What You Should Know About Iron Deficiency Anemia (IDA) - hsmedlife


Inadequate iron for the synthesis of hemoglobin inside the red blood cells can lead to impaired red blood cells production. Iron is the most common nutritional deficiency globally that can lead to abnormal clinical signs and symptoms along with or without microcytic hypochromic anemia.   

Causes for iron deficiency anemia

 
1.Hemorrhage/blood loss.
 

This can lead to loss of red blood cells by which substantial iron loss can occur, from the circulation. For instances of these hemorrhages, gastrointestinal bleeding, heavy menstrual bleeding and some

parasitic conditions etc can be mentioned.

 
2.Increased the iron demand with specific physiological conditions
 

Iron demand is increased at rapid growing of the body and during pregnancy.

 
3.Decreased absorption
 

Decrease acidity of the stomach(gastrectomy antacid), coffee, and calcium ions can be lead to

decrease ion absorption. Ferric irons should be converted into ferrous to absorption.

Since proximal small intestine, Any mucosal structural or functional changes of that part lead to

iron malabsorption.

 
4.Inadequate intake of irons.
 

Especially in vegetarians and in vegans, people more prone to get iron deficiency, and also Poor

socioeconomic status with lack of availability of iron-containing foods can be a cause.

5.Defective in the iron metabolism.
 

Hepcidin is a synthesis in the liver that maintains the release of iron into blood circulation. If any

problem with hepcidin can be lead to depleted iron in circulation.

Pathogenesis of iron deficiency anemia

 

The average intake of iron should be at male; 8mg-10mg and female;14mg-16mg in normal healthy individuals. In pregnancy and growth spurt amount of iron that should consume will increase(about 1mg-2mg/day).

When iron demand is not meet the intake of iron, that lead to iron deficiency OR imbalance between iron loss and intake.

 

Iron deficiency can be due to

1)Inadequate iron intake.

Primarily seen in vegetarian or vegan people.

 
2)Hemorrhage. (bleeding manifestation)

Chronic blood loss is the most commonest cause in the world of IDA; peptic ulcer disease, hemorrhoids, Colon carcinoma, menorrhagia, metrorrhagia

3)Increased demand due to some physiological conditions.

Pregnancy mothers, infants, and adolescence have high iron demand due to rapid physiological

changes in their bodies.

 
4)Decrease absorption
Absorption of iron can be altered due to,

-Ionized state of the iron. (ferrous is more absorbable than ferric)

  acidic nature of the stomach.

-Formation of insoluble complexes.

-Pathological conditions in mucosa of the proximal small interstine.

-Coffee and tea diminished iron absorption.

   

Significants outcome of the iron deficiency.

-Abnormal structural changes in early normoblasts.
-It diminished red cell production.
-Interfere red cell production in throughout pathway that causing anemia.
-Effect on reduction of protoporphyrin level.
-Significant memory and cognitive impairment.
 

Clinical outcome with symptoms and sign of iron deficiency anaemia

-Fatigue
-Pallor
-Refuse cognitive function and memory
-Dysphagia
-Koilonychia (Spoon shape nails)
-Brittle nails
-Infertility
-Loss of hair
-Pica syndrome (neurobehavioral complication)
-Angular stomatitis
 

How to diagnose iron-deficiency anaemia

-Detailed history with relevant aspects of the iron-deficiency anaemia

Ex: diet, menstrual history, bleeding manifestation

-Examination finding

Ex: pallor, brittle nails, pica, mucosal atrophy..etc.

 
-Investigation
  • Full blood count;

Low hemoglobin than normal (male 12-13mg/dl and female 11-13)

Low pack cell volume (PCV) than normal(45%)

Mean corpuscle volume (MCV) less than 80 fL(microcytic)

Reduce mean corpuscle hemoglobin (MCH) to less than 27pg.

  • Blood picture;

Target cells

Pencil cells

Poikilocytosis (various in shape)

Anisocytosis (various in size)

  • Red cell distribution width (RDW)
  • RDW is increased in iron deficiency anemia
  • Red cell histogram (RCH)

RCH is shifted to the left side can be seen in iron deficiency anemia.

  • Reticulocyte count and reticulocyte hemoglobin

Reticulocyte count is less than normal level(normal level: 1-2%)

Reticulocyte hemoglobin is less than 29 pg.

 
  • Iron studies

Low serum ferritin

Low serum iron

High serum transferrin

Low saturation of serum iron

High total iron-binding capacity (TIBC)

High Serum soluble transferrin receptors ( S Tf R)

  • Hepcidin level

Hepcidin level is very low or undetectable in iron deficiency anemia.

   

Management of iron deficiency anemia

  • For children;

Oral iron liquid (3-6mg/kg/day) for 3-6 months duration according to severity.

Optimization of foods with iron.

  • For adults;

Oral iron therapy 100-200mg/day for 6 to 8 months duration.

Parental iron preparation. (ferrous sulfate)

Optimization diet with irons. (fortification of food)

Correct underlying condition.

Early treatment is very important with effective iron therapy and correct underlying pathological conditions.

Blood transfusion is needed if hemoglobin is less than 4g/dl or with cardiac or respiratory problems.

Also, patients should be advised to take iron-rich food

Ex: meat, bread, flour,potatoes and vegetable

 

Monitoring of the iron therapy with Tests

The Ideal test is reticulocyte hemoglobin concentration, and also, reticulocyte count is reliable
for the asses.
 
Full blood count (Hb, PCV, MCV, MCH, MCHC) can be done after three months of treatment.
 
Red cell distribution width (RDW).
 
Red cell histogram.
  The iron study also helpful but not essential.   Most of the time, parental preparations are preferred for patients who have failed oral iron therapy due to continuing bleeding, lack of compliance. Oral therapy should be stopped when parental therapy starting.  

Popular posts from this blog

How To Manage Depression Without Medication

Image
  It is easy to understand: the management of depression is often medication. However, there are other ways to beat depression without drugs and avoid falling into the downward spiral of psychotropic drugs. Depression affects more than 350 million people, or nearly 5% of the world's population. In France, the drug route is often the only one offered to people suffering from depression. However, there are many ways to combat this condition without psychotropic drugs.   Eat well There is no doubt that there is a link between diet and depression. Indeed, many studies have proven the correlation between food and mood. Thus, the consumption of omega 3 (fish such as salmon and tuna, but also nuts such as almonds and rapeseed oil) and vitamin B (green vegetables such as spinach, broccoli, orange, rice, or beef liver) promotes brain function and prevents certain mental disorders. Along with other care, a good diet can help you feel better.   Exposing yourself to light...
Read more

Acute Wound Management - hsmedlife

Image
  From the Latin word plaga, the wound is a skin lesion that manifests itself by an opening in the skin. It can be the consequence of a trauma, minor or severe, or of a pathological process.    There are two categories of wounds   Acute wounds. They can be defined as sores of sudden onset and of short duration. They include burns, post-operative wounds   linked to a surgical intervention. Or traumatic wounds following an accident, such as cuts, lacerations, but also bites / scratches, frostbite and insect bites. For acute wounds, the physiological healing process lasts between 2 and 4 weeks.    Chronic wounds They include leg ulcers, diabetic foot ulcers or bedsores. Their chronic nature is explained by the presence of an associated pathology which is at the origin and which slows down the healing process. This then requires medical treatment of the cause and the wound. Venous and / or arterial insufficiency, diabetes, prolonged immobility asso...
Read more