2. DEFINICION
• Cuando la cantidad perdida de hierro es
mayor que su absorción, se inicia el
desarrollo de la deficiencia de hierro. Es
una de las formas mas prevalentes de
malnutrición y explican en promedio
841.000 fallecidos cada año a nivel
mundial
4. Ciclo del hierro 2
Fe+ en exceso se une a apoferritina
para formar: FERRITINA Interioriza a través de las
fositas revestidas de clatrina
Endosoma ácido
Liberación del Fe.
Fe Hemo
Receptor membrana
Transferrina circulación.
Fe
5. Ciclo del hierro 3
Vm: 120 días.
Recambio diario: 0.8 a 1% de los
eritrocitos
Fagocitosis por sistema
reticuloendotelial
Degradación de la hemoglobina:
globina a.a. y el Fe pasa a la
membrana de la célula RE donde es
captado nuevamente por la
transferrina circulante.
6. Absorción del hierro
• Intestino delgado.
• Ácido estómago mantiene el
hierro en solución.
• Fe es captado por la célula de
la luz intestinal .
• Hierro férrico se convierte en
ferroso por una ferrirreductasa.
• Transportado al interior de la
célula por DMT 1
• Almacenamiento como
ferritina o liberación a
transferrina plasmática.
7. Datos nutricionales acerca del
hierro.
• Absorción del hierro se facilita por agentes reductores.
• Requerimientos mínimos de hierro: hombres absorber 1mg/dia,
mujeres 1,4mg/día.
• Dieta: 6mg de hierro elemental por cada 1000 calorías. Hombres
ingieren 15mg/d y absorben 6%, mujeres 11mg/d y absorben
12%.
• Hierro en forma de Hemo (carnes rojas) se absorbe con mayor
facilidad.
• Vegetarianos: fitatos y fosfatos reducen 50% absorción de hierro.
• Pérdida de hierro: hemorragias, descamación de células
epidérmicas de la piel e intestinales.
8. Estadíos de la ferropenia:
Demandas o
Movilización de Disminución de Agotamiento
pérdidas
hierro de los los depósitos de depósitos de ANEMIA
superan
depósitos del hierro (conc. hierro : ferritina FERROPÉNICA
absorción de
sistema RE. Ferritina) <15ug/L
hierro.
9. Estadíos de la ferropenia
1. Disminución de hierro:
Disminución
Absorción intestinal
progresiva de las
de hierro debe estar
reservas de hierro
aumentada durante
(ferritina sérica <
esta fase.
12ug/L)
Amplitud de
Parámetros distribución de
eritrocitarios eritrocitos elevada.
normales Indica deficiencia de
hierro.
10. Estadíos de la ferropenia
2. Eritropoyesis con deficiencia de
hierro:
• Agotamiento de los depósitos de hierro.
(hierro sérico <50ug/dl y ferritina
disminuidos, CTFH aumentada).
• Disminución saturación transferrina.
Reciclaje.
11. Estadíos de la ferropenia
3. Anemia por deficiencia de hierro:
• Anormalidad importante de las pruebas
de laboratorio (F sérica, CTFH, Fe sérico,
%satHb).
• Elevación protoporfirina eritrocitaria
• ANEMIA MICROCÍTICA HIPOCRÓMICA
= fase avanzada.
12. Presentación clínica
• Las manifestaciones clínicas son debidas en
parte a la anemia y en parte a la falta de hierro.
SINTOMAS
INESPECIFICOS
13. Síntomas y signos por falta de
hierro tisular
Dependen de la
gravedad y cronicidad
Queilosis
de la anemia Pica
pagofagia Susceptibilidad
A infecciones
Glositis
Coiloniquia
Fatiga muscular
Disfagia Trastornos del
crecimiento y el
aprendizaje
Papiledema
16. Diagnostico
• Se deben separar las pruebas de laboratorio entre las
que corresponden al diagnostico de la deficiencia de
hierro de aquellas que corresponden a las
características de la anemia. En primera instancia se
debe realizar
Cuadro hemático
Ferritina sérica
Estudios de la medula ósea
Hierro sérico
concentración de protoporfirina eritrocitaria
17. Fases secuenciales de
deficiencia de hierro
• Disminución del hierro tisular
• Disminución del hierro medular
I. Diminución del
hierro • Aumento del nivel de transferrina
almacenado
• Disminución de VCM
• Disminución de HCM
II. Disminución del • Disminución de saturación de transferrina
hierro para
eritropoyesis • Aumento en la protoporfirina eritrocitaria libre
• Disminución de la hemoglobina
III. Disminucion de • Disminución del hematocrito
la Hb En sangfre
periferica
• Sintomas clinicos
IV. Descenso del • Signos clinicos
aporte de O2 a los
tejidos perifericos
20. Manejo
• Luego de identificar la enfermedad primaria que
origino la deficiencia de hierro se debe iniciar la
reposición del mineral.
• La gravedad y la causa definirán el método que
debe usarse en el tratamiento.
• Ancianos sintomáticos con deficiencia
cardiovascular: transfusiones de eritrocitos
• Personas jóvenes: reposición de hierro
21. Manejo
Transfusión de
eritrocitos Tratamiento con hierro Tratamiento parenteral
Se reserva para por vía oral con hierro
personas con anemia en pacientes Se puede administrar en
sintomática, sirve para asintomáticos con pacientes que no toleren
estabilizar al paciente, y anemia ferropenica la vía oral y en cuales las
estas mas relacionado establecida, se cuenta necesidades sean
con consecuencias de la con múltiples agudas o necesiten
anemia que con la medicamentos hierro de forma continua
ferropenia
Custom animation effects: video wall reveal picture(Basic)Tip: For best results when reproducing the picture effects on this slide, you may want to use the Snap objects to grid feature. To do so, right-click the slide background and select Grid and Guides. Under Snap to, select Snap objects to grid.To reproduce the background on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then clickBlank. Right-click the slide background area, and then click Format Background.In the Format Background dialog box, in the left pane, select Fill, and then do the following in the Fill pane: Select Picture or texture fill.Under Insert from, click File. In the Insert Picture dialog box, select a picture, and then click Insert.To reproduce the first row of squares with animation effects on this slide, do the following:On the Home tab, in the Drawing group, click Shapes, and then under Rectangles click Rectangle (first option on the left). On the slide, drag to draw the rectangle.Select the rectangle. Under DrawingTools, on the Format tab, in the Size group, do the following to change it into a square:In the Shape Height box, enter 2.5”.In the Shape Width box, enter 2.5”.Under DrawingTools, on the Format tab, in the Shape Styles group, do the following:Click the arrow next to Shape Fill, and then under Theme Colors click Black, Text 1 (first row, second option from the left).Click the arrow next to Shape Outline, and then click No Outline.Select the square. On the Home tab, in the Clipboard group, click the arrow underPaste, and then click Duplicate. Repeat this process two more times for a total of four squares.Press and hold CTRL, and then select all four squares.On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Top.Click Distribute Horizontally.Press and hold CTRL, and then select all four squares. On the Animations tab, in the Animations group, click CustomAnimation, and then do the following in the Custom Animation task pane:Click Add Effect, point to Exit, and then click More Effects. In the Add Exit Effect dialog box, under Subtle, click Fade, and then click OK.Under Modify: Fade, in the Start list, select With Previous. Under Modify: Fade, in the Speed list, select Very Fast. Also in the CustomAnimation task pane, do the following:Select the first animation effect. Click the arrow to the right of the first animation effect (fade effect for the first square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0, and then click OK.Select the second animation effect. Click the arrow to the right of the second animation effect (fade effect for the second square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.1, and then click OK.Select the third animation effect. Click the arrow to the right of the third animation effect (fade effect for the third square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.2, and then click OK.Select the fourth animation effect. Click the arrow to the right of the fourth animation effect (fade effect for the fourth square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.3, and then click OK.To reproduce the second row of squares with animation effects on this slide, do the following:On the slide, select one of the squares in the first row.On the Home tab, in the Clipboard group, click the arrow under Paste, click Duplicate, and then drag the duplicate square away from the first row of squares. Repeat this process two more times for a total of four new squares (a total of eight squares on the slide).On the Home tab, in the Editing group, click Select, and then click SelectionPane. Press and hold CTRL, and then in the Selection and Visibility pane, select the fifth, sixth, seventh, and eighth objects (four new squares). On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align Middle.Click Distribute Horizontally.In the Custom Animationtask pane, select the fifth, sixth, seventh, and eighth animation effects (fade effects for the second row of squares), and then do the following:Under Modify: Fade, in the Start list, select With Previous. Under Modify: Fade, in the Speed list, select Very Fast. Also in the CustomAnimation task pane, do the following:Select the fifth animation effect. Click the arrow to the right of the fifth animation effect (fade effect for the fifth square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.4, and then click OK.Select the sixth animation effect. Click the arrow to the right of the sixth animation effect (fade effect for the sixth square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.5, and then click OK.Select the seventh animation effect. Click the arrow to the right of the seventh animation effect (fade effect for the seventh square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.6, and then click OK.Select the eighth animation effect. Click the arrow to the right of the eighth animation effect (fade effect for the eighth square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.7, and then click OK.To reproduce the third row of squares with animation effects on this slide, do the following:On the slide, select one of the squares in the second row.On the Home tab, in the Clipboard group, click the arrow under Paste, click Duplicate, and then drag the duplicate square away from the second row of squares. Repeat this process two more times for a total of four new squares (a total of 12 squares on the slide).Press and hold CTRL, and then in the Selection and Visibility pane, select the ninth, 10th, 11th, and 12thobjects (four new squares). On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align Bottom.Click Distribute Horizontally.In the Custom Animationtask pane, select the ninth, 10th, 11th, and 12thanimation effects (fade effects for the third row of squares), and then do the following:Under Modify: Fade, in the Start list, select With Previous. Under Modify: Fade, in the Speed list, select Very Fast. Also in the CustomAnimation task pane, do the following:Select the ninth animation effect. Click the arrow to the right of the ninth animation effect (fade effect for the ninth square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.8, and then click OK.Select the 10th animation effect. Click the arrow to the right of the 10th animation effect (fade effect for the 10th square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 0.9, and then click OK.Select the 11th animation effect. Click the arrow to the right of the 11th animation effect (fade effect for the 11th square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 1, and then click OK.Select the 12th animation effect. Click the arrow to the right of the 12th animation effect (fade effect for the 12th square), and then click Timing. In the Fade dialog box, on the Timing tab, in the Delay box, enter 1.1, and then click OK.
