Iron Deficiency Anemia ( IDA )

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Iron Deficiency Anemia ( IDA ). Liang Aibin, MD/PhD Dept. of Hematology TongJi Hospital of TongJi University. Ⅰ. Introduction to IDA. Iron deficiency is the state in which the content of iron in the body is less than normal.
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Iron Deficiency Anemia ( IDA )Liang Aibin, MD/PhDDept. of Hematology TongJi Hospital of TongJi UniversityⅠ. Introduction to IDA
  • Iron deficiency is the state in which the content of iron in the body is less than normal.
  • Iron Deficiency Anemia is resulting from lack of sufficient iron for synthesis of hemoglobin.
  • IDA is common nutritional and hematologic disorder worldwide, affecting an estimated 2 billion people.
  • IDA may occur as a result of many causes.
  • Despite improvement in diet and more effective and widespread use of well-absorbed forms of iron to fortify foods, IDA remains the most common cause of anemia of infancy & childhood.
  • Ⅱ. Iron Metabolism A. Iron compounds in the body B. Iron kinetics C. Iron requirements Ⅱ. Iron MetabolismA. Iron compounds in the bodyStores1000mgTissue500 mgRed Cells2300 mgIRONBody Compartments - 75 kg manAbsorption < 1 mg/dayExcretion < 1 mg/day3 mgB. Iron kinetics(1) Iron sources:Dietary iron,recycled iron(2) Iron absorption,transport,use or storage and excretion Iron Absorption from duodenum
  • Iron absorption is increased in the presence of iron deficiency, and it decreases when there is iron overload.
  • At least nine proteins appear to be involved in this mechanism.
  • INTRACELLULAR IRON TRANSPORTFe+3TransferrinTransferrin receptorH+H+LysosomeFe+3H+H+CIRCULATING RBCsMONONUCLEARPHAGOCYTESFeFeFeFeFeFeFerritinFeTransferrin ReceptorFeFeFeFerritinFeFerritinFeslowHemosiderinFeFeRBC PRECURSORFeFeTRANSFERRINC.Iron RequirementsⅢ. Etiology & Pathogenesis1. Causes of Iron Deficiency(1) Insufficient storage iron in fetus(2) Insufficient intake of iron(3) Rapid growth(4) Faulty or incomplete iron absorption(5) Excessive loss of iron2. PathogenesisIron↓+Protoporphyrins↑→Heme↓+Globin→ HGB ↓ *Stages in development of iron deficiencyID.IDE:latent iron deficiencyIDA:anemic stageStages in Development of Iron DeficiencyⅠ(ID)Loss of storage ironⅡ(IDE)Loss of circulating ironⅢ(IDA)Decreased HGB productionSF(Serum Ferritin)↓Bone marrow stainable iron:hemosiderin sideroblast ↓FEP↑SI↓TIBC↑TS↓ HGB↓MCV↓MCH↓MCHC↓ID:Iron depletionIDE:Iron deficient erythropoiesisIDA:Iron deficiency anemiaⅣ. Clinical Manifestation1. Peak age: 6 mo~2 yr2. Pallor,fatigue,weakness, etc3. Extra-medullary hematopoiesis: hepatosplenomegaly 4. Nonhematologic manifestations(1) Cardiorespiratory system: tachypnea, tachycardia,CHF(2) Gastrointestinal effects:anorexia,pica,etc(3) Nervous system: irritability, spiritlessness, etc(4) Impaired WBC function and immunity: infection(5) Others: koilonychia,etc Ⅴ. Laboratory Findings1. Blood Smear: Hb↓↓、RBC↓、 MCV↓、MCH↓、MCHC↓ → hypochromic, microcytic anemia Ret:N .↓ anisocytosis2. Bone Marrow: hypercellular with erythro- hyperplasia. Cytoplasmic maturation lags behind nuclear maturation.3. Tests Regarding Iron Metabolism(1) SF(Serum ferritin)↓(2) FEP(free erythrocyte protoporphyrin) ↑(3) SI(Serum iron) ↓,TIBC(total iron binding capacity)↑(4) Bone marrow stainable iron: hemosiderin ↓, sideroblast <15% Ⅵ. Diagnosis & Differential Diagnosis1. Diagnostic Criteria for IDA(1) Hypochromic, microcytic anemia: Hb↓, MCV<80 fl , MCH <26 pg , MCHC <0.31(2) Definite cause(s) and / or manifestation(s)(3) SI<10.7 μmol/L(4) TIBC>62.7 μmol/L,TS<10-15%(5) BM stainable iron: hemosiderin↓or absent , sideroblast <15% (6) FEP>0.9 μmol/L(7) SF<16 μg / L(8) response to iron therapy2. Differential DiagnosisIDA must be differentiated from several other hypochromic,microcytic anemiasⅦ.Treatment 1. Correct the basic problem (eg. dietary, bleeding sources and similar problems) 2. Oral Iron(1) The recommended oral dose of elemental iron is 1.5~2 mg/kg 3 times between meals (4.5-6 mg/kg/d)(2) Various iron complex and concentrates are available e.g. Ferrous sulfate:20~30 mg/ kg/d(3) A Ret rise in 3~5 days and Hb increase in 1~2 wk after the initiation of iron therapy. After Hb becomes normal,treat for 2~3 more mo to replenish iron stores3. Intramuscular Iron4. Ascorbic Acid5. Blood Transfusion Packed red blood cell transfusion for children with extremely low levels of Hb: 5-10 ml/kg /dose6. Diet:improvement in the diet with reduction of milk intake, use of iron-fortified formulas, and an increase in iron-containing food such as meat, eggs, fortified infant cereals, and green vegetables* Failure to Correct Presumed IDAResponses to Iron Therapy in Iron Deficiency AnemiaⅧ. PreventionIDA can be prevented by using iron-fortified infant formulas or supplemental iron-fortified solid foods*Recommended iron intake Full-term infants:1 mg/kg/d(0.5-3 yr) Preterm infants: 2 mg/kg/d (starting no later than 2 mo)
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