Iron Deficiency
Anemia
(IDA)
By:
Ashraf Abdulkarim Al-Bahla
Anae
mia
• Significa reduction leas 10 %) in
nt (at t mass or
circulati
hemoglobin red cellappropriate their
for
ng
age
content and sex, leading theto
Normal
corresponding decrease in the Appearance
Oxygen - carrying capacity of
blood.
• WHO criteria - Hb < 13 gm/dl in
men & Hb < 12 gm/dl in women
Pallor due to
Anemia
Iron Deficiency
Anemia
(IDA)
• Iron deficiency is defined as a decreased
total iron body content
• Iron deficiency anemia occurs when iron
deficiency is severe enough to diminish
erythropoiesis and cause the
development of anemia.
Grades of Anaemia
Epidemiology of iron
deficiency
• ~30% of the global population have
anemia
•1
• Iron deficiency is the predominant
cause of anemia2
• Women and children are most at risk
• Regardless of geography
• Green represents iron deficiency
anemia (IDA)
Role of Iron
• Carrier of oxygen from lung
to tissues
• Transport of electrons
within
cells
• Co-factor of essential
enzymatic reactions:
Neurotransmissi
on
Synthesis of
steroid
hormones
Synthesis of
bile salts
Detoxification processes
in the liver
IRON CYCLE
Transferrin -protein responsible for
transporting iron in the body.
Tissues with higher requirement for
iron ( bone marrow, liver & placenta)
contain more transferrin receptors.
Ferritin – intracellular storage of
iron
! Hemosiderin – long term iron storage
pool
IRON SOURCES
Rice
Spinach
Black beans
Corn
Lettuce Non-heme iron
Wheat
Soya beans
Ferr
itin
Fish muscle
Veal
liver
Hemoglobin Heme iron
Veal muscle
0 5 10 15 25
20
Iron Absorption (% of dose)
IRON LOSSES NORMALLY
1. Very small amounts
in urine, bile and
sweat
2. Cells shed from
skin, intestinal and
urinary tracts
3. Menstrual blood
loss
4. Pregnancy and
lactation
Etiology
• Iron-deficiency anemia is usually due to :
blood loss
poor diet
Malabsorbtion of iron from the git
Increase iron requirement at
pregnancy ,infant and chilfhood
• Blood Loss
Blood lost causes iron depletion
In women, long or heavy menstrual
periods or bleeding fibroids in the
uterus.
Pregnancy
Pregnancy
Internal bleeding
• Poor Diet
Low iron intake.
During some stages of life, such as
pregnancy and childhood.
• Inability To Absorb Enough Iron
Even if you have enough iron in your
diet, your body may not be able to
absorb it. This can happen if you have
intestinal surgery or a disease of the
intestine celiac disease and IBD.
Prescripe drugs that reduce acid
in the stomach also can interfere
with iron absorption antacid .
Presentation of Anemia
CLINICAL SIGNS OF IDA
SOME OTHER
• Pagophagia - craving ice
•
MANIFESTATIONS
Pica - craving of nonfood substances
• e.g., dirt, clay, laundry starch
• Restless Legs
• angular stomatitis - cracking of corners of mouth
• Koilonychia - thin, spoon-shaped fingernails
DIAGNO
• CBC
• Low RBCs SIS
• Low Hb
• Low Ht
• Low absolute reticulocyte count
• Low MCV (microcytic anemia)
• Low MCH
• High RDW
• Elevated Platelets (Thrombocytosis) may be Normal
• Normal WBCs but may elevated
• Low serum ferritin
• Low serum iron
• Low transferrin saturation
• High serum transferrin
• High Total Iron Binding Capacity (TIBC)
• Peripheral smear in iron deficiency anemia microcytic
PERIPHERAL BLOOD SMEAR
Normal analyses Found microcytes
Hypochromia
DIAGNOSIS
• Low serum iron and ferritin and elevated TIBC is
diagnostic
• Patient above 50 years with asymptomatic iron
deficiency anemia should be investigated for
FOBT if positive we do bidirectional endoscopy,
negative none invasive H pylori test if positive
treat it.
DDx of Microcytic Hypochromic Anemia
Complications of Iron Deficiency Anemia
(IDA)
• Heart failure
• In pregnancy premature delivery and uterine atony
• In Children delay growth and development
• Infection
Management of IDA
Treatment of the underlying condition
Examples include:
Abnormal uterine bleeding: e.g., hormonal therapy (OCPs), tranexamic acid, gynecological
surgery
GI pathology
H. pylori eradication therapy
GI bleeding: e.g., polypectomy, treatment of GI malignancy (e.g., colon cancer)
Hookworm infection: antihelminthics
Malnutrition or malabsorption: Identification and treatment of underlying causes (e.g., eating
disorders) and nutritional supplementation
Dietary modifications
All patients
Encourage consumption of iron-rich foods.
Counsel patients taking iron supplements to avoid the following substances that reduce iron
absorption:
• Food: e.g., tea, cereals, dairy products
• Drugs: e.g., calcium, antacids, PPIs
• Infants < 1 year old: Avoid cow's milk.
Cow's milk is low in iron and can cause gastrointestinal bleeding or protein-
losing enteropathy in infants with hypersensitivity or allergies.
Breastmilk or iron-fortified formula should be given instead.
Management of IDA
Iron therapy
Oral supplementation is effective and inexpensive, however, adherence is often poor due to side
effects. Parenteral iron therapy is beneficial in select cases.
Oral Iron Therapy
We start with oral iron preparations
Dosage
Adults: typically the equivalent of 100–200 mg elemental iron daily
As of 2020, there are no formal recommendations for optimal treatment. Lower doses or every-
other- day dosing are being advocated more recently, as they may improve iron absorption and reduce
adverse effects.
Children: 3–6 mg/kg per day in a liquid preparation
Available forms (ferrous preparations)
Ferrous sulfate
(Ferrous sulfate 325–650 mg (65–130 mg elemental iron) PO once daily
Ferrous fumarate
Ferrous fumarate 325 mg (106 mg elemental iron) PO once daily
Ferrous gluconate
Ferrous gluconate 325–975 mg (38–114 mg elemental iron) PO once daily
Absorption may be enhanced by simultaneous consumption of vitamin C (e.g., in orange juice).
Management of IDA
Adverse effects of oral iron therapy
Gastrointestinal discomfort
Nausea,
Constipation,
Black discoloration of stool .
Adverse effects are common (affecting up to 70% of patients) and may
be severe enough that they lead to discontinuation of treatment. Note
that fecal occult blood testing is unaffected by oral iron.
Duration
Should initially be administered for 3–6 months or three months after
correction of anemia in order to build iron stores
Management of IDA
Parenteral Iron Therapy
Indications
Oral iron therapy intolerance, nonadherence, or contraindications
Intestinal malabsorption
Patients who refuse indicated blood transfusions
Chronic bleeding refractory to oral therapy
Renal anemia, together with EPO treatment
Patients with ESRD often have low iron stores due to ongoing blood
loss during dialysis. Furthermore, the rate at which iron can be
mobilized from a patient's stores after EPO administration is
limited. Add IV iron to these patients' regimens maximizes the
benefit of EPO
Management of IDA
Dosage
Determine iron deficit using the Ganzoni
formula Total iron deficit in mg =
subject weight in kg × (target hemoglobuin in g/dl – actual hemoglobin in g/dl) × 2.4 + iron stores in
mg ( a value of 500 mg is used for iron stores for adults and children weighing > 35 kg and 15 mg/kg
for
children under 35 kg)
Doses are typically given one week apart: However, iron dextran may be given daily until
the deficit is replaced.
Choose a replacement preparation.
Available forms (ferrous preparations)
Iron dextran
An initial test dose is required for iron dextran because the risk
of anaphylactic reactions is higher than with other preparations.
Iron dextran; first ever administration: 25 mg IV or IM once; subsequent
doses: 100 mg IV or IM
Iron sucrose 200–300 mg IV infusion
Ferrous gluconate 125 mg IV infusion
Ferumoxytol 510 mg IV
Management of IDA
Adverse effects of Parenteral Iron Therapy
Thrombophlebitis
Myalgia, arthralgia, and headaches within 1–2 days of infusion
Rare: anaphylaxis (typically from iron dextran)
Duration
Depends on the iron deficit and chosen IV preparation
Monitoring
Check CBC monthly until in normal range, then every three months for one year, then
once again after another year.
Adequate response: After one month, hemoglobin should have increased by ≥ 1
g/dL.
This response also confirms the diagnosis.
Management of IDA
Blood Transfusion
Indications of blood transfusion in IDA
Acute blood loss and patient hemodynamically unstable
Hb less than 7
Patient with CHF Hb less than 8
Patient with anemia unresponse to other treatments.
Thank
you
