1. Hany Lashen University of Sheffield

3. Definition is based on low haemoglobin and / or haematocrite. Age groupHb Threshold (dg/l) Children <4.9911 Children 5-11.9911.5 Children 12-14.9912 Non-pregnant women12 Pregnant women11 Men (> 15)13

4.  Classification:  Blood film: microcytic hypocrhomic.  Onset: Acute (haemorrhage) vs chronic.  Cause: ▪ Iron deficiency. ▪ Vitamin B12 and folic acid deficiency. ▪ Haemoglobinopathy: thalassaemia and sickle cell. ▪ Haemorrhage.  IDA is the commonest cause.

5. Region (countries)% Africa (46)40.7 Americas (38)58 South East Asia (11)14.9 Europe (52)22.9 Eastern Mediterranean (21)84.3 Western Pacific (27)13.8

6. AfghanistanKuwaitSaudi Arabia BahrainLebanonsomalia DjiboutiLibyaSudan EgyptMorocoSyria IranOmanTunisia IraqPakistanUAE JordanQatarYemen

7. Category of public health significancePrevalence of anaemia (%) Severe> 40 Moderate20-39.9 Mild5-19.9 Normal< 4.9

8. Age group%Millions Preschool children47.4293 School age children25.4305 Non-pregnant women41.856 Pregnant women30.2468 Men12.7260 Elderly23.9164

9.  Most common worldwide.  Need to differentiate between ID and IDA.  Microcytic hypochromic.  Has physiological and pathological causes.  Physiological: children and women, blood donors vegans.  Pathological: IBD, Kidney disease, Cancer, Chronic inflammatory diseases, parasitic infestation, etc.  Iron deficiency per se can have undesired effect on cognition, fatigue and immunity.

10.  In jejunum mainly.  Controls serum levels.  5-10% of dietary intake normally.  Increases 3-4 fold when depleted.  Two forms: haem and nonhaem.  Haem absorption not affected by elements.  Nonhaem affected by inhibitors & enhancers.  ID arise when demands exceed supply.

11. GroupAgeMean Wt. Requirement for growth (mg/day) Basal loss Mg/day Menstrual Loss mg/day Males11-14450.550.62 15-1764.40.60.9 18+751.05 Females11-1446.10.550.65 11-1446.10.550.650.48 15-1756.40.350.790.48 18+61820.870.48 Postmenopause620.87 Lactating621.15

12. RequirementHigh (15%)Intermediate (12%)Low (10%)v. Low (5%) Males: 1.179.712.214.629.2 1.512.515.718.837.6 1.059.111.413.727.4 Females: 1.29.311.71428 1.6821.827.732.765.4 1.6220.725.83162 1.4619.624.529.458.8 0.877.59.411.322.6 1.151012.51530

13. Estimates based on the prevalence of anaemia (WHO). Age groupIndustrial world (%)Non-industrial world (%) 0-420.139 4-145.948.1 Pregnant women22.752 All women10.342.3 Men4.330 Elderly1245.2

14.  Low Hb.  Microcytic hypochromic.  Exclude haemoglobinopathy esp. thalassaemia.  :Check iron stores:  Low ferretin.  Low transferrin saturation.  High erythrocyte protoporphyrin.  High serum transferrin receptor level.  Bone marrow iron stain.  Establish the cause.

15.  Who?  Pregnant women.  School children.  How?  FBC.  Ferretin.

16.  Obstetrics:  Hb <8.5 dg/l leads to poor outcome (low birth weight, prematurity, postpartum haemorrhage, infection, slow recovery).  Gynaecology:  Heavy periods (half body iron could be lost in one year ~ 1.5 g).  Oral iron unlikely to keep pace with the loss.

17. TypeMax doseTest dose Ferric carboxymaltose1000 mgNoEurope, Asia, Australia Ferumoxytol510NoFDA Iron isomaltoside20 mg/kgNoEurope (2009) Dexferrum100YesHMWID InfeD100YesLMWID Ferrlecit125NoGluconate Venofer200NoSucrose

18. Ganzoni formula: Total iron dose [mg iron] = Body weight [kg] x (Target Hb – Actual Hb) [g/dL] x 2.4 + Iron for iron stores [mg iron]. Iron for stores + 500 mg for weight >35 kg.

19.  IDA very prevalent world wide.  ID prevalence is difficult to assess.  Proper diagnosis & assess iron stores.  Iron supplement should be considered for vulnerable groups.  Health economics should be in operation.  Assess the need, the cause, the time, the efficacy of oral vs. IV iron.  Patient’s compliance in certain cases.