Kea Med College
Iron Deficiency Anemia
Group members:- Amanuel Nesredin KHOR 6137/11
Haymanot Abraham KHOR 6160/11
Hermela Fasil KHOR 6206/11
Saron Mesganaw KHOR 6194/11
Yonatan Bekele KHOR 6198/11
Acknowledgment
• Thank GOD for everything
• we would like to send out our gratitude to health professionals
working at different levels to combat IDA as well as the current
pandemic.
preface
• in these next few slides we will try to discuss blood and its
composition with emphasis on Red blood cells, since the presentation
is concerned with an important integral part of the Red blood cell,
hemoglobin.
• we will also be discussing about iron deficiency, its signs and
symptoms, diagnosis and treatment
• we will also be discussing about prevalence of iron deficiency anemia
in Ethiopia as compared to the world
• we will also be discussing about how we can get enough amount of
iron daily intake from our daily meals and which types of edibles carry
sufficient amount of iron and about the nutritional importance of iron
intake
Introduction
• Iron deficiency anemia is a common type of anemia — a condition in
which blood lacks adequate healthy red blood cells. Red blood cells
carry oxygen to the body's tissues.
• As the name implies, iron deficiency anemia is due to insufficient iron.
Without enough iron, your body can't produce enough of a substance
in red blood cells that enables them to carry oxygen (hemoglobin).
• Anemia, as defined by the World Health Organization is a low blood
hemoglobin concentration (below 130 g/L for men, 120 g/L for nonpregnant women and below 110 g/L in pregnant women). However,
the reference range for normal blood hemoglobin levels may vary in
individuals depending on gender, race, age, dietary habits, and
geographical area. Children, elderly people, pregnant and lactating
women, and people with disease causing blood loss are at higher risk
as compared to other groups of the population.
Introduction continued
• Anemia is an important global public health problem, affecting the
lives of more than 2 billion people globally, accounting for about 30%
of the world’s population, which is the most common public health
problem in developing countries occurring at all stages of life. An
estimated 43% population in developing, and 9% in developed
countries, are anemic. In Ethiopia, anemia affects 17% women and
11% men aged 15–49 years.
• Iron is an essential mineral that is needed to form hemoglobin, an
oxygen carrying protein inside red blood cells
Blood and its composition
• Blood
• is the only fluid tissue
• constitutes 6-8% of the total
body weight
• consists of cells suspended in
a fluid called plasma.
• about 45% cells; 55% plasma
Plasma
Formed elements
• The three main blood cells/formed elements are:
• red blood cells (erythrocytes)
• white blood cells (leucocyte)
• platelets (thrombocytes)
• Leukocytes are :
• a heterogeneous group of nucleated cells
• responsible for the body’s defenses
• transported by the blood to the various tissues where they exert their
physiologic role, e.g. phagocytosis.
• The normal WBC count is ~4,000 to 10,000/L (4.0–10.0 x 103/L)
• Leukocytes are usually divided into:
• Granulocytes, which have specific granules, and
• Agranulocytes, which lack specific granules
Formed elements continued
• Granulocytes/ Polymorphonuclear leukocytes are divided into:
• Neutrophils (with faintly staining granules),
• Eosinophils (with large reddish or eosinophilic granules), and
• Basophils (with large dark blue or basophilic granules).
• Agranulocytes/mononuclear leukocytes are divided into:
• Lymphocytes and
• Monocytes
• Platelets (Thrombocytes):
are small, non nucleated (anucleated), round/oval cells/cell fragments
• They are produced in the bone marrow by fragmentation of megakaryocytes,
which are large and multinucleated cells
• Their primary function is preventing blood loss from hemorrhage by forming a
platelet plug
Erythrocytes (Red Blood Cells)
• Are the most numerous cells in the blood
• The normal RBC count is approximately 4.5 to 6 million cells per microliter.
• Their primary function is gas exchange.
• carry oxygen from the lungs to the tissues
• return carbon dioxide (CO2), a waste product of metabolism, from the
tissues to the lungs to be exhaled
• are anucleated cells containing few organelles
• a large proportion of their cytoplasm consists of the iron containing oxygen
transport molecule hemoglobin.
• shaped like biconcave disks approximately 7 to 8 m in diameter with a
thickness of 1.7-2.4m
• The biconcave disk shape gives red blood cells (RBCs) the flexibility to squeeze
their way through capillaries and other small blood vessels.
Erythrocytes (Red Blood Cells) continued
• normally survives in the blood stream for approximately 120 days
• after finishing its life span, it is removed by the phagocytic cells of the reticuloendothelial system,
broken down and some of its constituents re utilized for the formation of new cells.
• Red blood cells are formed in the red bone marrow of bones. Stem cells in the red bone marrow
are called hemocytoblasts. They give rise to all of the formed elements in blood. If a stem cell
commits to becoming a cell called a proerythroblast, it will develop into a new red blood cell.
• Hemoglobin is an oxygen-binding protein found in erythrocytes that transports oxygen from the
lungs to tissues. Each hemoglobin molecule is a tetramer made of four polypeptide globin chains.
Each globin subunit contains a heme moiety formed of an organic protoporphyrin ring and a
central iron ion in the ferrous state (Fe2+). The iron molecule in each heme moiety can bind and
unbind oxygen, allowing for oxygen transport in the body. The most common type of hemoglobin
in the adult is HbA, which comprises two alpha-globin and two beta-globin subunits
Iron and its function in our body
• Iron is an essential element for blood production. About 70 percent of
your body's iron is found in the red blood cells of your blood called
hemoglobin and in muscle cells called myoglobin. Hemoglobin is
essential for transferring oxygen in your blood from the lungs to the
tissues. Myoglobin, in muscle cells, accepts, stores, transports and
releases oxygen.
• About 6 percent of body iron is a component of certain proteins,
essential for respiration and energy metabolism, and as a component
of enzymes involved in the synthesis of collagen and some
neurotransmitters. Iron also is needed for proper immune function.
Daily iron requirement
• The amount of iron you need is: 8.7mg a day for men over 18.
• 14.8mg a day for women aged 19 to 50.
• 8.7mg a day for women over 50.
• 27 to 45mg a day for pregnant women.
• N.B:- Excessive iron can be damaging to the gastrointestinal system.
Symptoms of iron toxicity include nausea, vomiting, diarrhea and
stomach pain. Over time, iron can accumulate in the organs, and
cause fatal damage to the liver or brain.
Iron metabolism and homeostasis
• Human iron metabolism is the set of chemical reactions that maintain
human homeostasis of iron at the systemic and cellular level. Iron is
both necessary to the body and potentially toxic.
• Human iron homeostasis is regulated at two different levels. Systemic
iron levels are balanced by the controlled absorption of dietary iron
by enterocytes, the cells that line the interior of the intestines, and
the uncontrolled loss of iron from epithelial sloughing, sweat, injuries
and blood loss. In addition, systemic iron is continuously recycled.
Cellular iron levels are controlled differently by different cell types
due to the expression of particular iron regulatory and transport
proteins.
Iron metabolism and homeostasis continued
Systemic iron regulation
Dietary iron uptake
• Like most mineral nutrients, the majority of the iron absorbed from digested
food or supplements is absorbed in the duodenum by enterocytes of the
duodenal lining.
• To be absorbed, dietary iron can be absorbed as part of a protein such as
heme protein or iron must be in its ferrous Fe2+ form.
• Iron absorption from diet is enhanced in the presence of vitamin C and
diminished by excess calcium, zinc, or manganese.
• The human body’s rate of iron absorption appears to respond to a variety of
interdependent factors, including total iron stores, the extent to which the
bone marrow is producing new red blood cells, the concentration of
hemoglobin in the blood, and the oxygen content of the blood. The body also
absorbs less iron during times of inflammation, in order to deprive bacteria of
iron.
Iron metabolism and homeostasis continued
• Iron recycling and loss
• Most of the iron in the body is hoarded and recycled by the
reticuloendothelial system, which breaks down aged red blood cells.
• When red cells die, hemoglobin is broken up: iron is salvaged,
transported to the bone marrow by proteins called transferrins, and
used again in the production of new red blood cells; the remainder of
the hemoglobin forms the basis of bilirubin, a chemical that is
excreted into the bile and gives the feces their characteristic yellowbrown colour.
• there is no known physiologic regulatory mechanism for excreting
iron.
Iron metabolism and homeostasis continued
• Cellular iron regulation
• Iron import
• The labile iron pool
• The storage iron pool
• Iron export
• Translational control of cellular iron
Where can we get iron from?
• Iron is regulated and metabolized in our body in two levels as we have
tried to discuss above. we have also discussed about the daily iron
intakes our body requires. so what type of foods are rich in iron and
are able to supplement us with the amount needed?
• Spinach, liver, legumes, red meat, pumpkin and fruits like banana and
apple are rich in iron.
Iron deficiency
• Two types of iron deficiency
• 1. Functional iron deficiency
• adequate iron stores but insufficient iron availability for incorporation
into erythrocyte precursors. This is due to increased levels of
pethidine.
• defined by the presence of stain able iron in the bone marrow
together with a serum ferritin value within normal limits
• 2. Actual iron deficiency
• severely reduced or absent iron stores
• reduced iron intake
Iron deficiency continued
• Functional or actual iron deficiency can result from a variety of
causes.
• some of which can be:•
•
•
•
•
•
•
•
Increased demand for iron, which the diet cannot accommodate.
Increased loss of iron (usually through loss of blood).
Nutritional deficiency.
Acid-reducing medications: Acid-reducing medications reduce the
absorption of dietary iron. Proton pump inhibitors (PPIs), H2
antihistamines, and antacids will reduce iron metabolism.
Damage to the intestinal lining.
pregnancy
inflammation
Acute blood loss or acute liver cirrhosis creates a lack of transferrin
therefore causing iron to be secreted from the body.
Iron deficiency anemia
• Anemia usually refers to a condition in which your blood has lower
than normal number of red blood cells.
• Iron deficiency anemia is a condition in which the body lack enough
red blood cells to transport oxygen rich blood to body tissues.
• iron deficiency anemia is the most common form of anemia and it
develops over time if the body does not have enough iron to
manufucture red blood cells.
• without enough iron the body uses up all the iron it has stored in the
liver, bone marrow and other organs.
• once the stored iron is depleted the body is able to make very few red
blood cells and these red blood cells the body makes are abnormal
and do not have the hemoglobin capacity as normal red cells would.
Iron deficiency anemia continued
• iron deficiency anemia is caused by different reason of which the most common ones are:•
blood loss
•
poor diet and
•
in ability to absorb enough iron from diet
•
organ failure especially liver and kidney
• Blood loss
• causes of blood loss could be:•Trauma
•in women long and heavy menstrual period, bleeding during delivery
•internal bleeding
•diseases like malaria, hookworm and schistosom infestation
poor diet
low iron intake
during pregnancy some women might not have adequate intake
childhood
inability to absorb enough iron from diet
intestinal disease or recent intestinal related surgery may impair absorption even if there is adequate intake of iron
medications like antacids and proton pump inhibitors interfere with the metabolism process of iron
Iron deficiency anemia continued
• organ failure
• When your kidneys are damaged, they produce less erythropoetin
(EPO), a hormone that signals your bone marrow—the spongy tissue
inside most of your bones—to make red blood cells. With less EPO,
your body makes fewer red blood cells, and less oxygen is delivered to
your organs and tissues.
Other causes of anemia related to CKD include:• blood loss, particularly if you are treated with dialysis for kidney
failure
• infection
• inflammation
• malnutrition, a condition that occurs when the body doesn’t get
enough nutrients
Iron deficiency anemia continued
• Chronic liver disease (CLD) of any cause is frequently associated with
hematological abnormalities. Among these, anemia is a frequent
occurrence, seen in about 75% of patients with advanced liver
disease.
• The liver performs a major role in iron homeostasis. It is the main
organ for the production of the iron regulatory hormone hepcidin,
expressed in iron excess conditions as well as in cases of
inflammation, blocking the absorption of iron from the enterocytes.
• Hemolysis also represents a common cause of anemia in patients
with liver disease
Iron deficiency anemia continued
Clinical presentation of iron deficiency anemia
Iron deficiency anemia often develops gradually, with small amounts of blood loss.
Such persons may remain asymptomatic until their iron stores become sufficiently depleted to compromise red cell
production and other tissues.
however the most common sign and symptoms of iron deficiency anemia are:-
pallor
fatigue
dyspnea
chest pain
dizziness, headache and light headedness
tachycardia
brittle nails
cracks in the sides of mouth
Iron deficiency anemia continued
less common signs and symptoms include:cold hands and feet
irritability
frequent infections
an unusual cravings for non nutritional substances like
ice, dirt, etc.... this is called pica
restless leg syndrome(RLS)
there is also relation between the signs and symptoms and the cause of
the iron deficiency anemia such as a bright red blood in stool or bloody
stool can signal intestinal bleeding which in turn signals the anemia is
due to blood loss from the intestine.
long and heavy menstrual period can also signal that a woman with
such condition is likely to develop iron deficiency anemia
Iron deficiency anemia continued
• severe and chronic iron deficiency anemia can lead to problems with growth and development in
children, problems with the fetus in pregnant woman and herself as well, angina, leg pain or
claudication.
• Iron deficiency anemia in pregnant women
Anemia occurs in up to one third of women during the 3rd trimester. The most common causes are:iron deficiency and
folate deficiency
Early symptoms of anemia are usually nonexistent or nonspecific. fatigue, weakness, lightheadedness, mild dyspnea during exertion, pallor and, if anemia is severe, tachycardia or hypo
tension.
Anemia increases risk of
Preterm delivery
Low birth weight
Postpartum maternal infections
Iron deficiency anemia continued
risk factors for iron deficiency anemia during pregnancy
Have two closely spaced pregnancies.
Are pregnant with more than one baby.
Are vomiting frequently due to morning sickness.
Don't consume enough iron.
Have a heavy pre-pregnancy menstrual flow.
Have a history of anemia before your pregnancy.
Iron deficiency anemia continued
• Diagnosis of IDA
apart from the clinical manifestations which are likely to be confused
with other diagnosis IDA can be diagnosed by laboratory investigations.
investigations like CBC will reveal the hemoglobin level, rbc indices
including MCV and MCH,and hematocrit, iron profile is also another
investigation which includes plasma iron, transferin, serum ferretin and
iron saturation.
Iron deficiency anemia continued
• Treatment of IDA
• As a public health student and future health officer the best way is
prevention. we can prevent IDA by educating and creating awareness
of then effects of IDA, by educating women especially pregnant
women to have a appropriate follow up, to check their menstrual
bleeding and to have regular check up, teach the community of the
importance of feeding children and the effects it will have on children
towards their growth and development.
• prevention is the best treatment
Iron deficiency anemia continued
IDA can be treated pharmacologically as well as in non pharmacological
methods.
pharmacologically it is treated with oral and parentral iron preparations.
Oral Iron supplement
this may take 3 to 6 month to replenish the depleted iron storage
the drug of choice for oral iron supplement is ferrous sulfate 325mg/tid
this amount provides around 180mg of iron.
other drugs include ferrous gluconate 325mg/tid, ferrous fumarate 100mg/6
times a day
these oral iron supplements are best absorbed when taken on empty stomach
Iron deficiency anemia continued
Adverse effects of oral Iron supplements
nausea
epigastric discomfort
abdominal cramp and constipation
Contraindications of oral Iron supplements
avoid taking multivitamins and other minerals 2 hours before
and after taking the oral supplement
avoid antibiotics
avoid antacids and proton pump inhibitors
avoid taking blood thinners and NSAIDs
Iron deficiency anemia continued
• Parentral iron supplements
Iron dextran
25-100 mg IV/IM qid or PRN but should not exceed 100mg per day
Adverse effects
fever, back pain, bronchospasm, nausea, light headedness
Iron sucrose complex
usually used for patients suffering from IDA caused by CKD
100mg IV per dialysis session given by push in 2-5 minutes not
exceeding 1000 mg per week
and 200-300 mg in non dialysis dependent CKD patients
Adverse effects
fever, nausea, headache
Iron deficiency anemia continued
Non pharmacological method of treating IDA
consuming iron rich diets like spinach, banana, apple, liver, red meat
avoiding stress, trauma and accidents
exercise
Prevalence of IDA in the world and in Ethiopia
• Globally, anaemia affects 1.62 billion people, which corresponds to 24.8% of the population.
population group
prevalence of anemia
(percentage)
population affected
(number in millions)
pre-school aged children
47.4
293
school-age children
25.4
305
pregnant women
41.8
56
non-pregnant women
30.2
468
men
12.7
260
elderly
23.9
164
total population
24.8
1620
• worldwide prevalence of anemia 1993-2005 WHO
Prevalence of IDA in the world and in Ethiopia
continued
• in a study conducted in Ethiopia on the 25th of November 2019
• The overall prevalence of anemia was 40.9%. Anemia was higher
among rural residents (46.6%) than urban residents (20.1%).
• In urban centers, being male and illiterate were significantly
associated with anemia.
• In rural areas, being female, presence of heart disease, central
obesity, illiteracy, and primary school completion were significantly
associated with anemia.
Conclusion
• one of the main functions of the red blood cells is carrying oxygen to
tissues.
• the red blood cells perform this activity because of the presence of a
protein called hemoglobin.
• hemoglobin contains a heme part and a globin part. Heme is the iron
containing molecule that attaches reversibly to oxygen to deliver
oxygen to tissues and globin is the protein part of the hemoglobin
which surrounds the heme.
• the normal level of hemoglobin in our blood is between 13.8 to
17.2g/dl in males and 12.1 to 15.1 g/dL
Conclusion
• when hemoglobin levels fall below these numbers it results in
anemia.
• the most common cause of anemia is iron deficiency
• anemia resulting from iron deficiency is referred to as iron deficiency
anemia (IDA)
• IDA is more common in pregnant women and children
• IDA results from blood loss, poor diet and poor absorption most
commonly
• IDA is diagnosed through laboratory investigations like CBC and iron
profile
• it is difficult to diagnose IDA based on clinical signs and symptoms
since most of the signs and symptoms can be mistaken with other
diagnosis
Conclusion
• the best way to treat IDA is prevention as is in all other diseases and
disorders
• treatment include pharmacological and non pharmacological
treatment methods
• pharmacologically oral supplements, ferrous sulphate being the DOC,
and parentral supplements like iron sucrose can be used
• non pharmacologically iron rich diet helps in the treatment
• prevalence of IDA is greater in the rural residents than urban
residents in Ethiopia
• hence we recommend emphasis be given to prevention and
treatment methods in the rural areas of Ethiopia
References
• Prevalence of Anemia and Associated Factors Among “Apparently Healthy” Urban and Rural Residents in Ethiopia:
A Comparative Cross-Sectional Study by Tinsae Shemelise Tesfaye, Department of Epidemiology and Bio statistics,
College of Medicine and Health Science, Dilla University, Dilla, Ethiopia, Fasil Tessema, Habtemu Jarso Department
of Epidemiology and Bio statistics, Jimma University, Jimma, Ethiopia in november 25, 2019
• Iron deficiency anemia by Shoneza Kingston and Fizal Ali
• Anemia prevalence and etiology among women, men, and children in Ethiopia: a study protocol for a national
population-based survey by Amare Worku Tadesse, Elena C. Hemler, Christopher Andersen, Simone Passarelli,
Alemayehu Worku, Christopher R. Sudfeld, Yemane Berhane & Wafaie W. Fawzi in 24 october, 2019
• https://www.ucsfhealth.org
• https://www.who.int/health-topics/anaemia
• https://www.who.int/vmnis/anaemia/prevalence/summary/anaemia_data_status_t2/
• https://reference.medscape.com/drug
• https://emedicine.medscape.com/article/202333-clinical
•THANK YOU