IRON DEFICIENCY ANAEMIA

STUDY DESIGN AND INTERPRETATION

PRESENTED BY Click to edit Master subtitle style DR.PRIYANKA R. PHONDE.

6/14/12

ANEMIA Definition

Decrease in the number of circulating red blood cells. Most common hematologic disorder. Reduction of hemoglobin concentration below reference value.

6/14/12

ANEMIA Causes

Blood loss Decreased production of red blood cells (Marrow failure) Increased destruction of red blood cells

Hemolysis

Distinguished by reticulocyte count

Decreased in states of decreased production Increased in destruction of red blood cells

6/14/12

Causes of Iron Deficiency

IRON

Blood Loss

Gastrointestinal Tract Menstrual Blood Loss Urinary Blood Loss (Rare) Blood in Sputum (Rarer) Pregnancy Infancy Adolescence Polycythemia Vera Tropical Sprue

Increased Iron Utilization

Malabsorption
6/14/12

IRON DEFICIENCY
Symptoms

Fatigue - Sometimes out of proportion to anemia Atrophic glossitis Pica (Apetite For Non Food Substances Such As An Ice, Clay) Koilonychia (Nail spooning) Esophageal Web Dizzenes
6/14/12

SEROLOGY
Mean Hemoglobin Erythrocytes BLOOD concentration (Hg) corpuscular parameters PARAMETERS volume (MCV) F: 7,2 10;

100 fl Erythrocytes count RDW(Red cell (RBC) Distrubution

F: 4-5,5; Width)

M: 7,8-11,3 mmol N: 80Fe/l (12-18 g/dl)

6/14/12

corpuscular Hematocrit (Hct) hemoglobin

M: 4,5-6 x1012/l (4Mean / l) 6 x106

ORAL

IRON DEFICIENCY ANEMIA CURE

200 mg of iron daily 1 hour before meal (e.g. 100 mg twice daily) How long?

14 days + (Hg required level Hg current level) x 4

half of the dose - 6 9 months to restore iron reserve Absorption

is enhanced: vit C, meat, orange juice, fish is inhibited: cereals, tea, milk

6/14/12

IRON THERAPY

Initial response takes 7-14 days Modest reticulocytosis (7-10%) Correction of anemia requires 2-3 months 6 months of therapy beyond correction of anemia needed to replete stores, assuming no further loss of blood/iron Parenteral iron possible, but problematic

6/14/12

IRON DEFICIENCY ANEMIA

Country S. India N. India Latin America Israel Poland Sweden USA

Prevalence Men (%) Women (%)

6 4 14 35 64 17 29 7 13

Pregnant Women (%) 56 80 38 47 22

Aim of the study

To determine the effect of the timing of iron deficiency anemia during pregnancy on fetal growth and birth outcome.

6/14/12

To determine the association between iron deficiency anemia in pregnancy and birth outcomes. To assess whether iron deficiency anemia increase risk of fetal growth. To assess the effects of routine iron & folate supplementation on haematological, biochemical parameters and on pregnancy outcome.

Objectives

6/14/12

Hypothesis There is a Causal Relationship between Maternal Iron- Deficiency Anemia and Birth Outcome.

Research Questions Is the maternal anemia, assessed primarily as hemoglobin concentration, is causally related to babies weight at birth or duration of gestation ?

6/14/12

Study design

Retrospective study use to identify the effects of maternal- iron deficiency anemia on birth outcome.

Materials and Simple random sampling method. methods

The sample size including (69) pregnant women.

6/14/12

Materials and methods

Self-designated questionnaire, self reported and filling questionnaire used to collect data. Use of 21 questions to determine the effects of maternal-iron deficiency anemia on Birth outcome.
6/14/12

Data analysis

6/14/12

Age of the mother

Percent Frequency 4.3% 66.7% 23.2% 5.8% 100.0% 3 46 16 4 69 Age of the mother Less than 20 years 20-30 years 31-40 years Missing System Total

Do you take iron during pregnancy?

Percent Do you take iron during Frequency pregnancy? 62 7 69 Yes No Total

89.9% 10.1% 100.0%

Hb level during this pregnancy

Percent Frequency Hb level during this pregnancy Grater than> 10g\L Less than<10g\L Total

58.0% 42.0% 100.0%

40 29 69

Gestational age in the delivery

Percent Frequency Gestational age in the delivery Less than 35 wk Between 36-42 wk Total

15.9% 84.1% 100.0%

11 58 69

Baby weight
Percent Frequency Baby weight

30.4%

21

Less than 2.50g

69.6% 100.0%

48 69

2.5-4.5 g Total

Type of delivery
Percent 62.3% 37.7% 100.0% Frequency 43 26 69 Type of delivery C\S N\D Total

Results of the hypothesis

6/14/12

ANOVA test between taking iron during pregnancy and baby weight
Sig. F Mean Square Df Sum of Squares

.912 -

.012 -

.003 .218 -

1 67 68

.003 14.606 14.609

Regression Residual Total

Since the level of significance (0.912) is bigger than 0.05, we accept the hypothesis and conclude that There exists no significant relationship, in the significance level 0.05, between taking iron during pregnancy and baby weight.

Simple Linear Regression model between taking iron during pregnancy and baby weight.
t 7.868 .111 B 1.673 2.074E-02 (Constant) Do you take iron during pregnancy?

Since the R equal (0.014) and R square equal (0.000) there is no correlation between taking iron during pregnancy and baby weight.

ANOVA test: between taking iron during pregnancy and type of delivery.
Sig. F Mean Square Df Sum of Squares

.770 -

.086 -

.021 .242 -

1 67 68

.021 16.182 16.203

Regression Residual Total

Since the level of significance (0.770) is bigger than 0.05, we accept the hypothesis and conclude that There exists no significant relationship, in the significance level 0.05, between taking iron during pregnancy and type of delivery.

Simple Linear Regression model: between taking iron during pregnancy and type of delivery.
t 5.869 .294 1.313 5.760E-02 B (Constant) Do you take iron during pregnancy?

Since the R equal (0.036) and R square equal (0.001) there is a very weak correlation between taking iron during pregnancy and type of delivery.

ANOVA test between: taking iron during pregnancy and gestational age in the delivery. of Sig. F Mean Df Sum
Square Squares

.230 -

1.466 -

.198 .135 -

1 67 68

.198 9.048 9.246

Regression Residual Total

Since the level of significance (0.230) is bigger than 0.05, we accept the hypothesis and conclude that There exists no significant relationship, in the significance level 0.05, between taking iron during pregnancy and gestational age in the delivery.

Simple Linear Regression model: between taking iron during pregnancy and gestational age in the delivery.
t 9.831 1.211 B 1.645 .177 (Constant) Do you take iron during pregnancy?

Since the R equal (0.146) and R square equal (0.021) there is a very weak correlation between taking iron during pregnancy and gestational age in the deliver

Discussion

No correlation between baby weight and taking iron supplement during 3rd trimester of pregnancy. No correlation between type of delivery and gestational age with mother Hb level during pregnancy. The correlation between the other variables, is very weak. Supplementation of anemic or no anemic pregnant women with (IDA) does not appear to increase birth weight or the duration of gestation.

6/14/12

A negative association between anemia and duration of gestation and low birth weight has been reported in the majority of studies, although a causal link remains to be proven. Finally; we reject our hypothesis, and found that their was no causal relationship between maternal iron deficiency anemia & birth outcomes
6/14/12

Limitation of the study

First, there is a chance of recall bias in the process of gathering data. Given low income and low socioeconomic status of the pregnant women of this study, it was not feasible to carry out longitudinal studies. Second, it is difficult to determine the prevalence of maternal iron deficiency in the pregnant women because of the criteria used to define iron deficiency. Third; our result indicate that the third 6/14/12 trimester of pregnancy have no affect on birth

Recommendations

Recommended Guidelines for Preventing And Treating Iron Deficiency Anemia In Pregnant Women

At a scheduled third-trimester visit, or if the first prenatal visit occurs in the third trimester, obtain a blood specimen and determine the hemoglobin concentration. Obtain medical evaluation when the hemoglobin concentration is <9.0 g/dl.

6/14/12

Prescribe 60-120 mg of supplemental iron per day when the hemoglobin concentration is between 9.0 - 10.9 g/dl. Prescribe 30 mg of supplemental iron per day when the hemoglobin concentration is 11.0 g/dl.

6/14/12

IRON AND CHILD DEVELOPMENT

FINDING: Increasing evidence that iron deficiency in children impedes development and that supplementation can reverse delays IMPLICATION: Safe and effective public health interventions are needed to address iron deficiency in children

Sources: Behavioral and developmental effects of preventing iron-deficiency anemia in healthy full-term infants. Iron deficiency anemia in infancy: long-lasting effects on auditory and visual system functioning. Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children, placebo controlled study. Reversal of developmental delays in iron-deficient anaemic infants treated with iron.

6/14/12

IRON AND GROWTH

FINDING: In India, iron supplementation supported growth in iron-deficient children, but delayed growth in iron-replete children (Growth delay is believed to result from excess iron competing with zinc absorption) IMPLICATION: Iron supplementation for children is not necessarily a magic bullet
Source:. The effect of iron therapy on the growth of iron-replete and iron-deplete children.

6/14/12

IRON SUPPLEMENTATION PROTOCOLS

FINDING: Among lactating women, weekly and daily supplementation had comparable effects on iron status and, in India, weekly supplementation was effective for anemia prevention IMPLICATION: Intermittent (nondaily) supplementation is an option to be considered

Sources: Daily versus weekly iron supplementation and prevention of iron deficiency anaemia in lactating women. Anemia prophylaxis in adolescent school girls by weekly or daily iron-folate supplementation.

6/14/12

FORTIFICATION VEHICLES-1

FINDING: Cereal fortification may improve iron intake but evidence of general effectiveness is still lacking IMPLICATION: Cereal fortification is not a magic bullet for addressing iron deficiency in children

Sources: SUSTAIN Guidelines for Iron Fortification of Cereal Food Staples.

6/14/12

FORTIFICATION VEHICLES-2

FINDING: A study in Chile found that just 3% of infants fed iron-fortified milk (ferrous sulfate + ascorbic acid) were anemic versus 26% of those fed non-fortified milk IMPLICATION: In some cultures, milk fortification may be a viable vehicle for fortification to reduce iron deficiency

Source: Prevention of iron deficiency by milk fortification.

6/14/12

FORTIFICATION VEHICLES-3

FINDING: Fortified fish/soy sauce found acceptable. IMPLICATION: In some cultures, foods such as fish/soy sauce may be viable vehicles for fortification to reduce iron deficiency

Sources: Combating iodine and iron deficiencies through the double fortification of fish sauce, mixed fish sauce, and salt brine . Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic women.

6/14/12

IRON SPRINKLES
n

FINDINGS:, sprinkles were shown to be as effective as the standard therapy in treating anemia and, in Zambia, iron+zinc sprinkles did reduce anemia but did not improve zinc status or catch-up growth in infants IMPLICATION: Sprinkles is a promising intervention with high acceptance rates and proven efficacy but cost may be a major constraint

Sources: Treatment of anemia with micrencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children.

6/14/12

Impact of iron deficiency anemia on prevalence of gestational diabetes

OBJECTIVE:

mellitus.

Increased Hb and ferritin have been associated with gestational diabetes mellitus (GDM). This study was performed to determine whether the prevalence of GDM is influenced by iron deficiency anemia.

RESEARCH DESIGN AND METHODS:

In a retrospective case-control study, 242 women with iron deficiency anemia (Hb<10 g/dl with features of iron deficiency) were compared with 484 nonanemic women matched for year of birth, who were delivered within the same 24-month period in our hospital, with respect to maternal demographics, infant outcome, and the prevalence of GDM diagnosed according to the World Health Organization criteria.

RESULTS:

6/14/12

There was no difference in the pre pregnancy weight or BMI, but the anemic group had more multiparas and significantly lower gestational weight and BMI increments and prevalence of GDM (odds ratio [OR] 0.52, 95% CI 0.27-0.97), which was inversely correlated (P=0.045) with the duration of anemia. To determine the independent effect of anemia on GDM, multiple logistic regression analysis was performed adjusting for the effects of multiparity and BMI, and anemia was confirmed to be significantly associated with decreased prevalence of GDM (adjusted OR 0.46, 95% CI 0.23-0.90).

CONCLUSIONS:

Prevalence of GDM in relation to duration and timing of iron deficiency anemia.

Prevalence of GDM in relation to duration and timing of iron deficiency anaemia. See text for description of anaemic groups. Comparison by Pearsons correlation between incidence of GDM and anaemic groups; 6/14/12 P = 0.045.

THANK YOU

6/14/12