Diagnosis of iron deficiency anemia

Diagnosis of iron deficiency anemia

1. Diagnosis of iron deficiency anemia Dr. Govind Kendre Seth G.S. medical college& KEM hospital, Parel , Mumbai

2. history Age Sex Socioeconomic strata Diet & personal history Developmental history History pointing towards probable etiology Treatment history & compliance

3. Symptoms & signs General symptoms Characteristic symptoms

4. Clinical examination

5. cbc Hb & Hct RBC count MCV (<80fL/cell) MCH (<27pg/cell) MCHC(<33%) RDW(>15) TLC & differential (unchanged) Platelet count (>4.5lakh) Reticulocyte count

6. Rbc count Measured by laser light scatter methodology In IDA decreased in proportion with MCV MCV÷RBC >13

7. MCV Mean on histogram of RBC size distribution <80fl

8. rdw Coefficient of variation or SD of size distribution Quantifies degree of anisocytosis Normally <15% Increase with decrease in IDA & normal in thal & ACD

9. Peripheral smear Hypochromic microcytic picture Anisocytosis Pencil shaped poikilocytes Occasional Target cells

10. Bone marrow examination Cellularity variable RBC precursors increased Absent sideroblasts & macrophage hemosiderin by iron stain

11. Indicators of Iron status Sr. iron TIBC % saturation Sr. ferritin BM stainable iron

12. Sr iron Diurnal variation 50-150mcg/dl Always interpreted in combination with TIBC & Tr saturation

13. Tibc Indirect measure of transferrin concentration 200-400mg/dl

14. T r Saturation Sr iron TIBC N Range 20-45% <20% suggest IDA >45% in Hemochromatosis  

15. ferritin High molecular weight protein consists of 20% iron Serves as iron reserve in RE cells & hepatocytes Small amount present in serum reflect iron stores 45-340ng/dl In setting of inflammation value <100 suggest depleted iron stores <10 in severe IDA

16. Newer MARKERS CHr sTfR Hepcidin ZPP

17. CHr Realtime snapshot of iron directly available for Hb synthesis By flow cytometry light scatter N range (26-32pg) <26 in iron deficient erythropoiesis Response to EPO can be assesed Little affected by inflammation

18. sTfR Present on external surface of plasma membrane Iron-transferrin complex binds to receptor complex internalised & iron released Proteolytic cleavage releases truncated sTfR Inverse relation to iron status Not an acute phase reactant N range 1.8-4.6 mg/L

19. HEPCIDIN Regulator of iron metabolism Binds to ferroportin & degrade it leading to decreased iron absorption & export Decrease in IDA

20. Developmental stages of iron deficiency Iron depletion Iron deficiency IDA

21. IRON STATUS

22. Acd vs ida

23. Lab parameters

24. IRIDA AR TMPRSS6 gene on chromosome 22 encoding serine protease Metriptase2 Metriptase 2 is a negative regulator of hepcidin Mutation leads to decreased activity of metriptase 2 with subsequent increase in hepcidin which decrease iron absorption

25. Thank you