iron deficiency anemia

IRON DEFICIENCY

ANEMIA(IDA)

IRON

4% of Earth’s Crust

4±1 gm total Body Iron in Adult Human

Hb2± 0.5 gm

Storage(Fe+++)

1 ± 0.5 gm

Ferritin

Haemosiderin

Essential iron: Myoglobin & Iron-Containing Enz. (e.g.cytochromes, catalases)

Plasma 4 ± 1 mg

Protein-iron complex Ferritin Haemosiderin

Solubility Water-soluble Insoluble

Molecular weight ~ 450.000 Variable

structure Apoferritin

( outer prtn.coat )

& iron-phosphate-

hydroxide core

Derived from partial

lysosomal digestion

of aggregates of

ferritin molecules

% of iron in the structure 20 37

In Perls’ - reaction

(Prussian blue-reaction)

under light microscope

Not visible

Visible

in macrophage & normoblasts

Binding ~4500 iron atoms

/molecule of apof.

Variable

Daily Iron Cycle

Enterocytes &Iron absorption

HEPCIDIN A polypeptide produced by the liver

The major hormonal regulator of

iron homeostasis It inhibits iron release from macrophages, intestinal

epithelial cells & from placental syncytiotrophoblasts

by accelerating degradation of ferroportin mRNA Iron deficiency , hypoxia & ineffective erythropoiesis

inhibits hepcidin production

iron release from pre-mentioned cells As acute phase protein,

hepcidin production is induced by inflammation via IL-6

Ancylostoma

Sequence of Events in IDA

SEQUENCE OF EVENTS IN IDA I

Hb 15 g/dL

RCC 5 million/ µL

MCH 30 pg Hct. 45 %

MCHC 33 g/dL

MCV 86 fL

Serum Iron UIBC

20 µmol/L 40 µmol/L

TIBC= 60 µmol/L

Saturation 33%

p.ferritin N. 15-300 µg/L

WBC7,500/µL

Platelet400,000/µL

SEQUENCE OF EVENTS IN IDA II

BLEEDING

40 ml/ Day

20 mgIRON

Iron Absorption

up to5

mg/Day

Net Daily Loss= 20-5 = 15 mg

1500------ = 100 Days 15

Latent Iron

Deficiency

No Clinical FeaturesNormal Blood Values

If Iron Stores= 1500 mg

1/3 of ACD are microcytic hypochromic

Causes of microcytic hypochromic anemias

The 1st step in the evaluation of microcytic anemia is to rule out IDA,HOW?