Anemia Defisiensi Besi

Dr. Deli Theo. SpPK

FK.Universitas Methodist Indonesia
Medan
ANEMIA YANG SERING DI JUMPAI DI INDONESIA
ANEMIA DEFISIENSI BESI
ANEMIA INFLAMASI
ANEMIA MEGALOBLASTIK ( DEF ASAM FOLAT )
ANEMIA HEMOLITIK
- THALASEMIA
OBAT OBATAN
ANEMIA ec INSUFISIENSI RENAL
ANEMIA GRAVIDARUM
 Distribusi besi
Besi merupakan satu unsur terbanyak di kulit
bumi, dan def besi merupakan sebab terbanyak
anemia
Kebutuhan tertinggi akan besi terjadi pada bayi
berumur 1 tahun pertumbuhan sangat cepat
di sertai pembentukan eritrosit yg intensif
( dibutuhkan 1 1,5 mg/hari )
Kehamilan/laktasi ( 2,5 4,0 mg/hari )
Jumlah total besi dalam tubuh 35 mg/kg pada
wanita dan 50 mg/kg pada laki - laki
Haemoglobin mengadung kira kira 2/3 besi
tubuh
Besi di angkut oleh transferin(beta globulin BM
80.000) ke dalam eritroblas di sst dan retikulosit
Eritrosit di hancurkan RE dan besinya di
bebaskan kedlm plasma dan sebagian di dalam
RE sebagai haemosiderin dan Feritin
Feritin adalah kompleks protein besi yg larut
dlm air dgn BM 465000
Haemosiderin adalah kompleks protein besi yg
tdk larut dlm air
Iron Metabolism Absorption

Primarily in mucosa of proximal small intestine

Amount absorbed depends on
Amount of iron ingested
Form of ingested iron - ferric iron not easily absorbed
Tissue iron stores inversely related to amount
absorbed
Condition of mucosal cells in GI tract
Hematopoietic activity of bone marrow
Intralumunial factors (parasites, toxins, etc)
 Iron Metabolism - Transport

Major iron transport protein is transferrin.

Each gram of transferrin will bind 1.4 mg of iron.
Total transferrin present in plasma to bind
253-435 mg of iron/dL of plasma Total
iron-binding capacity (TIBC)
Serum iron concentration is 70 201
mg/dL 95% is complexed with transferrin
Transferrin is about 1/3 saturated with
iron (% saturation = serum iron/TIBC X 100%)
The reserve iron-binding capacity of
transferrin is called the unsaturated
iron-binding capacity or UIBC (UIBC =
TIBC serum iron)
Most iron bound to transferrin comes
from the breakdown of hemoglobin
Excess iron deposited in tissues
 Iron metabolism - Storage

Major storage depot is liver

Stored as ferritin and hemosiderin
Ferritin
primary storage compound for bodys need
Readily released for heme synthesis
Small amounts found in blood parallels
the storage iron in the body
Hemosiderin
Major long term storage form of iron
Slow release
Estimation of hemosiderin made on bone
marrow tissue sections
Iron Metabolism - Requirements
Body iron conserved through reutilization only
about 1 mg lost per day
Iron deficiency occurs when negative iron balance
Increased requirements
Inadequate diet
Malabsorption
Iron overload when
Increased absorption
Multiple transfusions
Iron injections
Increased Iron Requirements

Menstruation menstruating females

have twice the daily requirements as
males (2 mg/day)
Pregnancy 3.4 mg/day
Infancy/childhood rapid growth
At birth, enough iron stores for 4-5 months
Milk is poor source of iron
Iron supplementation recommended
 Sebab anemia mikrositik hipokrom

Besi Protoporfirin

a. Def besi Anemia

b. Peradangan Sideroblastik
kronik atau
keganasan

HAEM + GLOBIN

Talasaemia atau

HAEMOGLOBIN
 PEMERIKSAN BAHAN KHUSUS

ANEMIA DEFF Fe

Indeks sel darah merah dan gambaran darah tepi

Serum Iron
TIBC
Saturation Transferin
Ferritin
Serum Transferin
Hemosiderin Urine, SST
 Low MCV / MHC

Blood Film

Serum Iron

High Normal / High Low

Bone marrow Iron HbF/A2 Feritin

Low Normal / High

Sideroblastic anemia Thalassaemia Iron Deficiency Anaemia of

chronic disease
 Gambaran darah tepi anemia def besi
Pada permulaan adalah normositik normokrom,
kemudian berubah menjadi mikrositik hipokrom
dan pada yg sdh lanjut tampak anisositosis dan
poikilositosis
Retikulosit, Hb, Ht berkurang
Sumsum tulang tampak hiperplasia seri eritrosit
Kadar besi dlm serum menurun
TIBC meningkat
Feritin serum berkurang
- Laboratorium :
- SADT : anemi mikrositik, hipokromik,
poikilositosis, target sel , anisositosis,