Hypochromic anemias -Iron Deficiency Anemia its causes ,sings, treatment

Hypochromic anemias

Iron Deficiency Anemia:

•                

                                                                                                                                                                 Definition :

Anemia due to inadequate supply of iron to support optimal erythropiesis

    

Character :

 

Microcytic hypochromic .

Reduction in plasma iron and transfusion .

Reduction in ferritin saturation

Depletion of bone marrow and other body iron stores

Iron  metabolism:  

Iron is essential to human life because of it’s central role in heme molecule  

- It is distributed in two compartments:

  Essential (function ) , HB , myoglobin and enzymes.

Non essential (storage) providing reserve iron for time of need.

     

                       Total body iron from 2-6 gm.

80% functional form and 20% storage form.

50 mg/ kg (men)

40 mg/kg  (women)

 - Iron is stored as ferritin and hemosiderin.

         - Maximal absorption of iron occurs       throughout the duodenum and upper part of jejunum .

         - Absorbed iron is transported via intestinal capillaries with little lymphatics with no enterohepatic circulation .

It’s absorption is increased in

 

 Iron deficiency states

Hemolytic anemia

Hypoxia

Hemochromatosis
Cirrhosis and portocaval shunt

^3rd trimester of pregnancy

It’s absorption is decreased in :-

Patients with iron overload .

Malabsorption states.

Malignancy and infection .

Inflammatory disease .

Total daily excretion in males postmenopausal females 1 m / day .

Excretion is increased in menstruating females , during pregnancy and after delivery .

Iron Requirements: 

In addition to exceptional stress in menstruation , pregnancy and lactation , iron is needed for different physiologic processes by 0.5 mg/day and it is also needed for growth in infancy and adolescence.

  

*Pathogenesis

Iron deficiency anemia occurs either due to inadequate intake or due to high output.

Clinical manifestation: 

Symptoms:

Vague symptoms

Signs:

        Pallor .

         Nail changes.

        . Cardiac dilatation and congestive cardiac              failure (especially in elderly)

       Hemmic murmers heard over heart .

        Menstrual irregularities .

        Numbness and tingling sensation .

      In infants : irritability and difficulties in feeding

*Investigations  

Blood film :

Small erythrocytes (microcytic ) poorly filled with HB (hypochromic) with marked variation in sizes (anisocytosis ) and shape ( poikilocytosis)
Blood indices:

                          MCV < 80 fl .

                          MCHC < 30 gm/dl.

 ug /dl . Plasma iron concentration < 60

                           TIBC  > 350 u/dl.

% .Transferrin saturation  15

Treatment:

Oral  simple ferrous salts (sulfate ,gluconate or fumarate )

Ascorbic acid may be added to increase iron absorption.

Side effects :

Nausea , epigastric pain , abdominal cramps , diarrhea or constipation and vomiting .

Parentral :

Preparation : Iron dextran ( Imferon)

Indication for parentral iron :  

   1-Chronic uncorrectable bleeding

    2- Patients who is unable to take iron     

     3-Unreliable patients

     Patients with malabsorption syndrome 4-

  

Side effects :  

Headache , fever , urticaria , local pain  , arthralgia , dizziness , hypotension and rarely anaphylactic reaction which may be fatal.