Iron Deficiency Anemia

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Iron Deficiency Anemia

• Dr.Tanyarat Jomgeow

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Causes of iron deficiency ???
Increases demands pregnancy, menstruation,
child growth Malnutrition poor
diet Malabsorption enteropathies,
gastrectomy Blood loss chronic blood loss in
GI, uterine
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Anemia
Type of anemia RBC morphology Normocytic M
icrocytic Macrocytic
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Why small sized RBC ???
Hemoglobin
Thalassemia
Heam
Globin
Iron
Iron deficiency Chronic diseases
Sideroblastic anemia
Protoporphyrin
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Daily loss 1mg
Daily iron cycle
Daily absorption 1 mg
Liver, cells and tissues, muscle myoglobin
Deliver iron via transferin receptor
Transferrin
Plasma
Macrophages
Bone marrow pronormoblasts
RBC in circulation
Iron store in RE system as ferritin and
hemosiderin
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Stage 1 iron still sufficient for erythropoiesis
Stage 2 erythropoiesis is reduced
Stage 3 Manifest iron deficiency erythropoiesis
is reduced
Three stage of iron deficiency
Hb, Hct, RBC morphology and indices
Hb, Hct, MCV, MCH, MCHC are decreased
progressively anemia
Hb, Hct, MCV, MCH, MCHC are normal or decreased
Hb, Hct, MCV, MCH, MCHC are normal
Iron stores
reduced
depleted
depleted
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Laboratory

• Laboratory findings
• Laboratory diagnosis

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Laboratory findings

• CBC WBC and differential cell count normal or
• variable depend on patient condition,
• Hb, Hct
• RBC morphology gt hypochromic microcytic cells
• with occasional poikilocytes
• platelet gt adequate or depend on patient
  condition
• 2. RBC indices gt MCV, MCH, MCHC
• 3. Reticulocyte count gt low related to degree of
  anemia
• 4. Serum iron (SI) , Total iron binding
  capacity (TIBC)
• 5. Serum ferritin
• 6. Serum transferrin receptor (sTfR)
• 7. Transferrin saturation

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Laboratory diagnosis
Suspicious
Hypochromic microcytic anemia
Low Si and ferritin Raised TIBC and sTfR
Lab. diagnosis
Investigation of cause

• 1. For female
• Menorrhagia
• Pregnancy

• 2. For male or
• female (1. not found)
• GI bleeding
• Stool occult blood test
• GI endoscopy
• Investigation of other causes

Treat cause and iron uptake
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Lab. Parameter
Iron deficiency
Chronic diseases
Thalassemia
Sideroblastic anemia
Low in congenital type MCV raised in acquired type
Reduced very low for degree of anemia
MCV MCH MCHC
Reduced in related to severity of anemia
Normal or mild reduction
Serum iron
Reduced
Reduced
Normal
Raised
TIBC
Raised
Reduced
Normal
Normal
sTfR
Raised
Normal/low
variable
Normal
Serum ferritin
Reduced
Normal/ Raised
Normal
Raised