Dr : MANAL ABDALLA ASSOCIATE PROFESSOR CLINICAL PATHOLOGY TAIBAH UNIVERSITY KSA

Most iron in the o!" is #resent in the he$o%&o in 'n! s$'&& #'rt in $"o%&o in ( en)"$es s*+h 's +'t'&'se 'n! +"to+hro$e P,-./ .en)"$e

Tot'& o!" iron +ontent is '##ro0i$'t&" - %$ The '1er'%e &oss o2 3 $% o2 iron #er !'" $*st e re#&'+e! " !iet'r" so*r+es ( #re%n'nt or $enstr*'te! 4o$en 'n! +hi&!ren h'1e %re'ter iron re5*ire$ents o2ten o t'ine! " !iet s*##&e$ent'tion

The tot'& Iron +ontent o2 the '!*&t o!" is '##ro0i$'te&" - % 67/ $$o&8( o2 4hi+h t4o thir!s is in h'e$o%&o in9 Iron stores 6 $'in&" s#&een( &i1er 'n! one $'rro48 +ont'in ' o*t one,5*'rter o2 the o!"(s iron9

Most o2 the re$'in!er is in $"o%&o in( 'n! other h'e$o#roteins9 On&" /93 o2 the tot'& o!" iron is in the #&'s$'( 4here it is '&$ost '&& o*n! to ' tr'ns#ort #rotein( tr'ns2errin

' si%ni2i+'nt '$o*nt o2 iron is store! 's 2erritin 'n! he$osi!erine $'in&" in the one $'rro4 (&i1er . 'n! s#&een

Functions of Iron
Formulation of hemoglobin Formulation of myoglobin Binding O2 to RBC and transport Muscle activity Immune system T cell antibodies

Iron Distribution
Functional

Forms Hemoglobin Myoglobin Cytochromes

Storage

Forms Apoferritin Ferritin Hemosiderin

The $e'n !'i&" int':e o2 iron is ' o*t ;/ $%( &ess th'n 3/< o2 this is ' sor e!9 Re%*&'tion o2 iron ' sor#tion is !eter$ine! " the st'te o2 o!" iron( ein% in+re'se! 4hen the" 're !e#&ete! 'n! !e+re'se! 4hen the" 're '!e5*'te It is '&so in+re'se! er"thro#oiesis is in+re'se! 4hen

The $'in site o2 iron ' sor#tion is the #ro0i$'& s$'&& o4e&

Iron Absorption
Mucosal

cells Duodenum Absorptive Surface Time Types of Iron

Iron is $ore re'!i&" ' sor#e! in the Fe;= 2or$ *t !iet'r" iron is $'in&" in the Fe>= 2or$9 G'stri+ se+retions &i er'te iron 2ro$ 2oo! 'n! #ro$ote +on1ersion o2 Fe>= to Fe=; As+or i+ '+i! 2'+i&it'te iron ' sor tion 4hi&e #h"ti+ '+i!( #hos#h'tes 'n! o0'&'tes 2or$ inso&* &e +o$#&e0es 4ith iron 'n! !e+re'se its ' sor#tion9 On+e ' sor e!( Iron is either tr'ns#orte! !ire+t&" into the &oo! stre'$ or +o$ ines 4ith '#o2erretin in $*+os'& +e&&s to 2or$ 2erritin

In the &oo!( iron is tr'ns#orte! o*n! to tr'ns2errin9 Tr'ns2errin is nor$'&&" ' o*t one thir! s't*r'te! 4ith iron9 In tiss*es( iron is o*n! in 2erretin 'n! h'e$osi!rin9 Free iron is 1er" to0i+ 'n! #rotein in!in% '&&o4s iron to e tr'ns#orte! 'n! store! in ' non,to0i+ 2or$9 Iron is &ost 2ro$ the o!" in 2'e+es( " !es5*'$'tion o2 s:in 'n! in 4o$en " $enstr*'& &oo! &oss

PLASMA IRON:

ormal plasma iron concentration in men is !" #$" microgram % dl lo&er in &omen It's measurement is of little value in investigation of iron defeciency( because many conditions as infection( trauma( chronic inflammatory disorders and neoplasia are associated &ith lo& plasma iron concentrations It is of value in diagnosis of haemochromatosis and in iron poisining

:Iron is !e+re'se! in Iron !e2i+ien+" 'ne$i' Chroni+ in2&'$'tor" !isor!ers Chroni+ &oo! &oss Chroni+ !ise'ses 's SLE ( RA Thir! tri$ester o2 #re%n'n+" In'!e5*'te iron ' sor tion

This may be due to inade)uate inta*e( impaired absorption( e+cessive loss or a combination of these, The anaemia that develops is hypochromic and microcytic and if there is an obvious cause of iron defeciency( further investigation of the anaemia is not re)uired, -o& plasma ferretin concentration and%or an increase in transferrin receptor concentration &ill indicate iron defeciency,

Ser*$ iron &e1e& is :in+re'se! in Th'&'sse$i' 'n! he$o&"ti+ 'ne$i' he$o+hro$'tosis A+*te iron #oisnin% A+ti1e +irrhosis 'n! '+*te he#'titis

PLASMA TOTAL IRON BINDING CAPACITY: Measurement of plasma iron binding capacity is a functional measurement of transferrin concentration, .no&ing the plasma iron concentration( the transferrin saturation can be calculated( normally about //0 1lasma total iron binding capacity is increased in iron defeciency Transferrin saturation is increased in iron overload

Iron saturation 2

ser*$ iron +on+entr'tion 0 3//

TIBC

:De+re'se! iron in!in% +'#'+it" He$o+hro$'tosis A+*te iron #oisnin% A+*te he#'titis 'n! '+ti1e +irrhosis H"#o#rotene$i' Th'&'sse$i' Ne#hrosis 'n! ne#hritis

In+re'se! iron :+'#'+it"

in!in%

Iron deficiency anemia ( 1regnancy 3 third trimester 4cute and chronic blood loss

PLASMA FERRETIN It is superior to plasma iron and iron binding capacity for the assessment of body iron stores In healthy indivuduals ( plasma ferretin concentrations are usually &ithin the range 2"5/"" ug% The only *no&n cause of a lo& concentration is a decrease in body iron stores

TRANSFERRIN RECEPTORS6 It is a recent addition to the tests available for the investigation of iron status It is increased in iron defeciency, The plasma concentration increase 2 to / times normal &hen anaemia is present( but the rise occur only after iron stores are depleted It rises also in conditions in &hich there is chronically increased erythroid proliferation

E1'&*'tion o2 st't*s

o!" iron

Iron o1er&o'! Ser*$ iron +on+entr'tion( #er+ent'%e tr'ns2errin s't*r'tion Ser*$ 2erritin +on+entr'tion Bone $'rro4 iron (Co$#*te! to$o%r'#h" 6CT s+'n (M'%neti+ reson'n+e i$'%in% 6MRI Li1er io#s"

Iron !e2i+ien+" Most o2 the &' or'tor" tests 're re&'te! to re! &oo! +e&& #ro!*+tion: CBC B&oo! in!i+es Ser*$ iron Ser*$ TIBC Ser*$ 2erritine Iron s't*r'tion Tr'ns2errine re+e#tors

Iron !e2i+ien+" in!i+'tors

Stor'%e iron !e#&etion St'in' &e one $'rro4 iron Ser*$ 2erritin +on+entr'tion In+re'se! tot'& iron in!in% (+'#'+it" 6TIBC

This can occur &ith increased intestinal absorbtion of iron either acutely as in iron poisining or chronically, Increased parenteral iron administration occur in patients given repeated blood transfusions and lead to overloading of iron stores, 7+cess iron is deposite mainly as hemosidrin in R7 cells,

7+cess of Fe/8 is added to the sample to saturate serum transferrin, 9ncomple+ed Fe/8 is precipitated &ith magnesium hydro+ide carbonate and the iron bonded to protein in the supernatent is then spectrophoto5metrically measured,