Iron-Deficiency
Anemia
Zhongshan Hospital,Fudan University
Zou Shanhua
Definition
Absent iron-store
hemoglobin synthesis↓
A microcytic and hypochromic anemia
The most common nutritional anemia
Iron metabolism,
Iron source and absorption
1.Heme iron,
hemoglobin stomach acid,prolease heme heme oxygenase
protoporphyrin
iron
Its absorption is not influenced by food ingrediant
Iron source and absorption
2.Nonheme iron,
Fe3＋ →stomach acid,VitC →Fe2+
3.Contains:10-15mg/d;10% absorbed
4.Absorption portions,duodenum and upper part of
jejunum
5,Absorption rate
Iron transportation
Fe2+ → Fe3+ → ferritin
Fe3+→transferrin→receptor (erythroblast)
→ mitochondria protoporphyrin heme
ferritin
Total iron-binding capacity(TIBC)
Serum iron (SI)
Transferrin saturation,SI/TIBC× 100%＝ 33%~35%
Tansferrin receptor
Iron distribution and storage
Normal iron content Male,50mg/kg weight
Female,35mg/kg weight
Iron distribution 66.7% --- hemoglobin
3.3% --- myoglobin
29.7% --- ferritin and hemosiderin
< 1% --- enzymes,transferrin and
ferritin in blood plasma
Form of storage:ferritin and hemosiderin
Iron recycle and excretion
Recycle
Excretion
0.5-1.5mg/d
epithelial cell of intestinal tract
bile
urinary tract
skin
sweating
Etiology and mechanism
rapid growing infants,adolacent
relative
Insufficient pregnant and lactating female
uptake inadequate nutrition,dietary bias
absolute postgastrectomy
anacidity
frequent vomit
chronic diarrhea
Etiology and mechanism
digestion tract hemorrhage,peptic ulcer, cancer,
Overabundance ancylostomiasis, varices,
Loss acute gastritis,hemorrhoids
( hemorrhage ) recurrent rhinorrhagia
excessive menses
Clinical manifestations
Oxygen deficiency of organs,
symptom,dizzy,fatige,palpitation，
short of breath,tinnitus
physical finding,paleness,
ankle edema
cardiac murmur
Clinical manifestations
Enzyme activity ↓,
nervous system,agitation,excitation,restlessness,
headache
skin and mucosa,dry skin,shedding hair,
koilonychia
atrophic glossitis
angular cheilitis
Immunity ↓:infection
Pica, like eating clay,lime and coal,
crude rice,etc,
Dysphagia (Plummer-Vinson syndrome)
Laboratory findings
Peripheral blood,
1.HB↓
2.Microcytic hypochromic anemia,
MCV< 80fl,MCH< 26pg,MCHC<32%
3.Red blood cell distribution width (RDW) ↑
4.Reticulocyte count,normal or mild increase
Laboratory findings
Bone marrow,
1.Erythroid hyperplastia(mide to moderate),
polychromatic and ortho-chromatic normoblast
make the majority
2,cytoplasma less mature than cell nucleus
3.Intracellular and extracellular iron stain of bone
marrow (-)
Laboratory findings
Biochemistry study,
1.SI↓ <8.95μ mol/L(500μ g/L),
TIBC ↑> 64.44 μ mol/L (3600μ g/L),
Transferrin saturation ↓ < 15%,
2,Ferritin↓ <12?g/L,high sensitivity and
specificity
3,Free protoporphyrin↑
diagnosis
Stages,prelatent iron-deficiency,
latent iron-deficiency,
iron-deficiency anemia
Procedure,
1.anemia 2.iron-deficiency 3.cause of iron-deficency
Point,
1.Causes and clinical findings of iron deficiency
2.Peripheral blood,microcytic hypochromic anemia
3.Bone marrow iron stain
4.Ferritin
5.Iron diagnostic therapy:Ret increase
Differential diagnosis
Hemoglobinopathy and thalassemia
Anemia of chronic disease
Sideroblastic anemia
Treatment
Causal treatment
Ferrotherapy
Treatment
Oral iron,ferrous sulfate,ferrous fumarate,ferrous
gluconate,ferrous succinate,etc,
＋ VitC
effect,in 1 week,Ret↑
in 2 weeks,HB↑
in 2 months,normal peripheral blood,
maintenace therapy for 3-6months
ineffective,insufficient dose,malabsorption,
iron loss> iron intake,
medicine of poor quality,wrong diagnosis
Treatment
Parenteral iron,iron dextran
Suitable for,intolerance,malabsorption,severe
gastrointestinal disease,late phase of pregnance
Dose,
total amount(mg)＝ [150-patient`s
Hb(g/L) ]× weight(kg)× 0.33
Prevention
Anemia
Zhongshan Hospital,Fudan University
Zou Shanhua
Definition
Absent iron-store
hemoglobin synthesis↓
A microcytic and hypochromic anemia
The most common nutritional anemia
Iron metabolism,
Iron source and absorption
1.Heme iron,
hemoglobin stomach acid,prolease heme heme oxygenase
protoporphyrin
iron
Its absorption is not influenced by food ingrediant
Iron source and absorption
2.Nonheme iron,
Fe3＋ →stomach acid,VitC →Fe2+
3.Contains:10-15mg/d;10% absorbed
4.Absorption portions,duodenum and upper part of
jejunum
5,Absorption rate
Iron transportation
Fe2+ → Fe3+ → ferritin
Fe3+→transferrin→receptor (erythroblast)
→ mitochondria protoporphyrin heme
ferritin
Total iron-binding capacity(TIBC)
Serum iron (SI)
Transferrin saturation,SI/TIBC× 100%＝ 33%~35%
Tansferrin receptor
Iron distribution and storage
Normal iron content Male,50mg/kg weight
Female,35mg/kg weight
Iron distribution 66.7% --- hemoglobin
3.3% --- myoglobin
29.7% --- ferritin and hemosiderin
< 1% --- enzymes,transferrin and
ferritin in blood plasma
Form of storage:ferritin and hemosiderin
Iron recycle and excretion
Recycle
Excretion
0.5-1.5mg/d
epithelial cell of intestinal tract
bile
urinary tract
skin
sweating
Etiology and mechanism
rapid growing infants,adolacent
relative
Insufficient pregnant and lactating female
uptake inadequate nutrition,dietary bias
absolute postgastrectomy
anacidity
frequent vomit
chronic diarrhea
Etiology and mechanism
digestion tract hemorrhage,peptic ulcer, cancer,
Overabundance ancylostomiasis, varices,
Loss acute gastritis,hemorrhoids
( hemorrhage ) recurrent rhinorrhagia
excessive menses
Clinical manifestations
Oxygen deficiency of organs,
symptom,dizzy,fatige,palpitation，
short of breath,tinnitus
physical finding,paleness,
ankle edema
cardiac murmur
Clinical manifestations
Enzyme activity ↓,
nervous system,agitation,excitation,restlessness,
headache
skin and mucosa,dry skin,shedding hair,
koilonychia
atrophic glossitis
angular cheilitis
Immunity ↓:infection
Pica, like eating clay,lime and coal,
crude rice,etc,
Dysphagia (Plummer-Vinson syndrome)
Laboratory findings
Peripheral blood,
1.HB↓
2.Microcytic hypochromic anemia,
MCV< 80fl,MCH< 26pg,MCHC<32%
3.Red blood cell distribution width (RDW) ↑
4.Reticulocyte count,normal or mild increase
Laboratory findings
Bone marrow,
1.Erythroid hyperplastia(mide to moderate),
polychromatic and ortho-chromatic normoblast
make the majority
2,cytoplasma less mature than cell nucleus
3.Intracellular and extracellular iron stain of bone
marrow (-)
Laboratory findings
Biochemistry study,
1.SI↓ <8.95μ mol/L(500μ g/L),
TIBC ↑> 64.44 μ mol/L (3600μ g/L),
Transferrin saturation ↓ < 15%,
2,Ferritin↓ <12?g/L,high sensitivity and
specificity
3,Free protoporphyrin↑
diagnosis
Stages,prelatent iron-deficiency,
latent iron-deficiency,
iron-deficiency anemia
Procedure,
1.anemia 2.iron-deficiency 3.cause of iron-deficency
Point,
1.Causes and clinical findings of iron deficiency
2.Peripheral blood,microcytic hypochromic anemia
3.Bone marrow iron stain
4.Ferritin
5.Iron diagnostic therapy:Ret increase
Differential diagnosis
Hemoglobinopathy and thalassemia
Anemia of chronic disease
Sideroblastic anemia
Treatment
Causal treatment
Ferrotherapy
Treatment
Oral iron,ferrous sulfate,ferrous fumarate,ferrous
gluconate,ferrous succinate,etc,
＋ VitC
effect,in 1 week,Ret↑
in 2 weeks,HB↑
in 2 months,normal peripheral blood,
maintenace therapy for 3-6months
ineffective,insufficient dose,malabsorption,
iron loss> iron intake,
medicine of poor quality,wrong diagnosis
Treatment
Parenteral iron,iron dextran
Suitable for,intolerance,malabsorption,severe
gastrointestinal disease,late phase of pregnance
Dose,
total amount(mg)＝ [150-patient`s
Hb(g/L) ]× weight(kg)× 0.33
Prevention
