Iron deficiency anemia is a common nutritional disorder worldwide. It results from low iron stores due to dietary lack, impaired absorption, increased requirements, or chronic blood loss. Clinically it presents as a hypochromic, microcytic anemia. It is diagnosed based on low iron levels, high total iron binding capacity, and low transferrin saturation in the blood. Treatment involves oral or injectable iron supplementation to replenish stores as well as treating any underlying cause. Prognosis is generally good if treated, but depends on any comorbidities present.

1. Iron Deficiency of Anemia
General
Metabolism
Morphology
Clinical Manifestations & diagnosis
Treatment
Prognosis
PROF: DR. RAFI AHMED GHORI
Medical Unit-IV
Liaquat University of Medical & Health Sciences,
Jamshoro

2. Iron Deficiency Anemia
General
 Probably most common nutritional
disorders world-wide.
 In the U.S.A most particularly common
in toddlers, adolescent girls, women of
child-bearing Age.
 Etiology of IDA varies a little depending
on populating group

4. Iron Deficiency Anemia
Metabolism
 Total body iron contents
 women: ~2gm
• women have smaller store of iron than do men even healthy
young
 men: ~6gm
 Functional versus storage compartments
 Functional: ~80% in hemoglobin
• reminder in mayoglobin, catalase, cytochromes
 Storage: ~15-20% in hemosiderin, ferritin

6. Iron Deficiency Anemia
Metabolism
 Storage
 Ferritin protein iron complex
 particularly found in liver, spleen, bone marrow,
skeletal muscles
 Liver: most stored in parenchymal cells
 Other tissue: most stored in mononuclear
phagocytic cells
 Within cells, protein shells degraded, iron
aggregated into hemosiderin granules

7. Iron Deficiency Anemia
Metabolism
 Storage
 Ferritin (cont’d)
 Only trace amounts of hemosiderin usually found
- principally in reticuloendothelial cells in BM, spleen, and
liver
 Very small amounts of ferritin in plasma
- level is very good indicator of body iron storage
 Storage iron pool important
- readily mobilizable

8. Iron Deficiency Anemia
Metabolism
 Mucosal uptake

9. Iron Deficiency Anemia
Metabolism
 Transport of iron
 In plasma: transferrin, usually ~33%saturated with
iron
 Transferrin delivers iron to cells
 Immature RBCs possess high-affinity receptors for
transferrin

10. Iron Deficiency Anemia
Metabolism
 Body losses of iron are limited
 Iron balance is maintained largely by regulation of
absorptive uptake
 Factors are largely unknown
• Rate and level of absorption are dependent on
total body iron content and erythropoietin
 activity (need of erythroid precursors)
 As body storages rise, % of absorbed iron falls
 With ineffective erythropoieses, iron absorption
increases

11. Iron Deficiency Anemia
Etiology
 Iron requirement: 1 to 1.5 mg./day, so
about 1 mg. must be absorbed /day
 only 10-15% of ingested iron is
absorbed
• daily iron requirement 5 to 10 mg. for
men
• 7 to 20 mg. for women
 average deit in “Western” world 15 to 20
mg.

12. Iron Deficiency Anemia
Etiology
 Bioavailability is imoportant
 heme iron is more absorbable than
inorganic iron
- absorption or inorganic iron influenced
by other dietary contents

13. Iron Deficiency Anemia
Etiology
 Dietary lack
 Impaired absorption
 increased requirement
 Chronic blood loss

14. Iron Deficiency Anemia
Etiology
 Dietary lack
 Rare in industrialized countries with
abundant food supplies (including meat)
• Elderly
• Very poor
• Infants
• Children
 More common in developing countries where
food is less abundant

15. Iron Deficiency Anemia
Etiology
 Impaired absorption
 Sprue
 Intestinal steatorrhea
 Chronic diarrhea
 Gastrectomy
 Food items

16. Iron Deficiency Anemia
Etiology
 Increased requirement
 Growing infants and children
 adolescents
 Premenopausal (particularly
pregnant) women
• economically deprived women multiple and
frequent pregnancies

17. Iron Deficiency Anemia
Etiology
 chronic blood loss
 Most important cause in Western world
 External hemorrhage depletes iron reseves
 GI tract
 ulcers, gastritis, carcinoma, hemorrhoids,
parasitic diseases
 Urinary tract
 Tumors
 Genital tract
 Menorrhagia, uterine cancer

18. Iron Deficiency Anemia
Etiology
 Iron deficiency in adult men and
postmenopausal women in the
“Western” world
 GI blood loss should be top
differential, unless proven otherwise

19. Iron Deficiency Anemia
Clinical and laboratory
 Hypochromic, microcytic anemia
 Other changes (in long-standing deficiency)
 Koilonychia
 Alopecia
 Atrophic changes in tongue and gastric
mucosa
 Intestinal malabsorbtion

20. Iron Deficiency Anemia
Clinical and laboratory
 Plummer-Vinson syndrome
 (AKS Paterson-Brown-kelly syndrome)
 Microcytic hypochromic anemia
 Atrophic glossitis
 Esophageal webs

21. Iron Deficiency Anemia
Clinical and laboratory
 In early stages of blood loss (of negative iron
balance), reserves usually adequate to maintain
normal Hgb/Hct,serum iron, transferrin
saturation
 Depletion of reserves eventually lowers
serum iron, transferrin saturation
 Bone marrow attempts to keep up with
increase erythroid activity

24. Iron Deficiency Anemia
Clinical and laboratory
 anemia appears when all iron stores are
depleted
 low serum iron, low transferrin saturation,
low serum ferritin

25. Iron Deficiency of Anemia
Morphology
 Bone marrow
 Mild to doderate increase in erythropoietic activity
• Increased normoblasts
 Stainable iron disappears
 Peripheral blood smear
 red cells are small (microcytic)
 pale (hypochromic)

26. HYPOCHROMIC, MICROCYTIC
PICTURE OF R.B.Cs

27. Iron deficiency Anemia
Clinical and Laboratory
 Dominating signs often related to underlying
cause fe anemia
 Diagnosis rests on laboratory studies
 Decreased Hgb/Hct
 Hypothermia, microcytosis, poikilocytosis
 Serum iron, serum ferritin low
 Total plasma iron-binding capacity high
 Decreased transferrin saturation

28. Laboratory Findings

30. Lab Testing Algorithm for
Iron Deficiency Anemia (IDA)

32. Iron deficiency Anemia
Differentials Diagnosis
 Spherocytosis, hereditary
 Thalassemia, Alpha
 Thalasseamia, Beta
 Anemia of chronic disorders
 Hemoglobin CC disease
 Hemoglobin DD disease
 Lead poisoning
 Microcytic anemias
 Sideroblastic anemias

33. Iron deficiency Anemia
Treatment
 Medical Care:
• Iron deficiency should be treated with oral or
injectable iron.
• Diet
• underlying etiology should be corrected so the
deficiency does not recur.
 Surgical Care:
• Surgical treatment consists of stopping hemorrhage
and correcting the underlying defect.

34. Iron deficiency Anemia
Prognosis
Iron deficiency anemia is an easily treated
disorder with an excellent outcome;
however, it may be caused by an underlying
condition with a poor prognosis, such as
neoplasia. Similarly, the prognosis may be
altered by a comorbid condition such as
coronary artery disease.