1. This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.

4. Anemia is a condition in which your blood has a lower than normal level of red blood cells or the red blood cells do not have enough hemoglobin.. Male: 4.7 to 6.1 million cells per microliter (cells/mcL) Female: 4.2 to 5.4 million cells/mcL

5. Type of Depend on reticulocyte index Depend on reticulocyte index 1_If (>2% ) there is RBC destruction or loss. 2_ if (<2%) there is inadequate RBC production by bone marrow. RI=RC*Hct/N Hct

6. :If reticulocyte index (<2%) examine the smear and RBC indices A_ if microcytic (MCV<80): * iron deficiency anemia * Anemia of chronic disease * Thalassemia B_ if macrocytic (MCV>100): * Vit B12,folate def. * Liver disease b/c alter metabolism of plasma lipoprotein in to their Membrane ___ altering RBC shape. C_ if normocytic anemia : * Tumor *renal failure *anemia of chronic disease

7. If reticulocyte index (>2%): A_ acute blood loss B_ hemolysis

8. IRON DEFICIENCY ANEMIA MOST COMMON COUSE OF ANEMIA WORLD WIDE.

9. WHAT IS THE CAUSES A-Chronic blood lose : A-Chronic blood lose : Most common cause of IDA Menstrual bleeding,if not GI blood loss iron need B- Dietary deficiency /. iron need B- Dietary deficiency /

10. C- Inability to absorb iron C- Inability to absorb iron. The iron in your food is absorbed by the body in the small intestine. Diseases that affect your small intestine’s ability to absorb nutrients, such as Crohn’s disease or celiac disease

11. DIETARY DEFICINCY SEEN IN THESE AGE GROUP : INFANT INFANT : accurse if the diet is predominantly milk( in iron) human Children Children also have requirement for iron b/c accelerate growth. ADOLESCENT ADOLESCENT : b/c rapid growth +loss of menstrual blood (in women). PREGNANT WOMEN PREGNANT WOMEN : iron requirement.

12. Clinical features Pallor Fatigue,generalize weakness Dyspnea, Tachycardia, Lightheadedness tachycardia

13. pallor Anemia causes pale skin because the blood of an anemic person is deficient in oxygen. Oxygen binds to the Hemoglobin molecules in red blood cells, this is what turns blood red. dyspnea Red blood cells carry oxygen from your lungs to the tissues in your body. when you are anemic, your tissues don't get enough oxygen so your lungs try to breath in more oxygen to compensate tachycardia if you're anemic (low RBC count), then low or inadequate oxygen delivered to your tissues and organs, your hypoxic (lack of oxygen) tissues will send signals to your brain that it lacks oxygen and can't function properly. In response, your brain will stimulate your heart to pump faster (tachycardia) in order to compensate for the lack of oxygen

14. DIAGNOSIS 1-LABORATORY TEST A- serum ferritin B- transferrin level C- serum iron D- microcytic,hypochromic RBC on peripheral smear Normal Results Male: 12-300 ng/mL Female: 12-150 ng/mL

15. DIAGNOSIS 2- BONE MARROW BIOPSY: Indicated if laboratory evidence of iron deficiency is present &no source of blood loss is found. 3- STOOL TEST: If GI bleeding is suspect

16. Treatment 1- Oral iron replacement (ferrous sulfate) Given to menstruating women,pregnant,poor iron diet A-What side effects can this medication cause? 1-Constipation.. 2-stomach upset.

17. 2-PARENTERAL IRON REPLACEMENT: * IRON DEXRAN can be administered IV or IM. *it is given for pt with poor absorption, pt require more iron than oral therapy, pt who cannot tolerate oral ferrous sulfate.

18. 3-BLOOD TRANSFUSION 3-BLOOD TRANSFUSION: Is not recommended unless anemia is severe or pt. has cardiopulmonary dis

19. How can I increase the iron in my diet? Foods high in iron Liver Red meat Seafood Nuts Green leafy vegetables, such as spinach and broccoli Whole grains

21. Vitamin A Vitamin C Glycine Glycine is an amino acid found in a variety of foods, including beans, brown rice bran, eggs, fish, nuts, soy and whole grains Vitamin C works to enhance iron absorption by preventing the formation of insoluble and un-absorbable iron compounds and changing the chemical composition of iron from ferric to ferrous iron, which the body requires for absorption in the small intestine Vitamin A helps release iron stores within your body to make iron available,for your use and may aid in non-heme iron absorption (sweet potatoes, (carrots, broccoli

22. Food that decrease iron absorption Food that decrease iron absorption : Coffee and Tea Polyphenols: Calcium:

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