3. As iron deficiency chiefly influences the synthesis of heme, the production of Hb is decreased, and the red cells become microcyte and hypochromic. this anemia is also named nutritional microcytic anemia. Definition
6. Iron source Dietary iron is important source, such as meat, fish, liver, yolk, bean… Recycled From the breakdown of red cells, 80 % iron is reutilized to produce Hb Iron metabolism
7. Iron cycle Fe Fe Fe Fe Fe Ferritin Hemosiderin slow Fe Fe Fe Fe Fe Fe Fe Fe Fe Ferritin Ferritin Transferrin Receptor RBC PRECURSOR CIRCULATING RBCs Fe Fe TRANSFERRIN MONONUCLEAR PHAGOCYTES
18. iron absorption is influenced body’s iron stores the type of iron in the diet other dietary factors that either help or hinder iron absorption enhanced by Vitamin C meat diminished by phosphates, oxalates, and tannic acid The greatest influence on iron absorption is the amount stored in your body. Iron absorption
20. insufficient iron stores insufficient iron intake rapid growth and development failure of iron absorption iron loss Etiology
21. In newborn, the body contains about 0.2-0.5g of iron. Newborn term infants 75 mg/kg A preponderance of iron hemoglobin (75%) first 2-3 months hemoglobin concentration (iron is reclaimed and stored) adult has 5g Insufficient iron stores Etiology
22.
23. premature low birth weight twins infant with perinatal blood loss Insufficient iron stores the premature or low birth weight infant 64 mg/kg Etiology
24. Iron balance during the first year of life Full-term infant Premature infant Birth 1 year Birth 1 year Weight(kg) 3.3 10.5 1.5 9.5 Blood hemoglobin(g/dl) 20.0 12.3 20.0 12.3 Blood volume(ml) 290 800 135 720 Total hemoglobin(g) 58 98 27 89 Hemoglobin iron(mg) 198 335 90 300 Storage tissue iron(mg) 60 73 27 67 Total body iron(mg) 258 408 117 367 Net positive iron balance 0.4 0.7 (mg/day)
25. A diet containing 8-15mg of iron is necessary for optimal nutrition (approximately 10% is absorbed) the normal daily excretion of iron < 1mg/d Insufficient iron intake Etiology
26. 1mg/kg/day to a maximum of 15mg/day is required in a normal full-term infant 2mg/kg/day to a maximum of 15mg/day is required in Premature infants Etiology
27.
28. Iron content of infant foods Food iron(mg) unit Milk 0.5-1.5 liter Eggs 1.2 each Cereal,fortified 3.0-5.0 ounce Vegetables (strained) yellow 0.1-0.3 ounce green 0.3-0.4 ounce Meats (strained) Beef,lamb,beef liver 0.4-2.0 ounce Pork, liver ,bacon 6.6 ounce Fruits (strained) 0.2-0.4 ounce
29. Rapid growth and development The age of 6 months to 2 yrs is a period of rapid growth and development, correspondingly the infant’s blood volume must be proportionately expanded, the requirement of iron also increased Etiology
30. Iron balance during the first year of life Full-term infant Premature infant Birth 1 year Birth 1 year Weight(kg) 3.3 10.5 1.5 9.5 Blood hemoglobin(g/dl) 20.0 12.3 20.0 12.3 Blood volume(ml) 290 800 135 720 Total hemoglobin(g) 58 98 27 89 Hemoglobin iron(mg) 198 335 90 300 Storage tissue iron(mg) 60 73 27 67 Total body iron(mg) 258 408 117 367 Net positive iron balance 0.4 0.7 (mg/day)
31.
32. Iron loss infant during the first 2 months iron loss > iron absorption from the diet intolerance cow’s milk syndrome of sensitivity to cow’s milk 0.7 ml of blood in stool is lost each day (induced by a heat-labile protein in whole cow’s milk) Etiology
33. Iron loss occult bleeding (Chronic iron deficiency anemia) lesion of the gastrointestinal tract peptic ulcer meckels diverticulum polyp hemangioma hookworm infection Etiology
34. Infants at high risk for iron deficiency Increased iron needs Low birth weight High growth rate Chronic hypoxia Low hemoglobin after birth Blood loss Perinatal bleeding Dietary factors Early cow milk intake Early solid food intake Low vitamin C intake Low meat intake Breast-feeding for more than 6 months without iron supplements Low socioeconomic status
38. General manifestation Pallor the most common symptom palpebral conjunctivas mucous membranes of the oral cavity, the nails, palms, the rest of the skin also become pale. Dyspnea on exertion failure to thrive listlessness irritability fatigue dizziness vertigo The nails clubbing and koilo’nychia. Clinical manifestation
41. Others Gastrointestinal symptom : Anorexia, dysphagia, pica Cardiovascular symptom : A systolic murmur Tachycardia cardiomegaly congestive cardiac failure There is an increased incidence of infections tuberculosis chest gastrointestinal infections Nervous system : Irritability , decreased attentiveness shorter attention span, associated with behavioural and intellectual deficiencies. Clinical manifestation
42. Behavioural Change Lack of energy , irritability, poor concentration Nervous system Of course these are common problems associated with children that may not always becaused by iron deficiency Clinical manifestation
43. Learning Difficulties Learning difficulties can be present in anemic children, and there is some evidence to suggest that intellectual and physical development may not always be completely reversed when the child’s iron status has been corrected. Nervous system Clinical manifestation
44. red cells microcytic and hypochromic. Laboratory findings
50. Mean corpuscular volume (MCV)<80fl Mean corpuscular hemoglobin (MCH) <26pg Mean corpuscular hemoglobin concentration (MCHC)<31% Red blood cell indices Laboratory findings
51.
52. Serum irons below 9-10.7 umol/L ( normal range is 12.8-31.3) Serum ferritin less than 12ug/l The total iron-binding capacity(TIBC) more than 62.7 umol/L Free erythrocyte protoporphyrin (FEP) more than 0.9umol/L Laboratory findings
53.
54.
55. The highest incidence age 6m-3yrs A history of inadequate intake of iron History of chronic malabsorption or infections The clinical manifestation The peripheral blood smear microcytic and hypochromic red cells A good hematopoietic respons after 3-7 days of adminstration of iron. then the red cells and Hb other laboratory examinations : bone marrow serum iron or serum ferritin Diagnosis
56. Anemia of infection Protein of malnutrition Thalassemia acquired hemolytic anemia Pyridoxine deficiency Sideroblastic anemia lead poisoning Differential Diagnosis
67. Iron Content Of Some Common Foods Food Quantity Milligrams Of Iron Lean beef 100 grams 4.1 Chicken Breast 100 grams 0.6 Fish 100 grams 0.4 1 medium egg 60 gram 0.8 Baked beans 1/2 cup 1.9 Lentils 1/2 cup 2.5 Wholemeal 1 slice 0.7 Boiled spinach 1/2 cup 2.2 Broccoli 1/2 cup 0.7 Iron fortified baby cereal 15 grams 7.5
68.
69. Oral preparation of iron It is convenient to give iron in the form of an oral preparation a doses of 4-6mg/kg/day of elemental iron Treatment
70.
71. Dose of oral iron preparation Kind of iron infant children elemental iron Dose/day in 1g Ferrous sulfate 0.15-0.3g 0.3-0.6g 200mg Ferrous fumarate 0.1-0.2g 0.2-0.4g 330mg Ferrous gluconate 0.3-0.6g 0.6-1.2g 115mg ( Ferrous salts are absorbed better than ferric salts) therapy is generally continual 2-3 months after restoration of the Hb to normal.
72. Failure to respond to oral iron: the following reasons should be considered Failure or irregular administration of oral iron; administration verifiable by change in stool color to gray-black Inadequate iron dose Ineffective iron preparation Persistent or unrecognized blood loss, with the patient losing iron as fast as it is replaced. Incorrect diagnosis Coexistent disease that interferes with absorption or utilization of iron (infection , hepatic or renal disease …) Impaired GI absorption (e.g. concurrent administration of large amounts of antacids, which bind iron, as treatment of peptic ulcer )
73. Parenteral iron therapy indicated in children showing intolerance to oral iron reduced iron absorption persistent blood loss their parents are unreliable Treatment
74. The requirement of iron dextran milligrams is calculated as fellows: Total doses (mg) (elemental iron) · kg: body weight · 12.5 is the normal Hb in infant · 3.4 is elemental iron(mg) in 1 gram of Hb · 1.2 means an additional iron supplement of 20% for serum iron. 75 x kg x (12.5-Hb) x 3.4 x 1.2 100 Treatment
75. Iron dextran complex intramuscular ampoule containing 100mg elemental iron in 2ml. administer daily, on alternate days, biweekly. Treatment
76. The good response reticulocyte 48 ~ 72h a peak during the 5th to 7th days falls the normal level after 2-3 weeks Treatment
77. . Iron supplementation should be continued for a minimum of 3 months , not only to correct the hemoglobin but also to replenish the iron stores. Treatment
78. Therapeutic effect observation Response to iron supplements Replenish iron stores 1-3 mo Hemoglobin 4-30 days Reticulocyte , 5-7d peak 48-72 hr Bone marrow reaction; hyperplasia 36-48 hr Enzyme activity improve 12-24 hr reaction Time
79. Blood transfusion are rarely indicated in iron deficiency anemia, except for severe cases (Hb<60g/l) . Treatment
80.
81. I ron deficiency anemia definition I ron’s storage I ron’s absorption I ron deficiency anemia’s etiology T he first good response to iron medication T herapy time QUESTIONS