Ida

Classification of anemia

Causes of anemia

-Blood loss.

-Iron deficiency.

-Infection.

-RBC destruction (hemolysis) e.g. G6PD.

-B12 and Folate deficiency.

Red cells size and their indices

-Hb concentration and Hematocrit

-MCV, MCH, MCHC.

MCV

-IDA

-Thal

MCV-B12 -Folat

Normal MCV-hemolytic anemia

Iron deficiency anemia

Normal iron metabolism:-The primary function is oxygen transport.-Iron is absorbed by duodenum and jejunim-Average total body iron content 3500-4000 mg.-Approximately 2/3 found in hemoglobin, -Iron is also stored in RE cells (BM, Spleen and liver) as hemosiderin and ferratin.-Also iron found in myglobin and myeloperoxidase and in certain electron transfer.-Iron is more stable in ferric state (Fe+++) than in ferrous state (Fe++).

Iron + Hem

Iron Metabolism

Iron Absorption1-2 mg only

Plasma FeTransferrin carriers

4 mg

Body stores

1000 mg (M)

300-500 mg (F)

Myglobin300 mg

20 mg FeReturned to immature RBC

in BM

RBC2500 mg

R.E. 20 mgReleased daily

Via RE system90% extra vascular5-10% intra vascular

Loss (from GI tract)1-2 mg daily

Daily Fe++ turnover continuous process

Dietary iron:Iron is present in food as ferric hydroxides (ferric-protein complexes and hem-protein complexes).-meat, liver-vegetables, eggs.-The average diet contains 10-15mg and only 5-10% is normally absorbed.

Iron requirements:It varies depending on sex and age:Male/female 0.5-1 mg/dayPregnant female 1-2 mg/dayChildren 0.5 mg/day

Clinical features:• When ID is developing, the RE stores (hemosiderin and

ferritin) become completely depleted before anemia occurs.• At an early stage, no clinical abnormalities.• Later, patient may develops general symptoms and signs of

anemia.• In severe case of IDA ridged or spoon nails.

Causes:• Chronic blood loss

Fetomaternal Hemorrhage, inherited bleeding disorders menstrual peroid.

• Maternal iron deficiency (neonate).• Growth spurts (infants and children).• Gastrointestinal,

peptic ulcer, aspirin ingestion, carcinoma, hookworm, colitis, piles etc.

• Pregnancy• Rarely hematouria, self-inflicted blood loss, hemoglobinuria.

• Insufficient daily iron intake (poor diet).• Malabsorption.

Laboratory findings:•Red cell indices:

Low Hb conc.MCV, MCH, MCHC*

•Blood film:Hypochromic microcytic Picture.Occasional Target cells.Pencil shaped poikilocytes.Normal reticulocyte count.

•Bone marrow iron:Normal to hypercellular.RBC precursors are increased in number.Iron stain negative.

•Chemical testing on serum:Serum iron Decreased Transferrin/TIBC Normal to HighSerum ferritin Decreased (Very low)

Hypochromic Microcytic picture (IDA)

-ve BM Iron Stain +ve

Reticulocytes