

47. Iron deficiency develops
Poor diet
Chronic blood loss or both
Intestinal parasite
Bleeding Hemorrhoids
Peptic Ulcer
Heavy menstrual losses
Closed space pregnancy
Insufficient proteins
Insufficient calories
B – vitamins. / Ascorbic acid

48. Common situation where Iron Intake is inadequate.
During infancy:
Low iron content of milk
Fe stores at birth which are usually sufficient only for first 6 months.
During rapid growth in child hood and adolescences:
Because of the need of expanding iron stores.

49. Common situation where Iron Intake is inadequate.
During reproductive period: Menstrual losses
During pregnancy, because of increased:
Maternal blood volume
Demands of the fetus and placenta
Blood losses during child birth.

50. Iron overload Total amount of Fe in body can be increased by
Excessive intake.
Taking care of Abnormalities in iron absorption.
Parenteral administration of iron.
Overload iron by food alone  very difficult because of intestinal mucosal absorption.

51. Deposition of iron in the parenchymal cells of the liver.
Toxic intakes of iron reported in children and adults ingesting medicinal iron supplements.
Lethal dose for
Young Child = 3 grams
Adult = 200 – 250 mg/kg BW.
Overload can also be caused by defect in intestinal mucosa. (Hemochromatosis)
Deposition of iron in the parenchymal cells of the liver.

52. BONE MARROW FILM STAINED FOR HAEMOSIDERIN

53. Advance stage Graying pigmentation of skin Poor liver function
Liver enlargement and scaring
Pancreatic infiltration and resultant diabetes.
Myocardial disease resulting in Heart failure.

54. Things you need to know about Laboratory Testing for Iron Status
Serum ferritin most useful test
Low serum ferritin , a proof that patient is iron deficient
Normal serum ferritin does not always rule out iron deficiency
Certain conditions raise ferritin for reasons unrelated to iron status

55. DIFFERENTIAL DIAGNOSIS: IRON DEFICIENCY ANAEMIA

56. LABORATORY DIAGNOSIS Elevated % transferrin saturation
Increased serum ferritin
Genetic testing for mutations of HFE gene
Evidence parenchymal iron overload on liver biopsy
Amount of iron removed by venesection

57. WHEN DOES IRON BECOME A PROBLEM?
Normally 3-5 grams of iron in the body.
Tissue damage when total body iron is 7 – 15 g
Total body iron is also increased to variable ammounts at baseline by the ineffective hematopoiesis of MDS which leads to suppressed hepcidin: which leads to excessive intestinal absorption of iron and recycling of catabolic iron from the RES cells 57