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IRON DEFICIENCY ANEMIA презентация, доклад

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PLAN Definition of anemiaBlood parameters ``erythrocytes parameters``Iron metabolism and iron deficiency anemiaCharacteristic symptoms of iron deficiency anemiaBlood and bone marrow smearIron deficiency anemia cure, management of anemiaUsed references

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Слайд 1IRON DEFICIENCY ANEMIA
Done by: Islamova Sh.
Group: 646 P.
Checked by: Seyitkaliev

Zh. B.

IRON DEFICIENCY ANEMIA           Done by: Islamova Sh.Group:

Слайд 2PLAN
Definition of anemia
Blood parameters ``erythrocytes parameters``
Iron metabolism and iron deficiency

anemia
Characteristic symptoms of iron deficiency anemia
Blood and bone marrow smear
Iron

deficiency anemia cure, management of anemia
Used references

PLAN	Definition of anemiaBlood parameters ``erythrocytes parameters``Iron metabolism and iron deficiency anemiaCharacteristic symptoms of iron deficiency anemiaBlood and

Слайд 3ANEMIA - DEFINITION
REDUCTION OF HEMOGLOBIN CONCENTRATION BELOW REFERENCE VALUE

ANEMIA - DEFINITION	REDUCTION OF HEMOGLOBIN CONCENTRATION BELOW REFERENCE VALUE

Слайд 4BLOOD PARAMETERS
Hemoglobin concentration (Hg)
F: 7,2 –10; M: 7,8-11,3 mmol Fe/l

(12-18 g/dl)
Erythrocytes count (RBC)
F: 4-5,5; M: 4,5-6 x1012/l (4-6

x106 /l)
Hematocrit (Hct)
F: 37-47; M: 40-54; (37-54%)
Platelet count (Plt)
150 – 450 x 103/l (150-450 x 109/l)
Leukocytes count (WBC)
4-10 x 109/l (4-10 x 103/ l)

BLOOD PARAMETERSHemoglobin concentration (Hg)F: 7,2 –10; M: 7,8-11,3 mmol Fe/l (12-18 g/dl)Erythrocytes count (RBC)F: 4-5,5; M: 4,5-6

Слайд 5Erythrocytes parameters
Mean corpuscular volume (MCV)
N: 80-100 fl
RDW(Red cell Distrubution Width)


Mean corpuscular hemoglobin (MCH)
N: 27-34 pg
Mean corpuscular hemoglobin concentration (MCHC)
N:

310 – 370 g/lRBC (31-37 g/dl)

Erythrocytes parametersMean corpuscular volume (MCV)N: 80-100 flRDW(Red cell Distrubution Width) Mean corpuscular hemoglobin (MCH)N: 27-34 pgMean corpuscular

Слайд 6Reticulocytes
RET: 0,5-2%
ARC (absolute reticulocyte count ):
25-75x 109/l
CRC

(corrected reticulocyte count)
RPI (reticulocyte production index)

ReticulocytesRET: 0,5-2%ARC (absolute reticulocyte count ):  25-75x 109/lCRC (corrected reticulocyte count) RPI (reticulocyte production index)

Слайд 7IRON METABOLISM
Iron concentration (Fe)
N: 50-150 g/dl
Total Iron Binding Capacity
N: 250-450

g/dl
Transferrin saturation
Transferrin receptor concentration
Ferritin concentration
N: 50-300 g/l

IRON METABOLISMIron concentration (Fe)N: 50-150 g/dlTotal Iron Binding CapacityN: 250-450 g/dlTransferrin saturationTransferrin receptor concentrationFerritin concentrationN: 50-300 g/l

Слайд 8IRON DEFICIENCY ANEMIA
IRON METABOLISM
ABSORPTION IN DUODENUM
TRANSFERRIN TRANSPORTS IRON TO THE

CELLS
FERRITIN AND HEMOSYDERIN STORE IRON
10% of daily iron is

absorbed

IRON DEFICIENCY ANEMIAIRON METABOLISMABSORPTION IN DUODENUMTRANSFERRIN TRANSPORTS IRON TO THE CELLSFERRITIN AND HEMOSYDERIN STORE IRON 10% of

Слайд 9Most body iron is present in hemoglobin in circulating red

cells
The macrophages of the reticuloendotelial system store iron released from

hemoglobin as ferritin and hemosiderin
Small loss of iron each day in urine, faeces, skin and nails and in menstruating females as blood (1-2 mg daily)
Most body iron is present in hemoglobin in circulating red cellsThe macrophages of the reticuloendotelial system store

Слайд 11IRON DEFICIENCY - STAGES
Prelatent
reduction in iron stores without reduced

serum iron levels
Hb (N), MCV (N), iron absorption (), transferin

saturation (N), serum ferritin (), marrow iron ()
Latent
iron stores are exhausted, but the blood hemoglobin level remains normal
Hb (N), MCV (N), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent)
Iron deficiency anemia
blood hemoglobin concentration falls below the lower limit of normal
Hb (), MCV (), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent)

IRON DEFICIENCY - STAGESPrelatent reduction in iron stores without reduced serum iron levelsHb (N), MCV (N), iron

Слайд 12Laboratory tests in iron deficiency of increasing severity

Laboratory tests in iron deficiency of increasing severity

Слайд 13IRON DEFICIENCY ANEMIA
ETIOLOGY:
BLOOD LOSS
Chronic bleeding


MENORRHAGIA
PEPTIC ULCER
STOMACH CANCER
ULCERATIVE COLITIS
INTESTINAL CANCER
HAEMORRHOIDS

Intravascular hemolysis
Pulmonary hemosiderosis
Response to erythropoietin
DECREASED IRON INTAKE
INCREASED IRON REQUIRMENT (JUVENILE AGE, PREGNANCY, LACTATION)
CONGENITAL IRON DEFICIENCY

IRON DEFICIENCY ANEMIAETIOLOGY:BLOOD LOSS     Chronic bleeding MENORRHAGIA PEPTIC ULCERSTOMACH CANCERULCERATIVE COLITISINTESTINAL CANCERHAEMORRHOIDS

Слайд 14IRON DEFICIENCY ANEMIA
GENERAL ANEMIA’S SYMPTOMS:
FATIGABILITY
DIZZINESS
HEADACHE
SCOTOMAS
IRRITABILITY
ROARING
PALPITATION
CHD, CHF

IRON DEFICIENCY ANEMIAGENERAL ANEMIA’S SYMPTOMS:FATIGABILITYDIZZINESSHEADACHESCOTOMASIRRITABILITY ROARINGPALPITATIONCHD, CHF

Слайд 15CHARACTERISTIC SYMPTOMS

GLOSSITIS, STOMATITIS
DYSPHAGIA ( Plummer-Vinson syndrome)
ATROPHIC GASTRITIS
DRY, PALE SKIN
SPOON SHAPED

NAILS, KOILONYCHIA,
BLUE SCLERAE
HAIR LOSS
PICA (APETITE FOR NON FOOD SUBSTANCES

SUCH AS ICE, CLAY)
SPLENOMEGALY (10%)
INCREASED PLATELET COUNT

CHARACTERISTIC SYMPTOMSGLOSSITIS, STOMATITISDYSPHAGIA ( Plummer-Vinson syndrome)ATROPHIC GASTRITISDRY, PALE SKINSPOON SHAPED NAILS, KOILONYCHIA, BLUE SCLERAEHAIR LOSSPICA (APETITE FOR

Слайд 17IRON DEFICIENCY ANEMIA
MCV

MCH

MCHC N

Fe

TIBC and sTfR
TRANSFERIN SATURATION
FERRITIN

IRON DEFICIENCY ANEMIAMCVMCH MCHC NFe  TIBC and sTfRTRANSFERIN SATURATIONFERRITIN

Слайд 18BLOOD AND BONE MARROW SMEAR

BLOOD:
microcytosis, hipochromia, anulocytes, anisocytosis poikilocytosis
BONE MARROW
high

cellularity
mild to moderate erythroid hyperplasia (25-35%; N 16 –

18%)
polychromatic and pyknotic cytoplasm of erythroblasts is vacuolated and irregular in outline (micronormoblastic erythropoiesis)
absence of stainable iron
BLOOD AND  BONE MARROW SMEARBLOOD:microcytosis, hipochromia, anulocytes, anisocytosis poikilocytosisBONE MARROWhigh cellularity mild to moderate erythroid hyperplasia

Слайд 19Normal Blood Film

Normal Blood Film

Слайд 20MICROCYTES

MICROCYTES

Слайд 21HYPOCHROMIA

HYPOCHROMIA

Слайд 22Management
History and physical examination is sufficient to exclude serious disease

(e.g pregnant or lactating women, adolescents)
- CURE

ANEMIA
History and/or physical examination is insufficient (e.g old men, postmenopausal women)
- FIND ETIOLOGY OF ANEMIA AND CURE (CAUSAL TREATMENT)
Benzidine test
Gastroscopy
Colonoscopy
Gynaecological examination




ManagementHistory and physical examination is sufficient to exclude serious disease (e.g pregnant or lactating women, adolescents)

Слайд 23DIETARY IRON
There are 2 types of iron in the diet;

haem iron and non-haem iron
Haem iron is present in Hb

containing animal food like meat, liver & spleen
Non-haem iron is obtained from cereals, vegetables & beans
Milk is a poor source of iron, hence breast-fed babies need iron supplements
DIETARY IRONThere are 2 types of iron in the diet; haem iron and non-haem ironHaem iron is

Слайд 24ORAL IRON ABSORPTION TEST
1. baseline serum iron level
2. 200 -

400 mg of elemental iron orally
3. serum iron level 1-4

hours after ingestion
An increase in serum iron of at least 100 microg/dL indicates that oral iron absorption is generally adequate
ORAL IRON ABSORPTION TEST1. baseline serum iron level2. 200 - 400 mg of elemental iron orally3. serum

Слайд 25IRON DEFICIENCY ANEMIA CURE
ORAL
200 mg of iron daily 1 hour before

meal (e.g. 100 mg twice daily)

How long?
14 days + (Hg

required level – Hg current level) x 4

half of the dose - 6 – 9 months to restore iron reserve



IRON DEFICIENCY ANEMIA CUREORAL200 mg of iron daily 1 hour before meal (e.g. 100 mg twice daily)How

Слайд 27IRON DEFICIENCY ANEMIA CURE
PARENTERAL IRON SUBSTITUTION
Bad oral iron tolerance (nausea, diarrhoea)
Negative

oral iron absorption test
Necessity of quick management (CHD, CHF)
iron to

be injected (mg) = (15 - Hb/g%/) x body weight (kg) x 3
IM or IV ? (risk of anaphilactic reactions)

Intramuscular iron — Mobilization of iron from intramuscular (IM) sites is slow and occasionally incomplete. As a result, the rise in the hemoglobin concentration is only slightly faster than that which occurs following the use of oral iron preparations.

Ferric carboxymaltose — is a novel stable iron complex for intravenous (IV) use which can be given at single doses of up to 1000 mg of elemental iron per week over a recommended infusion time of 15 minutes. A number of trials have shown efficacy and safety of this agent in iron deficient patients.

IRON DEFICIENCY ANEMIA CUREPARENTERAL IRON SUBSTITUTIONBad oral iron tolerance (nausea, diarrhoea)Negative oral iron absorption testNecessity of quick

Слайд 28 "NPS News 70: Iron deficiency anaemia". NPS Medicines Wise. October

1, 2010. Retrieved November 5, 2010.
World Health Organization Fact Sheet No. 366,

Soil-Transmitted Helminth Infections, updated June 2013
"Iron deficiency anemia". Mayo Clinic. March 4, 2011. Retrieved December 11, 2012.
 Decsi, T.; Lohner, S. (2014). "Gaps in meeting nutrient needs in healthy toddlers.". Ann Nutr Metab. 65 (1): 22–8. doi:10.1159/000365795. PMID 25227596.
Handout: Iron Deficiency Anemia – National Anemia Action Council
Norris, Jack. B12: Are You Getting It? Vegan Outreach. Available online: http://www.veganhealth.org/b12, Accessed October 26, 2009

References

 

Слайд 29THANK YOU FOR YOUR
ATTENENTION!!!

THANK YOU FOR YOUR ATTENENTION!!!

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