HYPOCHROMIC ANEMIA

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HYPOCHROMIC ANEMIA IRON METABOLISM
SAWITREE CHIAMPANICHAYAKUL DEPARTMENT OF CLINICAL
MICROSCOPY FACULTY OF ASSOCIATED MEDICAL SCIENCES
CHIANG MAI UNIVERSITY
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OBJECTIVE

• Iron metabolism
• Iron distribution transport
• Dietary iron
• Iron absorption
• Iron requirements
• Disorders of iron metabolism
• Hypochromic anemia

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IRON

• To accept donate electron (Fe2 Fe3)
• component of cytochromes, oxygen-binding
• molecules
• cell growth,proliferation, differentiation
• damage tissues
• H2O2 OH

Fe2 Fe3
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Iron Metabolism

• Iron distribution transport
• transferrin, transferrin receptor
• ferritin , hemosiderin (Fe3)
• myoglobin, iron-containing enzymes
• Dietary iron
• Iron absorption
• Iron requirements

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DAILY IRON CYCLE
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The distribution of body iron
Amount of iron Male Female
in average adult (g) (g) of
total Hb 2.4 1.7 65 ferritin
hemosiderin 1.0 0.3 30 Myoglobin 0.15 0.12 3
.5 Heme enzyme 0.02 0.15 0.5 Transferrin-bound
0.004 0.003 0.1 iron
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Iron Metabolism

• Iron distribution transport
• Dietary iron
• ferric hydroxides
• ferric-protein complexs
• heme-protein complexes
• Iron absorption
• Iron requirements

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GI Absorption of Iron
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INTRACELLULAR IRON TRANSPORT
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Iron Metabolism

• Iron distribution transport
• Dietary iron
• Iron absorption
• Iron requirements

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Estimated daily iron requirements, Units are
mg/day
Adult men 0.5-1 Postmenopausal
female 0.5-1 Menstruating female
1-2 Pregnant female 1.5-3 Children 1.1 Fe
male (age 12-15) 1.6-2.6
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DISORDERS OF IRON METABOLISM
Diseases of iron deficiency 1. Iron-deficiency
anemia (IDA) 2. Anemia of chronic disease
(ACD) Diseases of iron overload
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What is iron-deficiency anemia ?
It is the lack of iron in the blood, which is
necessary to make hemoglobin.
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Symptoms
Fatigue - Sometimes out of proportion to
anemia Atrophic glossitis Pica Koilonychia (Nail
spooning) Esophageal Web
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Causes of Iron Deficiency

• Chronic blood loss
• Uterine
• GI tract
• Increased demands
• Prematurity
• Growth
• Pregnancy
• Malabsorption
• gastrectomy
• Poor diet

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Iron Deficiency Anemia (IDA)

• Most common cause of anemia
• Microcytic hypochromic anemia
• MCV, MCH, MCHC are reduced
• blood film small red cells (microcytic)
• pale red cells (hypochromic)

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Laboratory findings
1. Red cell indices blood film 2. Bone marrow
iron 3. Serum iron iron binding capacity 4.
Serum transferrin receptor (sTfR) 5. Serum
ferritin 6. Zinc protoporphyrin
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TIBC
Normal
Iron def.
ACD
Iron overload
Serum iron iron binding capacity
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Anemia of Chronic Diseases (ACD)

• Chronic inflammatory diseases
• Infections
• Non-infectious
• Malignant diseases

• release of iron from macrophage to plasma
• red cell life span
• response to EPO
• release IL-1 TNF

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Iron Overload

• Increased iron absorption
• Increased iron uptake
• Repeated red cell transfusions

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HYPOCHROMIC ANEMIAS

• Iron-deficiency anemia (IDA)
• Anemia of chronic disease (ACD)
• Sideroblastic anemia
• Thalassemia
• Lead poisoning

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The Cause of Hypochromic Anemia
Iron
Protoporphyrin

• Iron deficiency
• Chronic inflammation or malignant

• Sideroblastic anemia

Heme
Globin

• Thalassemia

Hemoglobin
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Sideroblastic Anemia

• A defect in heme synthesis
• Hereditary Acquired
• mitochondrial defects
• pyridoxal-6-phosphate
• mutation in the d-aminolevulinic acid synthase
• (ring sideroblasts in BM)
• myelodysplasia syndrome
• Hypochromic microcytic red cells

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Lead Poisoning

• Inhibits both heme globin synthesis
• Interferes with the breakdown of RNA by
  inhibiting pyrimidine 5nucleotidase
• accumulation of denatured RNA in red cells
• (basophilic stippling)
• Hypochromic anemia
• Ring sideroblasts (BM)
• Free erythrocyte protoporphyrin is raised

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Differential diagnosis of hypochromic anemia
IDA ACD Thalassemia
Siderblastic anemia Serum iron
N TIBC N N serum
ferritin N/ N BM iron stores
- Erythroblast iron
- - ring forms Hb N
N HbA2 N electrophoresis
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References
1. Hoffbrand AV, Pettit JE, Moss PAH. Essential
Haematology, 4th Ed. Blackwell Scientific
Publication, Oxford, 2001. 2. Turgeon ML.
Clinical Hematology (theory and Procedures), 3rd
Ed, Lippincott Williams Wilkins, Philadephia,
1999.
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The End