Lecture 2 Assist. Prof Dr. Hussein Naji Al-Shammari
Iron Deficiency Anemia
Iron Deficiency is the most common cause of anaemia world wilde. It is the most common cause of microcytic hypochromic anemia (Low MCV,MCHC, MCH). It is the most common micronutrient deficiency anaemia in the world affecting 24% of the world population. This is because Poverty, bad dietary habits, and excess pathological blood loss .
DIETARY IRON:There are 2 types of iron in the diet; haem iron and non-haem iron
a. Haem iron is present in Hb , muscle meat, and liver.
b. Non-haem iron is obtained from cereals, vegetables & beans
c. The average diet contains 10—15mg iron from which 5-10% absorbed (1—1.5mg/day) to balance the 1—1.5md/day iron loss.
STORAGE and Iron disruption OF IRON
Iron Distribution in the body :
Percentage of total
Ferritin /Hemosiderin (storage)
Liver, bone marrow, spleen
Transferrin bound iron (plasma)
Iron is stored as ferritin & hemosiderin compounds.1. Ferritin : water soluble protein-iron complex in tissue and plasma, contain 20% wt iron. Ferritin level reflects amount of stored iron in the body & it is the best mirror of iron in the storage in iron deficiency anaemia.
2. Hemosiderin : insoluble protein-iron complex as storage iron, visible in macrophages after staining by Perls (Prussian blue) reaction.
Daily Iron requirments ( mg/day):Group
Lossby; GIT, UT, Skin, hair loss
female 12—15 year
0.5—1Iron loss : 1.0 mg of iron is lost each day usually balanced by dialy absorbtion RISK GROUPS for iron deficiency:
1. Children of pre—school and school age both sex.
2. Adolescent girls.
3. Women of child bearing age (pregnant and lactation).
Iron absorbtion is restricted to the needs of the bodyFactors favoure absorption
Factors reducing absorption
Ferrous iron Fe2+
Ferric iron Fe3+
Acids :Hcl, vitamin C
Alkalis : antiacids , pancreatic secrtion
Precipit. agents: phytate, phosphate
Main sites of absorbtion are; Duodenum, Upper jejunumTransport of iron
Transferrin is the major protein responsible for transporting iron in the body, can bind two IRON atoms . It is produced in liver cells with increased synthesis in iron deficiency
Total iron binding capacity (TIBC): only 1/3 of transferrin saturated with iron
Plasma Transferrin : 300 μg/dL and Plasma Iron: 60-180 μg/dL
Causes of iron deficiencyETIOLOGY:Chronic blood loss : Menorrhagia, GIT hemorrhagia, Bleeding disorder, Pulmonary lesions with bleeding, Hemodialysis, Hematuria (chronic), Frequent blood venisection and donation (250 mg iron /unit blood).
Increased demand : Pregnancy , Lactation, Rapid growth
Malabsorbtion of iron (diseae of absorbtion sites) .
Inadequate iron intake: Decreased iron in the diet, Vegetarianism
The steps of iron deficiency (developments):Continued negative iron balance between intake , absorption and loss So cause : Depletion of iron stores….Reduction in plasma iron…….Reduction in Hb synthesis , hypochromia and , microcytosis………Anaemia
A. Pre-Latent IRON Deficiency: Decrease Storage bone marrow iron with normal Hb (no anaemia): but low serum ferritin, without reduction in serum iron & TIBC, with normal red cells morphology.
B. Latent anaemia: Absence of Storage Iron with normal Hb (No anaemia) bur decrease of Serum ferritin, Low iron and increase TIBC and increased transferrin, with normal red cells morphology.
C. Proper Iron deficiency Anemia (low Hb) with abnormal RBC morphology microcytic/hypochromic, with pencil shape.
Differential diagnosis of IRON deficiency anaemia : (other hypochromic):a. Iron deficiency anemia
b. Thalassemia .
c. Sideroblastic anemia
d. Anemia of chronic diseases , late stages
e. Lead poisoning
Laboratory features of Iron Deficiency Anaemia and other hpochromic anaemiaType of hypochromic anaemia
S. Transf. receptor
Laboratory diagnois of IDA ( Features):A. Hematology:
1. Low Hb,Htc,RBC: MCV,MCH,MCHC:
2. Low Retics count.
3. Plt: High/ normal
5. Smear (blood film): Hypochromia,anisocytosis,microcytosis, poikilocytosis, pencil cells.
B. Biochemical changes
1. Serum Iron: (Normal value : 60 – 180 μg/dL)
2. TIBC: (Normal value 250 - 430 μg/dL)
3. Serum Ferritin (N : Female;10-150 μg/L, Male;29-248 μg/L)
4. Transferrin saturation (Fe/TIBC normal > 15%): (<15% indicate IDA)
5. Serum Transferrin Receptor: