IDA

1. ANEMIA
Low level of Hb from
lower normal level
according to age , sex
and altitude.

2. Severity
 Mild anemia
With hemoglobin level 9-12 g/dl
 Moderate anemia
With hemoglobin level 6-9g/dl
 Severe anemia
With hemoglobin level <6g/dl

3. IRON DEFICENCY ANEMIA
 Iron deficiency anemia is the most common cause of anemia
worldwide ,caused from too little iron in the body means body iron
stores are depleted.
Insufficient iron for erythropoiesis.
 About 20% of women,
 90% of pregnant women,
 and 3% of men
do not have enough iron in their body.

4. Normal Iron Metabolism
 Normally in adult males only a small
amount of iron is lost by
exfoliation(removal of oldest skins) of
epithelial cells from GIT and Urinary
tracts and skin.
 Iron requirements is increased during
adolescence due to growth .
 In females iron need is greater due to
menstrual blood loss and increased
demand for iron by foetus during
pregnancy

6. Daily iron requirements
 Varies according to age and sex.
Infants upto 4 months: 0.5 mg
Infants 5-12 months and children :1 mg
Menstruating women :3 mg
Pregnancy :3-4 mg
Adult men and post menopausal
women:1 mg

7. Dietry source of iron:
 Meats ,liver ,
 Fish
 Eggs
 Beans
 Green leafy vegetables.(spinach)
 Dry fruits
 Milk is poor source of iron.

8. Body Iron Distribution
 Most body iron is present in
haemoglobin in circulating red cells
 The macrophages of the
reticuloendotelial system store iron
released from haemoglobin as ferritin
and hemosiderin
 Small loss of iron each day in urine,
faeces, skin and nails and in
menstruating females as blood (1-2
mg daily)

10. Iron Storage
 Iron is stored mainly in the liver in
reticuloendothelial system as
 Hemosiderin
 Ferritin
 Hemosiderin is the major long term storage
form of iron ; release slowly,
 Ferritin is the primary storage form of soluble
iron ;release readily at time of need.

11. Ferritin
 Iron storage protein
 In humans, it acts as a buffer against iron deficiency and iron overload
 Consists of:
 Apoferritin – protein component
 Core- ferric, hydroxyl ions and oxygen
 Largest amount of ferritin-bound iron is found in:
 Liver hepatocytes (majority of the stores)
 BM
 Spleen
 Excess dietary iron induces increased ferritin production
 Partially digested ferritin= HAEMOSIDERIN- insoluble and can be detected
in tissues (hepatocytes) using Perl’s Prussian blue stain

12. Hemosidrin
 Water insoluble protein iron complex
 Visible by light microscope
 It has higher iron to protein ration up to 37% than
ferritin up to 20%
 Formed by partial digestion of ferritin aggregates by
lysosomal enzymes.
 Hemosidrin is present predominately in macrophages
rather than hepatocytes.

13. Transferrin (Tf)
 Transports iron from palsma to erythroblast
 Mainly synthesized in the liver
 Fe3+ (ferric) couples to Tf
 Apotransferrin = Tf without iron
 Contains sites for max 2 iron molecules
 Synthesis is inversely proportional to iron store

14. Pathophysiology of IDA
Iron deficiency anaemia develops in three stages
 iron depletion
 Iron deficient erythropoiesis
 iron deficiency anaemia

15. Iron Depletion
 Stage 1 (Iron depletion): In the initial phase,
iron may be adequate to maintain normal levels
of hemoglobin and only serum ferritin levels
are decreased.
 Iron stores are exhausted as indicated by
decreased serum ferritin, serum iron normal
 No anaemia
 Erythrocyte morphology is normal

16. Iron Deficient
erythropoiesis
 Stage 2 (Iron deficient erythropoiesis): Progressive depletion
of iron reserves first lowers serum iron and transferrin
saturation levels without producing anemia (Hb, MCV and
MCH within normal range). Bone marrow, at this stage, shows
iron deficient erythropoiesis. There is insufficient iron to insert
into the protoporphyrin ring to form heme,
 Serum iron is also depleted.
 Anaemia and hypochromia are still not detectable
 Erythrocytes may became slightly microcytic

17. Iron Deficiency Anemia
 Stage 3 (Iron deficiency anemia): Anemia only appears when depleted
iron stores are accompanied by low serum iron, serum ferritin and
transferrin saturation. As the serum iron level falls and transferrin saturation
decreases below the critical value of <15%, the hemoglobin production is
impaired.Long standing negative flow leads to IDA
 Morphologically, there is first reduction in the size (microcytic) and later
increase in the central pallor (hypochromia) of red blood cells. Normally,
increasing cytoplasmic hemoglobin concentration acts as an inhibitor of
normoblast division. In iron deficiency, the failure of hemoglobin synthesis
allows extra mitoses (cell division) to occur during erythropoiesis, with the
production of small erythrocytes (microcyte).
 Blood loss significantly shorten this stage
 Classic microcytosis and hypochromia
 The situation represents advanced stage of severely deficient body iron

18. Causes of Iron Deficiency Anemia
 Blood Loss
 Gastrointestinal Tract
 Menstrual Blood Loss
 Urinary Blood Loss (Rare)
 Blood in Sputum (Rarer)
 Increased Iron Utilization
 Pregnancy
 Infancy
 Adolescence
 Polycythemia Vera

19. Malabsorption
 Tropical Sprue
 Gastrectomy
 Chronic atrophic gastritis
 Dietary inadequacy
 Parasitic infection
 Hook worm

20. Sign and Symptoms
• Fatigability
• Dizziness
• Headache
• Irritability
• Dry, pale skin
• Spoon shaped nails, Koilonychias
• Pica (Appetite for non food substances such as clay)
• Splenomegaly (10%)
• Increased platelet count

21. Laboratory Diagnosis

22. Complete Blood Count
 Rbc count normal-decrease
 Hemoglobin decreased
 Wbc count normal
 Palatelets normal-increase(in chronic
bleeding)
 RDW increased
 (is the first sign to appear even before microcytosis
of the cell occurs in the iron depletion stage of
anemia )

23. Red cell Indices
 PCV decreased
 MCV decreased
 MCH decreased
 MCHC decreased

24. Peripheral Film
 DLC normal-increase(in chronic infections)
 RBC morphology
Anisocytosis
 microcytosis
 Hypochormia
Poikilicytosis
 Tear drop cells
 Elliptocytes
 Target cells

28. Reticulocyte Count
 Normal- reduced-slightly

29. Iron Profile
 Serum iron low
 Serum ferritin low
 TIBC(total iron binding capacity) inreased
 Tansferrin saturation % low

30. Bone Marrow
 Bone marrow is hyper cellular with
polychromatic normoblast predominance
 Erythroid series is small and have tiny
projection from the cytoplasm
 Iron stain; Negative

35. Investigations
Occasionally Required
 Feaces examination for parasites
 LFT in case if liver damage

37. Prussian-blue Stain
 Iron is released from the hemosidrine
molecules by treating the slide with weak acid
solution .the free iron combines with potassium
ferrocynide to produce ferric Ferro cyanide.
Free iron will appear greenish blue

38. Procedure
 Air dry film
 Fix with methanol 10-20min
 Place slide in solution of 10g /l potassium Ferro cyanide in 0.1 mol/l HCL
for 30 min
 Wash in running tap water for 1 min
 Rinse in distilled water
 Counter stain with neutral red for10-15 sec

39. Differential diagnosis

40. Thank
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