Iron Deficiency anemia hematology mbbs.pptx

Hematology

1. Anemia is defined as a low number of red blood cells and Hb .

2. ADAPTATIONS TO ANEMIA Increase in Oxygenated Blood Flow Increase in cardiac rate Increase in cardiac output Increase in circulation rate Preferential increase in blood flow to vital organs 2. Increase in Oxygen Utilization by Tissues Increase in 2,3-bisphosphoglycerate in erythrocytes Decreased oxygen affinity of hemoglobin in tissues

3. Anemic syndrome Pale skin Unexplained fatigue or lack of energy Shortness of breath or chest pain, especially with activity Unexplained generalized weakness Rapid heartbeat Pounding or "whooshing" in the ears Headache, especially with activity

4. PHYSIOLOGIC ADAPTATIONS ARE INFLUENCED BY: Severity of the anemia The presence and severity of comorbidities (cardiovascular, respiratory diseases…) Speed of anemia onset

5. Degree of anemia Hemoglobin (g/dl) I 9.1—11.0 II 7.1—9.0 III 5.1—7.0 D EGREE OF ANEMISATION

6. Classification of Anemia I. Etiologic Classification Impaired RBC production Excessive destruction Blood loss II. Morphologic Classification  Macrocytic anemia Microcytic hypochromic anemia  Normochromic normocytic anemia

7. Anemias due to the decreased red cell production iron deficiency anemia, megaloblastic anemias (vitamin B12 deficiency, folate deficiency), aplastic anemias (including pure red cell aplasia), anemias of chronic disorders, renal anemia, anemia due to neoplastic infiltration of the bone marrow, myelodysplastic anemia

8. ANEMIA AND IRON DEFICIENCY ANEMIA

9. Iron deficiency and iron-deficiency anemia are global health problems and common medical conditions seen in everyday clinical practice. Iron is crucial to biologic functions, including respiration, energy production, DNA synthesis, and cell proliferation. Iron deficiency affects more than 2 billion people worldwide and iron-deficiency anemia remains the top cause of anemia.

10. Iron deficiency anemia The total body iron is about 4 g. This is maintained by a balance between absorption and body losses . Although the body only absorbs 1-2 mg daily to maintain equilibrium, the internal requirement for iron is greater (20-25 mg). A man with 5 L of blood volume has 2.5 g of iron incorporated into the hemoglobin, with a daily turnover of 20 mg for hemoglobin synthesis and degradation and another 5 mg for other requirements. Most of this iron passes through the plasma for reutilization. Iron in excess of these requirements is deposited in body stores as ferritin or hemosiderin.

11. Iron (4 – 5 g) Physiological losses (1 . 5 mg) Absorbtion (2 mg) Mechanisms of the development of iron deficiency Dietary iron deficiency Additional iron requirements Increased iron losses Malabsorption of iron

12. Once the food is consumed and digested, iron is mainly absorbed in the duodenum and proximal jejunum. Reasonably, haem iron is absorbed more efficiently than non- haem iron, apparently by endocytosis of the intact iron–protoporphyrin complex at the enterocyte brush border. After the digestion iron enters a common intracellular pool from which depending on the iron status of individuals it is either stored as ferritin in the enterocyte or exported from the enterocyte via the ferroportin transporter on the basal side of the cell.

13. Sideropenic syndrome (early stages of iron deficiency usually show no clinical manifestations, but with complete depletion of iron stores, anemia develops and clinical symptoms appear) “ Picophagia “(which are unusual cravings for nonfood items, such as ice, dirt, paint, or starch) Sore or smooth tongue Brittle, cracked nails or hair loss Cracks at the sides of the mouth

14. Therapy Once the cause of the anemia has been established, the principles of treatment are to treat the underlying disorder, administer iron, and observe the response. Continue iron therapy an additional 4 to 6 months (adults) after the hemoglobin normalizes to replenish the iron stores.  Iron deficiency anemia is treated with oral or parenteral iron preparation. Oral iron corrects the anemia just as rapidly and completely as parenteral iron in most cases if iron absorption from the GIT is normal. Common adverse effects of oral iron therapy: Nausea Epigastric discomfort Abdominal cramps Constipation or diarrhea Black stool

15. Parenteral iron therapy Iron dextran is a stable complex of ferric hydroxide and low-molecular-weight dextran containing 50 mg of elemental iron per milliliter of solution. It can be given deep IM or IV. adverse effects: light-headedness, fever, arthralgia, urticaria, bronchospasm…. Iron sucrose complex & iron sodium gluconate complex intravenous therapy may be substituted when there is: inadequate iron absorption, continued uncorrectable blood loss, noncompliance or intolerance to oral iron therapy, non-adherence, or a hemoglobin level less than 6 g per dL with signs of poor perfusion in patients who would otherwise receive transfusion (e.g., those who have religious objections).