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
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
- indication
- 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