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Iron deficiency anemia (PowerPoint)

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					  Iron deficiency anemia
Investigations and complications

     Deepak kumar
        First unit
     Final year MBBS
• Most common Anaemia Worldwide
• 50 – 90% pregnant women anaemic
• Actually a consequence primarily of expansion
  of plasma volume without normal expansion
  of maternal Hb mass and negative iron
  balance
 Etiology of iron deficiency anemia
i. Dietary lack

ii. Impaired absorption

iii. Increased demand

iv. Chronic blood loss
 Etiology of iron deficiency anemia
i. Dietary lack – most common in India – Faulty
   Dietary Habits

ii. Impaired absorption

iii. Increased demand

iv. Chronic blood loss
 Etiology of iron deficiency anemia
i. Dietary lack

ii. Impaired absorption – Sprue, Steatorrhoea,
     Chronic diarrhoea
iii. Increased demand

iv. Chronic blood loss
 Etiology of iron deficiency anemia
iii. Increased Demand
       Total iron needed - 750 to 1200 mg
            Depends on
               1.Growing fetus and placenta
               2.Expanding Maternal blood volume
Requires absorbtion of 5 to 8 mg of elemental
iron per day which in turn needs atleast 40 mg
of daily supplement
 Etiology of iron deficiency anemia
iv. Chronic blood loss
     Hookworm Infestations
     Gynecological Problems
      G.I Bleeds
               RISK FACTORS
•   Lower social class
•   Multiparity
•   Teenage pregnancy
•   Multiplicity
•   Previous menstrual problem
      STAGES OF IRON DEFICIENCY
STAGE OF IRON DEPLETION:
             -more iron leaves
             -stores wil be mobilised
             -serum fe ↓ , serum Tf ↑,TIBC↑

STAGE OF INEFFECTIVE ERYTHROPOIESIS:
             -few but normal RBCS
             -hypochromic but normocytic

STAGE OF IRON DEFICIENY ANAEMIA:
       CLINICAL FEATURES
SYMPTOMS
1)WEAKNESS AND EASY FATIGABILITY
2) GIDDINESS

3) BREATHLESSNESS ON EXERTION

4) DECREASED WORK CAPACITY

5) LOSS OF SLEEP

6) LOSS OF APPETITE AND
   INDIGESTION
7) PALPITATIONS

8) DYSPHAGIA

9) SYMPTOMS OF CONGESTIVE
    HEART FAILURE
                SIGNS

1) ALOPECIA

2) PALLOR OF SKIN AND MUCOUS MEMBRANES
3) FACIAL OEDEMA

4) ORAL LESIONS :- GLOSSITIS ,
  ATROPHY OF TONGUE PAPILLAE ,
  ANGULAR STOMATITIS , CHEILOSIS.
5) GASTRIC ATROPHY

6) PLUMMER-VINSON SYNDROME

        - GLOSSITIS
        - DYSPHAGIA
        - POST-CRICOD
            OESOPHAGEAL WEB
        - IRON-DEFICIENCY ANEMIA
7) PICA
      -COMPULSIVE INGESTION OF NON-NUTRTIVE
  SUBSTANCES
8) KOILONYCHIA

    -DUE TO IMPAIRED NAILBED
        EPITHELIAL GROWTH
    - PATHOGNOMONIC OF IRON-
        DEFICIENCY
9) PEDAL OEDEMA
10) SOFT SYSTOLIC MURMUR IN MITRAL AREA


11) CREPITATIONS AT THE BASE OF THE LUNGS
           INVESTIGATIONS

IRON DEFICIENCY ANAEMIA


    Stage of storage iron depletion
     Stage of iron deficient erythropoiesis
      Stage of iron deficiency anaemia
STAGE OF STORAGE IRON DEPLETION
• SERUM FERRITIN LEVELS
    Reflects iron stores
    Unaffected by recent iron uptake
    First abnormal laboratory test
    Normal :15-200µg/L
    <12µg/L Storage iron depletion
• RBC INDICES ARE NORMAL



• HAEMOGLOBIN LEVELS ARE NORMAL
          STAGE OF IRON DEFICIENT
             ERYTHROPOIESIS
• SERUM IRON <50µg/dl(Normal:50-120µg/dl)

• TOTAL IRON BINDING CAPACITY
     >350µg/dl (Normal:300-350µg/dl)

• SERUM TRANSFERRIN SATURATION
     <15% (Normal:20-50%)
     Decreased levels indicate decreased delivery of
  iron to the tissues
• SERUM TRANSFERRIN RECEPTORS
      3-5 Fold increase(Normal:5.3mg/L)
      Sensitive and specific marker
      But facilities are not routinely available

• NORMAL RBC INDICES

• NORMAL HAEMOGLOBIN LEVELS
STAGE OF IRON DEFICIENCY ANAEMIA
• HEMOGLOBIN
           <10.5g%
  SAHLI’S METHOD-most commonly used.
• Other methods
      Taliquist method-simple but not accurate
     Coppersulphate method
     Cyanomethhaemoglobin method-most
  accurate
•     RBC INDICES
     1. Mean corpuscular volume
          <75 fl (Normal:75-95fl)
          First to get reduced
          Most sensitive indicator

    2.Mean corpuscular hemoglobin
       <25pg (Normal:26-31pg)

    3.Mean corpuscular hemoglobin concentration
        <30g/dl (Normal:30-35g/dl)
        Decreased in severe iron depletion
4.Red cell distribution width
       It is an index of variation in size & shape of RBC
      >16 Normal(11-14).
      Normal in thalessemia

5.Free erythrocyte protoporphyrin
     >50µg/dl Normal(<35µg/dl)
    Defective iron supply to developing RBC’s
    Normal in thalessemia


 6.Hematocrit
     <30% (Normal:32-36%)
PERIPHERAL SMEAR
       • Hypochromic

       • Microcytic

       • Anisocytosis-variation in
         size

       • Poikilocytosis-
         abnormally shaped
         RBC’s
                    OTHER INVESTIGATIONS

• Bone marrow examination
    Indicated
      1.Refractory anemia
      2.diagnosis of kala-azar
      3.suspected aplastic
  anaemia

• Stool examination
• Urine examination
      For occult blood
      Culture- Bacteruria
• Peripheral smear
    For malarial parasite

• Chest X-ray (abdominal shielding)&Sputum exmn

• Renal function tests
          DIFFERENTIAL DIAGNOSIS OF
     HYPOCHROMIC MICROCYTIC ANAEMIA


  serum                     Serum               Hemoglobin
ferritin levels          ferritin levels      electrophoresis

  Bone marrow               bone marrow
     iron                   iron

IRON DEFICIENCY   ANAEMIA OF
   ANAEMIA          CHRONIC DISEASE        THALESSEMIA
           COMPLICATIONS

        A)EFFECTS ON THE MOTHER

DURING PREGNANCY

1) INFECTION
2) PRE-TERM LABOUR
3) HEART FAILURE
4) PRE-ECLAMPSIA
               DURING LABOUR

1) POSTPARTUM HAEMORRHAGE

2) CARDIAC FAILURE

3) SHOCK

4) UTERINE INERTIA
              PUERPERIUM

1)   PUERPERAL SEPSIS
2)   SUBINVOLUTION
3)   FAILING LACTATION
4)   PUERPERAL VENOUS THROMBOSIS
5)   PULMONARY EMBOLISM
          B)EFFECTS ON THE BABY
1) IUGR



2) LOW BIRTH WEIGHT BABIES



3) IUD
•


    THANK YOU

				
DOCUMENT INFO
Description: Anemia complicating pregnancy