HYPOCHROMIC ANEMIA & IRON METABOLISM. OBJECTIVE Iron metabolism Iron distribution & transport Dietary iron Iron absorption Iron requirements Disorders

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

  • To accept & donate electron (Fe2+ Fe3+) component of cytochromes, oxygen-binding molecules cell growth,proliferation, differentiation damage tissues H2O2 OHFe2+ Fe3+

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

  • Amount of iron Male Female %in average adult (g)(g) of total

    Hb2.41.765ferritin & hemosiderin 1.00.330Myoglobin0.150.123.5Heme enzyme0.020.150.5Transferrin-bound0.0040.0030.1ironThe distribution of body iron

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

  • GI Absorption of Iron


  • Iron distribution & transport Dietary iron Iron absorption Iron requirements

  • Adult men0.5-1Postmenopausal female 0.5-1Menstruating female 1-2Pregnant female1.5-3Children1.1Female (age 12-15) 1.6-2.6Estimated daily iron requirements, Units are mg/day

  • Diseases of iron deficiency1. Iron-deficiency anemia (IDA)2. Anemia of chronic disease (ACD)Diseases of iron overload

  • What is iron-deficiency anemia ?It is the lack of iron in the blood, which is necessary to make hemoglobin.

  • SymptomsFatigue - Sometimes out of proportion to anemiaAtrophic glossitisPicaKoilonychia (Nail spooning)Esophageal Web

  • Causes of Iron DeficiencyChronic blood lossUterineGI tractIncreased demandsPrematurityGrowthPregnancyMalabsorptiongastrectomyPoor diet

  • Iron Deficiency Anemia (IDA)Most common cause of anemiaMicrocytic hypochromic anemiaMCV, MCH, MCHC are reducedblood film: small red cells (microcytic): pale red cells (hypochromic)

  • Laboratory findings1. Red cell indices & blood film2. Bone marrow iron3. Serum iron & iron binding capacity4. Serum transferrin receptor (sTfR)5. Serum ferritin6. Zinc protoporphyrin

  • NormalIron def.ACDIron overloadTIBCSerum iron & iron binding capacity

  • 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

  • Increased iron absorption Increased iron uptake Repeated red cell transfusions

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

  • IronProtoporphyrinHemeGlobin+Hemoglobin Iron deficiency Chronic inflammation or malignant Thalassemia Sideroblastic anemiaThe Cause of Hypochromic 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

  • 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

  • Differential diagnosis of hypochromic anemia IDA ACD Thalassemia Siderblastic anemiaSerum iron NTIBC N Nserum ferritin N/ NBM iron stores - + + +Erythroblast iron - - +ring formsHb N N HbA2 Nelectrophoresis

  • HemochromatosisA genetically determined form of iron overload that results in progressive hepatic, pancreatic, cardiac, and other organ damage

  • HemochromatosisIt is one of the most common genetic disorders in the U.S.Present in heterozygous (one gene) form in 12% of nonblacks and 30% of blacksPresent in homozygous form (2 gene) in 1 in 200 nonblacks and 1 in 100 blacksHomozygotes will die of iron overload unless they give blood frequentlyHomozygotes absorb three times more iron from food than other peopleEven heterozygotes may be at risk for iron overload, increasing risk of heart disease

  • Hemochromatosis: Risk FactorsHigher risk in people of northern European descentMen tend to manifest symptoms earlier because they have no way to dispose of excess iron (menstruation, pregnancy, lactation)Men may develop symptoms in their 30s but may not be diagnosed until their 50sWomen often develop symptoms after menopause

  • Hemochromatosis: SymptomsJoint painFatigueLack of energyAbdominal painLoss of sex driveHeart problemsAbnormal pigmentation of the skin, making it look gray or bronze

  • Hemochromatosis: if untreated, may result in ArthritisLiver disease: cirrhosis, cancer, liver failureDamage to the pancreas, leading to diabetesHeart abnormalities, including arrhythmias and heart failureImpotence or early menopauseThyroid or adrenal problems

  • Hemochromatosis: Diagnosis and TreatmentTesting: serum ferritin and transferrin saturation can reveal excess stores of iron; followed by HFE (genetic) test and possible liver biopsyTreatment: regular phlebotomy to remove excess ironAvoidance of iron supplements and sources of iron in the diet, especially heme ironAwareness of iron cooking vessels