Tabuk University Faculty of Applied Medical Sciences Department Of Medical Lab. Technology 2 nd Year – Level 4 – AY Mr. Waggas Elaas, M.Sc, MLT

 To know about dietary iron, absorption, requirements & body distribution and transport.  To define iron deficiency anemia and its clinical presentation.  To know lab. Findings and diagnosis of IDA. Objectives 2

 Iron deficiency is defined as a decreased total iron body content.  Iron deficiency anemia occurs when iron deficiency is sufficiently severe to diminish erythropoiesis and cause the development of anemia.  500 million people around the world are affected.  So it is the most common cause of anaemia in every country around the world, and it is the most important cause of microcytic hypochromic anaemia  **(Other causes?) 3

 Iron in the body is about g.  Iron in the Haemoglobin of the RBCs represents a greatest percent of body constitutes (60-70%). hemosiderin ferritin  Iron is also stored in RE cells (BM, Spleen and liver) as hemosiderin and ferritin.  Also iron found in myglobin and myeloperoxidase *So, Iron presents in the body in two forms:  Ferritin.  Haemosiderin. Nutritional and metabolic aspects of the iron: 4

soluble and non-toxic form.  Ferritin is a globular protein complex and is the primary intracellular iron-storage protein keeping iron in a soluble and non-toxic form.  Found in the liver, plasma, and placenta.  It is a protein and iron compound.  It is Non-stainable and can be measured by Radio Immuno Assay (RIA).  Males have higher values than females (100 ng/ml for male and 30 ng/ml for female). Ferritin: 5

insoluble  It is insoluble iron form. complex of ferritin  is an intracellular iron-storage complex. It appears to be a complex of ferritin.  The iron within deposits of hemosiderin is very poorly available to supply iron when needed.  Found in liver, spleen and bone marrow.  Hemosiderin is most commonly found in macrophages.  It is stainable with haematoxylin and eosin. Hemosiderin: 6

 Is the plasma protein responsible for carrying the iron.  It is produced in the liver.  1 molecule of transferrin binds two atoms of iron.  Total iron binding capacity of transferrin is 250–370 μg/dL. Transferrin: 7

 Measures the blood's capacity to bind iron with transferrin.  It measures the maximum amount of iron Transferrin can carry, which indirectly measures transferrin, since transferrin is the most dynamic carrier.  TIBC is less expensive than a direct measurement of transferrin. Total iron-binding capacity (TIBC) 8

 Iron presents in meat, liver, (best sources) vegetables, and eggs.  The daily diet consumption of iron is mg.  Body absorb only 5-10 % of iron taken, but the proportion can be increased to % in iron deficiency and pregnancy.  Iron in food is present as : ferric hydroxide, ferric protien, haem protien complexes.  Absorption as ferrous form in duodenum. Dietary iron: 9

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Reducing absorptionFavoring absorption Inorganic ironHaem Ferric formsFerrous forms Alkalis(antacids, pancreatic secretions) Acids (Hcl, vit.C) Precipitating agents (phytates, phosphates) Solubilizing agents (sugars, amino acids) Iron overloadIron deficiency InfectionPregnancy TeaIneffective erythropoiesis Factors affecting iron absorption 12

 Is a liver protein considered to be the main regulator of iron metabolism.  The synthesis of hepcidin is stimulated by inflammation or by iron overload.  Hepcidin prevent the absorption of iron from the digestive tract and also inhibit the release of stored iron from macrophages and hepatocytes. Hepcidin 13

 Chronic blood loss, especially of G.I.T  Increased demands, during pregnancy, infancy, growth, lactation and menstruated women.  Malabsorption especially in the cases of gastroectomy,peptic ulcer, aspirin ingestion, carcinoma, hookworm.  Poor diet. Causes of iron deficiency anaemia: 14

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 When ID is developing, the RE stores (hemosiderin and ferritin) become completely depleted before anemia occurs.  At an early stage, no clinical abnormalities.  Later, patient may develops general symptoms and signs of anemia.  Spoon or ridged nails in severe case of IDA.  Dysphagia.  Pica : May be found, especially in pregnant women : a pattern of eating non-food materials, such as clay, chalk, paper, dirt or sand. Clinical features: 16

Spoon –shaped nails (Koilonychia ) 17

1.Low Hb, MCV, MCH, MCHC 2.Low Reticulocyte count 3.Platelets count moderately increased. 4.Blood film : microcytic hypochromic red cells, Target cells, Pencil shape cells 5.Serum iron : decreased. 6.TIBC : increased. 7.Serum ferritin : decreased. MCV : Mean Cell Volume MCH : Mean Cell Hemoglobin MCHC : Mean Cell Hemoglobin Concentration Lab. Findings & diagnosis 18

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Normal red blood cells : central pallor =1/3 of cell size 20

Iron deficiency Normal B.M 8. Bone marrow iron stores: absent 21

1. A 35 year old pregnant woman is seen for easy fatigue for many months. Physical examination is positive for pale conjunctiva, mild spooning of nails. Her Hb is 7.1 gm/dl. A. What is the most likely diagnosis for this case? B. What would you expect her PCV to be? 2. Which of the following normally contains >10% of body iron?  Transferrin  Heart  Neutrophils  Macrophages 3. All can cause Iron deficiency anemia EXCEPT:  Menorrhagia  bleeding from GIT  Pregnancy.  Transcoblamin 1 deficiency 4. With an iron deficiency anaemia:  Both serum iron and total iron binding capacity are reduced  The blood film shows a hyperchromic microcytic picture  The reticulocyte count is low in relation to the degree of anaemia  Serum ferritin levels are increased  The platelet count may be increased Homework-3 22