Anemia Defisiensi Besi

Diagnosis dan Tatalaksana

Anemia Defisiensi Besi

Populasi Umum : 1.5%.
Iron deficiency inadequate
replacement kehilangan besi tubuh.
Asymptomatic anemia variasi etiologi .
Defisiensi besi :
- wanita usia pertumbuhan
- menstruating women
- hamil kadar Hb <11 g/dl

Prevalensi Anemia 8 negara asia tenggara

Distribusi besi

Komponen penting
Metabolisme dan transfer elektron
1 mcg/ 1 ml sel darah merah
Feritin ,hemosiderin
Mioglobin,enzim
Dewasa : 35-45 mcg/kgbb
lebih sedikit

Total body iron of 3 4g

Iron transport pathway

Distribution of Iron in Adults

Etiologi

Pregnancy/lactation
Normal growth
Blood loss
Gastric bypass
Malabsorption

Celiac disease,IBD
Keganasan
Parasit
Diet

Kebutuhan

Besi

Pria dan wanita :0.5 dan 1 mg

Wanita Menstruasi dan hamil : 2 mg and 2.5
mg.
5% - 10% dari 10 to 20 mg besi dalam diet
dewasa di absorbsi.

Defisiensi besi 3 stadium perkembangan

Deplesi cadangan besi

Defisiensi besi eritropoisis
Anemia defisiensi besi

Etiologi defisiensi besi

Deplesi besi

Defisiensi besi Anemia def besi

Diet inadekuat
Pertumbuhan cepat
- bayi
- remaja
Haid normal
Donor darah

Haid >>
Hamil
Perdarahan akut
Malabsorbsi
Gastrectomy
Regional enteritis
Peradangan kronik
Terapi plebotomi
Diet

Perdarahan kronik
Peptic Ulcer
Tumor kolon
Diverticulitis
Parasit
Malabsorbsi berat
Myoma uteri
Diet

Diagnosis

Anamnesis
Riwayat penyakit pasien
Pemeriksaan fisik
laboratorium

Gambaran Klinik
Fatigue
koilonychia (spoon nails)
glossitis
Dysphagia
konsentrasi
daya ingat

Konjungtiva anemis
Gejala penyakit penyerta
Rambut rontok
Papil lidah atropi
Pallor

koilonychia

 Serum Iron
LOW
Serum Iron (SI) : jumlah besi yang terikat
dengan transferin

Total Iron Binding Capacity (TIBC)

HIGH
TIBC : ukuran
Laboratorium
Anemia
Defisiensi
dari jumlah
besi yang Besi
dapat
diikat transferin

 Serum Ferritin
LOW
Can be falselynormal in inflammatory
states

Saturasi Transferin : SI
TIBC
- 20-30%
- < 20 % : kurang

Laboratorium defisiensi besi

Deplesi Fe Defisiensi Fe

An. Def Fe

Hb

Normal

ringan

Mikrositer
hipokrom

Iron store (mg)

< 100

SI(ug/dl)

Normal

< 60

< 40

TIBC(ug/dl)

360-390

> 390

> 410

% saturasi

20-30

< 15

< 10

Ferritin

< 40

< 20

< 10

% sideroblast

40-60

> 100

> 200

Blood film:
Hypochromic microcytic Picture.
Occasional Target cells.
Pencil shaped poikilocytes.
Normal reticulocyte count.
Bone marrow iron:
Normal to hypercellular.
RBC precursors are increased in number.
Iron stain negative.

Iron Deficiency Anemia

cigar cell

Mikrositer Hipokrom ??
Anemia defisiensi besi
Anemia penyakit kronik
Thallasemia

Perbedaan antara thalasemia dan anemia

defisiensi besi

Lab

Def besi

thalasemia

SI

Low

Normal

Feritin

Low

Normal/high

TIBC

High

Fe SST

Low

Normal/high

RDW

High

Normal

MCV RBC

> 13

< 13

Perbedaan antara anemia penyakit kronik dan

anemia defisiensi besi

Hematology 2000

Diagnostic algorithm for iron deficiency anemia

American Family Physician, Volume 75, Number 5 March 1, 2007

Tatalaksana Anemia Defisiensi Fe

Koreksi defisiensi
besi restore
hemoglobin level.
Cadangan besi .
Parenteral iron
mungkin dibutuhkan
Terapi penyakit
dasar

Terapi lini pertama

- oral iron therapy
1 g/dL: 2-3 mgg
Iron sulfate 300 mg: 60
mg elemental iron
325 mg iron gluconate
36 mg elemental iron

 Teh, bran, cereal,atau pengobatan

pH lambung (antacid,PPI, H2
blockers) absorpsi.
Terapi besi IV
- chronic uncorrectable bleeding,
- intestinal malabsorption
- intolerance thd oral iron
- Hb < dari 6 g per dL

Peningkatan Hb yang diinginkan

BB
(kg)

1g

2g

3g

4g

5g

6g

7g

40

10

11

12

45

10

11

12

50

10

11

12

13

55

10

12

13

14

60

11

13

14

16

65

10

11

13

14

16

70

10

12

13

15

17

75

10

12

14

16

18

80

11

13

15

17

18

85

11

13

15

17

19

90

11

14

16

18

20

95

10

12

14

16

19

21

100

10

12

15

17

19

22

 Total defisit besi :

BB(kg) x (target Hb-actual Hb)x 2,4 +
depot besi.
depot besi : 500 g/dl
Transfusi
- fatigue
- sesak nafas
- penyakit jantung (asimptomatik)
Hb < 10 g/dl

Algorithm for evaluation and treatment of iron

deficiency anemia.

American Family Physician, Volume 75, Number 5 March 1, 2007