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    Add as FriendIron Deiciency Anaemia

    by: Shatdal

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    1 : IRON DEFICIENCY ANEMIA Dr. Shatdal Chaudhary Assistant Professor Department of Internal Medicine BP Koirala Institute of Health Sciences Dharan, Nepal
    2 : IRON METABOLISM INTRODUCTORY BACKGROUND Essential element in all living cells Transports and stores oxygen Integral part of many enzymes Quantity of body iron carefully controlled
    3 : Iron Metabolism
    4 : IRON Body Compartments - 80 kg man 3 mg Absorption < 1 mg/day Excretion < 1 mg/day (sweat, feces) transferrin
    5 : Absorption is increased by the presence of: glucose, fructose, amino acids and vitamin C IRON ABSORPTION Duodenum Iron is reduced to the ferrous(Fe 2+) form helping by the iron to the mucosal cell receptor sites Fe 3+ is complexed to other organic and inorganic molecule Fe 2+ was oxidized back to Fe 3+ and bound to apoferritin in the mucosal cells
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    7 : TRANSFERRIN (IRON TRANSPORT) Plasma transferrin is an 80 kDa glycoprotein The liver synthesizes transferrin and secretes it into the plasma. Transferrins are also produced locally in the testes and CNS. These two sites are relatively inaccessible to proteins in the general circulation (blood:testis barrier, blood:brain barrier). The locally synthesized transferrin could play a role in iron metabolism in these tissues.
    8 : The average red cell life span is 120 days. So 0.8 to 1.0% of red cells turn over each day. Each milliliter of red cells contains 1 mg of elemental iron. Normally, an adult male will need to absorb at least 1 mg of elemental iron daily to meet needs. Females in the childbearing years will need to absorb an average of 1.4 mg/d.
    9 : NUTRITIONAL IRON BALANCE The balance of iron metabolism is tightly controlled and designed to conserve iron for reutilization. There is no excretory pathway for iron The only mechanisms by which iron is lost from the body are blood loss (via GI bleeding, menses, or other bleeding) and the loss of epidermal cells from the skin and gut. Men lose about .6 mg/day whereas women almost double and loss is variable Amount of iron absorbed is 3-6% of the amount ingested
    10 : Iron source 1. Heme iron (40%) are present in meat, fish and liver (20-30% absorption). 2. Non-heme iron (60%) are present in green vegetables, fruits, beans and bread (3% absorption).
    11 : Iron bioavailability is affected by the nature of the foodstuff (heme iron being most readily absorbed) certain foodstuffs that include phytates and phosphates reduce iron absorption by about 50%. Food decrease iron absorption State of iron store in the body State of erythropoiesis in the body Infants, children, and adolescents
    12 : IRON DEFICIENCY ANEMIA Most common cause of anemia Worldwide estimated prevalence of iron deficiency Anemia one-half billion people.
    13 : IRON DEFICIENCY ANEMIA Prevalence
    14 : IRON DEFICIENCY ANEMIA STAGES OF IRON DEFICIENCY can be divided into three stages. 1. negative iron balance (depletion of body iron stores only): demands/losses of iron exceed the body’s ability to absorb iron from the diet. Under these circumstances the iron deficit must be made up by mobilization of iron from RE storage sites. iron stores—such as the serum ferritin level or the appearance of stainable iron on bone marrow aspirations—will decrease. serum iron, TIBC, and red cell protoporphyrin levels remain within normal limits. At this stage, red cell morphology and indices are normal.
    15 : 2. Period of iron deficient erythropoiesis (Biochemical Iron def with out anemia) When iron stores become depleted, the serum iron begins to fall. the TIBC and red cell protoporphyrin levels increases. first appearance of microcytic cells, one finds hypochromic reticulocytes in circulation.
    16 : 3. iron deficiency anemia. the hemoglobin and hematocrit begin to fall
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    18 : Causes of Iron deficiency
    19 : CLINICAL FEATURES Symptoms eg. fatigue, dizziness, headache, Pica Signs eg. pallor, glossitis, angular cheilosis, koilonychia, Plummer Vinson syndrome Koilonychia Glossitis
    20 : Angular Cheilosis or Stomatitis Plummer Vinson Syndrome : Oesophageal Web CLINICAL FEATURES OF IRON DEFICIENCY
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    22 : LABORATORY IRON STUDIES Serum Iron and Total Iron-Binding Capacity normal range for the serum iron is 50 to 150 µg/dL; The normal range for TIBC is 300 to 360 µg/dL. Serum Ferritin Earlist finding serum ferritin level correlates with total body iron stores As iron stores are depleted, the serum ferritin falls to 15 µ g/L. Such levels are virtually always diagnostic of absent body iron stores.
    23 : Evaluation of Bone Marrow Iron Stores serum ferritin level is a better indicator of iron overload than the marrow iron stain. Red Cell Protoporphyrin Levels protoporphyrin accumulates within the red cell Normal values are less than 30 µ g/dL of red cells. In iron deficiency, values in excess of 100 µ g/dL are seen. Serum Levels of Transferrin Receptor Protein Normal values are 4 to 9 µ g/L determined by immunoassay.
    24 : ABSENT IRON STORES IN BONE MARROW IN IRON DEFICIENCY Iron deficiency Normal control
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    26 : 5. PRINCIPLES OF TREATMENT Use oral iron ( not enteric coated tablets ) Replace iron deficit in total : Restore haemoglobin and MCV to normal Replenish iron stores Establish and treat the cause
    27 : LOOK FOR THE CAUSE OF IRON DEFICIENCY
    28 : Treatment The severity and cause of iron deficiency anemia will determine the appropriate approach to treatment. symptomatic elderly patients with severe iron deficiency anemia and cardiovascular instability may require red cell transfusions.
    29 : There are three major approaches. Red Cell Transfusion Oral Iron Therapy Parenteral Iron Therapy
    30 : Transfusion therapy is reserved for those individuals who have symptoms of anemia, cardiovascular instability, And continued and excessive blood loss
    31 : Oral Iron Therapy In the patient with established iron deficiency anemia who is asymptomatic Typically, for iron replacement therapy up to 300 mg of elemental iron per day is given, usually as three or four iron tablets/ day Ideally, oral iron preparations should be taken on an empty stomach The goal of therapy in individuals with iron deficiency anemia is not only to repair the anemia, but also to provide stores of at least 0.5 to 1.0 g of iron. Continue treatment for a period of 6 to 12 months after correction of the anemia.
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    33 : Complication of Oral Iron gastrointestinal distress abdominal pain, nausea, vomiting, or constipations are most prominent and is seen in 15 to 20% of patients Typically, the reticulocyte count should begin to increase within 4 to 7 days after initiation of therapy and peak at 1.5 weeks.
    34 : Parenteral Iron Therapy can be given to patients who are unable to tolerate oral iron, whose needs are relatively acute, or who need iron on an ongoing basis, usually due to persistent gastrointestinal blood loss. recombinant erythropoietin therapy
    35 : -iron dextran -intravenous sodium ferric gluconate (Ferrlecit) -and iron sucrose (Venofer) Total dose of iron required = Body weight (kg) X 2.3 X (15 - patient’s hemoglobin, g/dL) + 500 or 1000 mg (for stores). large dose of iron dextran is to be given in slow infusion diluted in 5% dextrose in water or 0.9% NaCl solution over 60-90 min. Early reaction: wheezing, chest pain, fall in blood pressure,
    36 : serious adverse reaction rate to iv iron dextran is 0.7%. arthralgias, skin rash, and low-grade fever.

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