Iron Deficiency Anemia

3r4t- 30-50% prevalence

• <10% of dietary iron is absorbed

Causes of Iron deficieny

DNB 2005, 2013

Enlist the causes of iron deficiency Anemia (3)

• Anemia of prematurity
• top feeding (cow’s milk)
• undernutrition
• blood loss (ulcer, hemangioma, divverticulums)
• parasite infestation
• H.pylori infection
• menstruration

Clinical features

DNB 2013

Clinical features and approach to nutritional amemia

• Asymptomatic
• Pallor - hb falls to 7-8 g/dl
  • in palprabral conjunctiva
  • in nail beds
  • tongue
  • palmar creases
• cold intolerance
• fatigue
• exercise induced dyspnea
• decreased concentrationn
• irritability
• anorexia
• flow murmur ⇒ congestive cardiac failure
• seizure
• stroke
• breath holding spells
• pica
• pagophagy

clinical progression

DNB 2013

sequential pathogenical changes associated with iron deficiency states

• in the initial stages of negative iron balance, reserves in the form of ferritin and hemosiderin may maintain normal Hb and Hct levels
• further fall in iron causes decrease in serum iron and transferrin saturationn without causing anemia
• initially there will be erythroid hyperplasia
• anemia occur only when iron stores are completely depleted and is accompanied with lowerr than normal iron, ferritin and transferrin saturation levels

metabolism of iron in human body

DNB 2022/1

Describe the iron metabolism in the human body

normal Hb values

<img src=https://i.ibb.co/tphBPvzp/image.png>

Diagnosis of IDA

DNB 2022

laboratory evaluation in the diagnosis of IDA

DNB 2024

role of redcell indices in the diagnosis of IDA

• Hb < 11
• MCV < 70 - late indicator
• S. ferritin <12 in less than 5 year, <15 in more than 5 year
• reticulocyte <27.5 in child, <28 in adult
• soluble transferrin receptor - increased
• tranferrin saturation <16%
• erythrocyte zinc porphyrin <5 year >70, >5 year >80
• hepacin <10 ng/ml

difference between other type of anemias

DNB 2013

What laboratory studies can be used to differentiate between different type of microcytic anemias

menzter index

• menzter index = MCV/ RBC
  • if >13 - IDA
  • if <13 - Thalassemia

Prevention of anemia

DNB 2018, DNB 1998

Prevention of iron deficiency anaemia in children

• encourage breast feeding atleast till 6 months of age
• avoid cow’s milk till 1 year (limit to 700 ml/day)
• routine screening at 9-12 months (AAP)
• milking of cord in neonate
• delayed cord clamping
• iron supplementation to preterm newborn

Treatment

DNB 2023/2, 1998/2

Treatment of iron deficiency anaemia in children

• oral
  • ferrous sulfate
  • 3-6 mg/kg/day
  • max daily dose 200 mg/day
  • inhibitor of absorption - calcium, fibre, oxalic acid, phytic acid
  • enhancers of absorption - vitamin C
• Paraenteral iron
  • indication
    • poor compliance to oral drug
    • malabsorption
  • LMW IRON Dextran - only FDA approved
• iron overdose can cause hemosiderosis / yersenia infection

Follow up

• repeat Hb after 1 month

causes of non repsonse

• poor complicance
• incorrect dosing
• malabsorption
• concurrent PPI, antacid, tannins
• blood loss
• lead poisoning
• co existing infection
• other anemia

Response to iron

• continue for 8-10 weeks after Hb normalisation

Time after iron administration	Response
12-24 hours	decreased irritablity, increased appetide
24-48 hours	erythroid hyperplasia
48-72 hours	reticulocytosis
4-30 days	increase in Hb
1-3 months	repletion of iron stores

IRIDA

• Iron resistant Iron deficiency Anemia
• AR disease
• mutation of TMPRSS 6 gene
• dysregualtion in hecidin
• onset - early saturation
• Labs - MCV - 45 to 60, transferrin saturation <5 %
• Management - paraenteral iron preparation