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Introduction
One of the most prevalent forms of malnutrition
Globally 50% of anemia is attributable to iron
deficiency
Iron metabolism
Critical element
Various functions
Carry O2 as part of Hemoglobin
Myoglobin
Cytochrome system in mitochondria
Free iron is toxic
ADULT FEMALE,60 kg
Hemoglobin
2500
1700
Myoglobin
500
300
Transferrin iron
Iron stores
600-1000
0-300
Iron cycle
Regulated by absorption
Iron losses are unregulated
Gi loss and menstrual cycle loss
Absortion in duodenum
Iron absorption
Dietary Fe in ferric form
Reduced to Fe2+ by ferric reductase
Transported through DMT1
Inside the cell stored as ferritin
Transported across BL membrane through
ferroportin
hepcidin low
50-200 ug/l
TIBC
300-360 ug/dl
Serum Fe
50-150 ug/dl
Transferrin saturation
30-50%
Marrow sideroblasts
40-60%
RBC protoporphyrin
30-50 ug/dl
Inadequate diet
Malabsorption syndromes
Post gastrecomy
Acute or chronic nflammation
Clinical features
Fatigue
Exercise intolerance
Dyspnea ,palpitation,syncope
Pica
Symptoms related to etiology
o/e
Pallor
Glossitis
Cheilitis
Platynychia,longitudinal ridging,koilonychia
Lab investigations
HEMOGRAM
Anemia
Low MCV,MCH
RDW high
Platelet count elevated
Peripheral smear
Microcytic hypochromic anemia with
anisopoikilocytosis
Iron studies
Differential diagnosis
Beta thalssemia trait
Anemia of chronic disease
MDS
TREATMENT
Red cell transfusion
Oral iron therapy
200-300mg/d in empty stomach in divided
doses
Ferrous
sulfate,fumarate,gluconate,polysaccharide iron
6-12 months after correction of anemia
Side effects
Abdominal pain,nausea,vomiting,constipation
Response to treatment
Reticulocyte increasewithin 4-7 d and peaks at 11.5 wks
Pareteral iron
Indications
Oral iron intolerance
Whose iron needs are relatively acute
Who need iron on an ongoing basis
2 modes
To administer total dose of iron together
To give small repeated doses of iron over a
period