Iron Deficiency Anemia

Prof.Dr.ARIF M SIDDIQUI
M2 , JHL
Iron Deficiency Anemia

 Most common cause of anemia

 Iron deficiency anemia is the last step ;

– Iron depletion: absent or decreased iron st
ores
– Iron deficiency: depletion of stores + low s
erum iron and ferritin
– Iron deficiency anemia: Anemia developin
g in an iron deficient patient
Total amount of body iron:3-5 g

1ml blood contains 1mg iron

Daily Iron Demands

Male 1 mg
Adolesc. 2-3 mg
Women in repr.age 2-3 mg
Pregnant 3-4 mg
Iron Metabolism

 Main sites of absorbtion are;

– Duodenum
– Upper jejunum
 Malabsorbtive states or gastrojejunost
omy prevent absorbtion.
Causes of iron deficiency
 Chronic blood loss
 Increased demand
 Malabsorbtion of iron
 Inadequate iron intake
 Intravascular hemolysis and hem
oglobinuria-hemosiderinuria
 Combinations
Increased demands

 Pregnancy

 Lactation

 Rapid growth
Decreased intake

 Decreased iron in the diet

– Vegetarianism
– Tea-tost type feeding (old age)
 Decreased absorbtion
– Gastric surgery
– Achlorhydria
– Sprue
– Pica
 Increased iron loss
 Menorrhagia
 GIT hemorrhagia
•Angiodysplasia
•P.Ulcer •Diverticulosis
•Oesophagitis •Meckel diverticula
•Varices •Colitis or inflammat
•Hiatal hernia ory Bowel disease
•Malignancy •Hemorrhoids
•NSAID use
•Parasites Hookwor
ms
Increased iron loss
 Bleeding disorder
 Pulmonary lesions with bleeding
 Hemoglobinuria – hemosiderinuria
(chronic intravascular hemolysis e
g PNH)
 Prosthetic cardiac valve
 Hemodialysis
 Hematuria (chronic)
 Frequent donation
Clinical features

 Fatigue may be disproportional to the

degree of anemia due to deficiency of t
issue enzymes which also need iron
 SOB

 Chlorosis (Greenish tinge)

 Glossitis

 Angular stomatitis

 Paterson-Kelly (Plummer Vinson) synd

rome
(oesephageal web leading to disphagia)
Clinical features

 Gastric atrophy
 Ozena-anosmia
 Nail changes
– Brittle/fragility
– Koilonchia/spooning
 Hair loss
 Splenomegaly
 HIGH OUTPUT CARDIAC FAILURE(
IN SEVERE CASES)
 Clinical features

 Pica:Appetite for bizzare food/subst

ances
– Geophagy (earth,clay)
– Pagophagia(ice)
– Amylophagia(starch)

 Tayanc-Prasad syndrome
(growth retardation, hypogonadism, hepatospleno
megaly, zinc and iron deficiency, geophagi)
Lab. Features

 Hb,Htc,RBC:Low
 MCV,MCH,MCHC:Low
 RDW: High
 Retics: Normal/Low
 Plt:Normal/Low/High
 WBC:Normal/Low
 Smear: Hypochromia,anisocytosis,microcy
tosis, poikilocytosis
NORMAL
IDA: ANISO,POIKILOCYTOSIS
PENCIL CELLS/CIGAR SHAPED CELLS
 Lab.Features
 Serum Iron:  (N: 60 – 180 μg/dL)
 TIBC:  (250 - 430 μg/dL)
 Serum Ferritin 

(N:Female;10-150 μg/L, Male;29-248 μg/L)

Males and post menopausal women<10 μg/L
Premenopausal women <5 μg/L
Iron def+Chr.Disease< 60 μg/L
 Lab.Features

 Transferrin saturation (Fe/TIBC):  (<15%)

<5%:definitely indicates iron deficiency
 Serum Transferrin Receptor: 
 Free Erythrocyte Protoporphyrin  (17 – 27 μg/dL)
 Bone marrow :
– Erythroid hyperplasia,
– Absence of hemosiderin (prussian blue st
ain)
Cont.

 MEN >40 YRS AND POSTMENOPA

USAL WOMEN SHOULD BE INVEST
IGATED FOR G.I BLEED (ENDOSC
OPY,BARIUM STUDY)

 STOOL FOR OVA AND CYST (ANCY

CLOSTOMA, SHISTOSOMA)
 Prelatent Latent Iron def. anemia
Findings Normal
period period Early Late
Hb g/dl N N N 8-14 <8

MCV fl N N N N,  

S. Ferr. N  <12 <12 <12

T. Sat. N N <16 <16 <16

BM iron N  - - -

FEP N N   

Symptom - - - + +
Ept.
- - - - +
change
Differential diagnosis

 Microcytic anemias
– Iron deficiency anemia
– Thalassemia ,HbC,HbE etc
– Sideroblastic anemia
– Lead poisoning
– Anemia of chronic diseases
 Diff.Diagnostic Tests
Iron deficiencChronic di Thalasse- Siderobl. Lead poison
y sease mia. anemia ing

S.Ferritin  N  N   N

TIBC   N  N N

S.Iron   N   Variable.

T.Satur.   N   N 

FEP   N  

Marrow iron - + + + +
HbA2 Ring
Special tests HbA2  RF etc. ALA, Pb
HbF  Siderobl
aminolaevulinic acid
porphobilinogen
Treatment

Oral iron therapy:

dose (mg) elemental
iron(mg)
Fe fumarate 200 65
Fe gluconate 300 35
Fe sulphate 200 65
Treatment
Oral iron therapy:
Total daily dose:150-200 mg elemental iron /FES
O4 325mg
Give in 3-4 divided doses,
Each one hour before meals.
Do not prefer enteric coated forms.
In case of GI intolerance;
 Change the route of administratio
n or
 Change the preparation or
Treatment
Non responding patients: ~50%
 possible causes
– Misdiagnosis
– Patient does not take the medicine due to
Non compliance,GI disturbance,black st
ools
– Continuing blood loss
– Malabsorbtion
– Underlying disease /comorbidity
– Combined deficiency
DILUTE IN 100ML N/S
POLYMALTOSE COMPLEX
DEWORMING
Treatment
 Parenteral iron therapy:
Routine use is not justified,
Response is not faster than oral replacement.
Indications
– Malabsorbtion
– Intolerance to oral replacement
 Colitis/enteritis
– Needs in excess of amount that can be given ora
lly
– Patient uncooperative/poor compliance
– Autologous blood donation setting
– Hemodialysis
Treatment
Parenteral iron therapy:
Total iron dose: (15-patient Hb) x bw x 3
Or IRON: DEFICIT*RBC volume*b.wt
Rbc volume: M: 30ml/kg F:27ml/kg
add 1 g to replenish stores
Iron Dextran: 50 mg/ml (i
v/im)
 Max daily dose is 10
0 mg im
Ferric gluconate:
 A test dose of 25 mg
elemental iron (2 mL
) must be given in 50
mL saline over 60 mi
nutes

 Ferric-hydroxy-sucrose
(100 mg/5mL)
– 2.5 ml first day
– 5ml third day
– 2x5 ml/week
Treatment
Parenteral replacement therapy may cause
– allergic reactions,
– local pain or induration,
– serum sickness like disease,
– lymphadenomegaly,
– arthralgia,
– myalgia etc.

***TRANSFUSION: WHEN angina, hea

rt failure, cerebral hypoxia
Preventive iron supplementatio
n

 Pregnants ( at 20-24 weeks Hb<

11 g/dL, Ferritin ).
 Lactation.
 Frequent blood donation.
 Autologous blood donation settin
gs.
 Gastrectomised patients.
 High dose asprin treatment.
THAANKYOU
ALLAH BLESS YOU ALL