paedia ironpediaticspresentationgmc222.pptx

Iron

1. Content : Introduction source RDA ( Recommended Dietary Allowance) Metabolism Function Disorder

2. IRON Iron is one of the most essential trace element . Total body iron content is 3 to 5 gm 75% present in blood , the rest is in liver , bone marrow & muscles . Iron is present in almost all cells . Heme is the most predominant iron containing substances . It is a constituent of protein / enzymes .

3. SOURCES OF IRON HEME IRON Liver Meat Poultry Fish NON HEME IRON Leafy Vegetables Legumes Beans Cereals Milk

4. IRON RDA Paediatrics Infant (7-12 months) – 11mg / day Toddlers (1-3years) – 7mg / day Kids (4-8years) – 10mg / day Child (9-13years) – 8mg / day Adult : 10-20mg / day Pregnancy : 40mg/day

5. IRON METABOLISM Absorption ⬇ Transport ⬇ Storage ⬇ Excretion

6. IRON ABSORPTION SITE (small intestine ) ⬇ Forms ( Heme & Non heme ) ⬇ Efficiency (About 10% of total food iron is absorbed)

7. Iron in food ⬇ (if the body doesn’t need iron) Mucosal cells in the intestine , Iron is not absorbed & is store excess iron in mucosal ➡ excreted in shed intestinal Ferritin (a storage protein) instead . Thus , iron ⬇ if the body needs iron absorption is reduced when Mucosal Ferritin releases the body doesn’t need iron to mucosal Transferrin iron . (a transport protein ) , which hands off iron to another Transferrin that travels through the blood to the rest of the body .

8. FACTORS AFFECTING ABSORPTION Factors increasing iron absorption : Ferrous form Ascorbic form Erythropoisis Hemochromatosis Factors decreasing iron absorption: Oxalate and phosphate Antacid Gastrointestinal disease

9. MECHANISM OF IRON ABSORPTION

10. STORAGE OF IRON STORAGE FORM : Heme Ferritin Hemosederin STORAGE SITE : Liver Intestine Spleen Bone Marrow

11. EXCRETION Iron excreted in the feces is mainly exogenous i.e. dietary iron that has not been absorbed. In females there are additional sources of loss , due to menstruation and pregnancy . Urine contains negligible amount of iron .

12. IRON FUNCTION Oxygen carriers - hemoglobin Oxygen storage - myoglobin Energy production - Cytochromes ( oxydative phosphorylation ) - Krebs cycle enzyme Others - Liver detoxification

13. FUNCTION OF IRON Iron is requird for synthesis of heme and non heme compound . HEME : - Hemoglobin - Myoglobin - Cytochromes - Catalase NON HEME : - Succinate dehydrogenase - Xanthine Oxdase - Iron Sulfur proteins

14. DISORDER OF IRON METABOLISM Iron Excess Iron Deficiency

15. IRON DEFICIENCY ANEMIA An anemia with increased cell production and an MCV <80fl characterized by hypochromic cells and low levels of iron stored in the body . Causes Features Lab Findings Treatment

16. IDA : Causes Deficient intake - lower intake of iron rich food - cow milk feeding Impaired absorption - gastric surgery - celiac disease Excessive loss - hookworm infestation - GI losses : peptic ulcer , carcinoma , polyp Increase Demand - growth spurt (infancy , puberty)

17. IDA : Features SYMPTOMS: Pallor Fatigue Palpiations Dizziness Irritability SIGNS: Angular Stomatitis Pica brittle nail koilonychia

18. IDA : Lab Findings Hematological Findings : CBC – decreased RBC , low MCV , low MCHC , elevated RDW PBS - Hypochromic microcytic anemia Biochemical Findings : - decreased transferrin saturation - elevated serum total iron binding capacity - decreased plasma ferritin and serum iron

19. IDA : Treatment Treatment of underlying causes - deworming against hookworm infestation - dietary counselling Oral Iron Therapy - 3-6mg/kg/day of elemental iron ; ferrous sulfate - Iron therapy increases reticulocyte count within 72-96hour . After correction of anemia , oral iron should be continued for 4-6month. Parenteral iron therapy - indicated for intolerance to oral iron malabsorption & high rate of ongoing blood loss . - IV iron sucrose 1-3mg /kg diluted in 150ml NS slow infusion over 30-90min.

20. Blood transfusion - In emergency situation such as urgent surgery , acute severe anemia with congestive cardiac failure , prior to invasive procedure .

21. IRON OVERLOAD HEMOSIDEROSIS - Increase in iron stores as hemosiderin - Without associated with tissue injury HEMOCHROMATOSIS - Excessive deposition of iron in tissue -Associated with tissue injury