1. IRON DEFICIENCY ANAEMIA BY DR. FATMA ALQAHTANI CONSULTANT HAEMATOLOGIST

2. 20
FORMULA 10
PER CENT OF INFANTS
BREAST MILK 20 10
COW’S MILK 20 10 4 6 9 12
AGE IN MONTHS
Percentage of infants with iron deficiency, defined as serum ferritin below 10µ g/l. after feeding iron-supplemented formulas, breast milk and cow’s milk.

3. Factors which affect iron content at birth
Iron content
Increased Decreased
Tissue iron High birth weight Low birth weight
Haemolytic disease
Blood Volume High birth weight Low birth weight
Late cord clamping Early cord clamping
Haemorrhage from cord
or placenta
Materno-fetal transfusion Feto-material transfusion
Feto-fetal transusion Feto-fetal transfusion
Cord haemoglobin Growth retardation Pre-term infant
Maternal anaemia Haemolytic disease
Maternal hypoxia

4. Daily Iron Losses and Requirements (mg)
Daily Loss Requirement Total Loss
for Growth (= Requirement)
Urine, skin, menses
Faeces, etc.
Infant (0-4 months)
(5-12 months)
Child
Adolescent male
Adolescent female
Menstruating female
Adult male
Post menopausal female
N.B: Average daily requirement during pregnancy is 3.0 – 4.0 mg.

7. IRON ABSORPTION Reduced by Favored by Dietary factors:
Increased Haem iron
Increased animal iron
Ferrous iron salts
Luminal factors:
Acid pH (e.g. gastric HCl)
Low molecular weight soluble chelates
(e.g. Vit. C, sugars, amino acids)
Ligand in meat (unidentified)
Systemic factors:
Iron deficiency
Increased erythropoiesis
Ineffective erythropoiesis
Pregnancy
Hypoxia
Reduced by
Decreased haem iron
Decreased animal iron
Ferric iron salts
Alkalis (e.g. pancreatic secretions)
Insoluble iron complexes (e.g. phytates, tannates in tea, bran)
Iron overload
Decreased erythropoiesis
Inflamatory disorders

11. Latent Iron Deficiency Normal Iron Deficiency Anaemia Red cell iron (peripheral film And indices) Normal normal hypochromic, microcytic MCV↓MCH↓MCHC↓ Iron stores (bone marrow Macrophage iron The development of iron deficiency anaemia. Reticuloendothelial (macrophage) stores are lost completely before anaemia develops.

12. serum iron Serum iron binding capacity
normal
iron deficiency
anaemia of chronic disorders
iron overload
µ mol/l
The serum iron and unsaturated serum iron binding capacity in normal subjects, iron deficiency, the anaemia of chronic disorders and iron overload. The total iron binding capacity (TIBC) is made up by the serum iron and the unsaturated iron binding capacity.

13. Depletion Deficient Deficiency Erythropoiesis Anaemia
Normal Iron Iron Iron
Depletion Deficient Deficiency
Erythropoiesis Anaemia
Iron Stores
Erythron Iron
RE Marrow Fe (O-6)
Transferrin IBC (µmol/l) 60±
Plasma Ferritin (µg/l) 100± <10
Iron Absorption Normal ↑ ↑
Plasma Iron (µmol/l) 20± <7
Transferrin Saturation (%) 35± <10
Sideroblasts (%) 40 – <10
RBC Protoporphyrin
(µg/dl RBC)
Erythrocytes normal normal normal
The sequence of changes induced by a gradual reduction in the iron content of the body.
0-|+ 65 20 ↑
<10
<15
100
Microcytic and hypochromic

14. IRON PROTOPORPHYRIN
(a) Iron deficiency Sideroblastic anaemia
(b) Chronic inflammation
or malignancy
HAEM + GLOBIN
Thalassaemia ( α or β )
HAEMOGLOBIN
The causes of a hypochromic microcytic anaemia include:
lack of iron (iron deficiency) or of iron release from macrophages to serum (anaemia of chronic inflammation or malignancy)
Failure of protoporphyrin synthesis (sideroblastic anaemia)
Failure of globin synthesis (α or β–thalassaemia). Lead also inhibits haem and globin synthesis.

15. Hypochromic and/or Microcytic Anaemia
Serum Fe
Serum Fe Increased Hyperferraemia
Serum Fe
Reduced Hypoferraemia
Serum Fe Normal
Bone marrow Sideroblast Fe Increased
Hemoglobin Electrophoresis, etc
Bone Marrow
Macrophage Iron
Serum Ferritin OR
Low
Absent
THLASSEMIA
IRON DEFICIENCY
SIDEROBLASTIC ANAEMIA
Normal or Increased
ANAEMIA OF CHRONIC DISORDERS
Increased
HEMOGLOBINOPATHIES (S,C,D,E)
CONGENITAL
ACQUIRED

16. Failure of response to oral iron
Continuing haemorrhage
Failure to take tablets
Wrong diagnosis – especially thalassaemia trait,sidroblastic anaemia
Mixed deficiency – associated with folate or vitamin B12 deficiency
Another cause for anaemia – e.g. malignancy, inflammation
Malabsorption – this must be extremely severe
Use of slow – release preparation