3. IRON IN HEALTH AND DISEASE

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

5. 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.

6. 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

7. BODY IRON CYCLING

8. FACTORS AFFECTING IRON ABSORPTION

9. 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

10. Factors affecting Iron Absorption
Absorbed through intestinal mucosa, only when needed
No excessive storage.
Ferrous (Fe++) is better absorbed than Fe+++ (Ferric)
Better absorbed in Acidic medium, by virtue of conversion of ferric to ferrous state.

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

12. 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.

13. 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.

14. IRON DEFICIENCY Hypochromic Microcytic 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

15. IRON REQUIREMENTS
Due to efficient conservation and reutilization in the body daily physiologic requirement is small.
Healthy man loses about 1 mg/day iron, while women lose about 1.5 mg/day
10% of average available dietary iron is absorbed which comes to 10 mg/day required for men and 18 mg/day required for women

16. 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

17. 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

18. CLINICAL FEATURES (Symptoms)
Dizziness
Headache
Weakness
Fatigue

19. CLINICAL FEATURES (signs)
Pallor
glossitis
angular cheilosis and
koilonychia.
Koilonychia
Glossitis

22. CLINICAL FEATURES OF IRON DEFICIENCY Angular Cheilosis or Stomatitis
                                        

24. Hypochromic microcytic red cells

27. 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

28. 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.

29. 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.

30. 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.

31. Deposition of iron in the parenchymal cells of the liver.
Toxic intakes of iron reported in children and adults ingesting medicine 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.

32. BONE MARROW FILM STAINED FOR HAEMOSIDERIN

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

34. 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

35. DIFFERENTIAL DIAGNOSIS: IRON DEFICIENCY ANAEMIA

36. 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

37. 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 37