FACTORS AFFECTING

SKIN COLOR

HEMOGLOBIN CONCENTRATION
STATE OF CONSTRICTION

DILATATION OF PERIPHERAL
VESSELS

PIGMENTATION AND SCT FLUID

ANEMI
A

REDUCTION IN RED CELL MASS

REDUCTION IN BLOOD
HEMOGLOBIN CONCENTRATION

FUNCTION OF THE
RED CELL

TO DELIVER AND
RELEASE ADEQUATE
QUANTITIES OF
OXYGEN TO THE
TISSUES TO MEET
THEIR METABOLIC
DEMANDS.

CRITERIA FOR IDENTIFYING

CHILDREN WITH LOW HgB &
HCT VALUES
AGE (%)

Hgb
(g/dl)

Htc

6-23
MOS
2-5 YRS

<10

<31

<11

<34

6-12 YRS

<12

<37

HEMOGLOBIN
LEVEL
AND SYMPTOMS
Hgb (g)
9-11

SYMPTOMS

6.0

Little to no
dysfunction
Extertional
dyspnea
Some weakness

3.0

Dyspnea at rest

5-7

2-1.5

Cardiac failure

EVALUATION OF THE
ANEMIC PATIENT

HISTORY
PHYSICAL

EXAMINATION

LABORATORY TESTS
CBC
RBC INDICES
RETICULOCYTE COUNT
EXAMINATION OF THE PERIPHERAL
SMEAR

RED BLOOD CELL

INDICES

MCV
NV =

80 -

100 f

RED BLOOD CELL

INDICES
MCH
NV= 2734 pg

RED BLOOD
CELL
INDICES

MCHC
NV

32 36

CORRECTED RC OR
RETICULOCYTE INDEX
(%)
NV

1 1.5 %

RETICULOCYTOSIS

ACUTE BLOOD LOSS

HEMOLYTIC ANEMIA

AFTER A THERAPEUTIC TRIAL OF

IRON

RETICULOCYTOPE
NIA
BONE MARROW FAILURE
APLASTIC ANEMIA
LEUKEMIA

PERIPHERAL SMEAR

HYPOCHROMIA
MICROCYTOSIS
ANISOPOIKILOCYTOSIS
TARGET CELLS
THROMBOCYTOSIS
THROMBOCYTOPENIA

CHEMICAL STUDIES
DECREASED SERUM IRON
INCREASED TOTAL IRON BINDING

CAPACITY
TRANSFERRIN SATURATION IS BELOW
15 %
SERUM IRON BELOW 5O ug / dl

CLASSIFICATION OF ANEMIA
ACCORDING TO
FUNCTIONAL DISTURBANCES
1.DISORDERS OF EFFECTIVE
PRODUCTION
2. DISORDERS WITH RAPID
ERYTHROCYTE DESTRUCTION
OR RC LOSS

RC

DISORDERS OF EFFECTIVE
RC PRODUCTION

DEPRESSED

NET RATE OF RC

PRODUCTION
DISORDERS OF ERYTHROCYTE
MATURATION
INEFFECTUAL ERYTHROPOIESIS
ABSOLUTE FAILURE OF
ERYTHROPOIESIS

ADDITION
AL
STUDIES

CONFIRMATO
RY STUDIRS

INITIAL SCREENING
and PRESUMPTIVE
DIAGNOSIS

ANEMIA

RED CELL INDICES

MCV, MCHC, MCH, RDW,
HDW
PERIPHERAL
SMEAR

RETICULOCYTE COUNT AND

INDICES

DIRECT ANTI GLOBULIN

TEST
G6PD screening
test Osmotic
fragility
Hb
ISOELECTROFOCUSIN
G & OTHER TESTS
FOR
RARE Hb VARIANTS

HISTORY
PHYSICEL EXAMINATION
NON-HEMATOLOGICAL
DISEASES:
(Renal, Thyroid, Metabolic,
Others)

Hb
ELECTROPHOR
ESIS
Bone Marrow
Aspirate/Blop
sy
Test for unstable
Hbs
CYTOGENETIC
STUDIES

Indirect bilirubin
LDH, Heptogloblin,
Serum B12
Serum, RBC Folate
Serum ferritin, iron,
TIBC
Circulating
transferrin
Receptor
Serum Lead and RBC
ZPP
RBC Enzyme
Panel
Membrane protein
studies

IRON DEFICIENCY
ANEMIA
MOST COMMON

CAUSE OF

ANEMIA
COMMON IN AGES
MONTHS

6 24

FORMS OF IRON
ACCORDING TO ITS
STABLE OXIDATIVE
STATES

FERROUS (
FERRIC

Fe 2+ )

( Fe 3+ )

IRON BINDING
AGENTS (CHELATORS)

DESFERRIOXAMINE

TRANSFRRRIN

DISTRIBUTION OF
IRON

AVERAGE ADULT - 3 - 5 g
(BALANCE =DIETARY UPTAKE AND
LOSS)

LOSSES : SKIN - 1 mg/

day MENSTRUATION - 2 mg /day

ETIOLOGY OF IRON
DEFICIENCY
A. INADEQUATE SUPPLY OF IRON
1 . LACK OF IRON STORES AT BIRTH (LBW,
PT, TWIN OR MULTIPLE BIRTHS, SEVERE IDA
IN MOTHER, FETAL BLD LOSS, BLEEDING
FROM THE 1ST FEW DAYS OF LIFE)
2. INADEQUATE INTAKE-DEFICIENT
DIETARY IRON

ETIOLOGY OF IRON
DEFICIENCY
B . IMPAIRED ABSORPTION
1. CHRONIC OR RECURRENT
DIARRHEA
2. MALABSORPTON SYNDROME
3 . GASTROINTESTINAL
ABNORMALITIES

ETIOLOGY OF IRON
DEFICIENCY ANEMIA
C.EXCESSIVE DEMANDS
FOR IRON FOR GROWTH
AS SEEN IN PT, LBW,
INFANTS, ADOLESCENT AND
PREGNANCY

ETIOLOGY OF
IRON DEFICIENCY
ANEMIA
D . BLOOD LOSS
1. ACUTE OR CHRONIC
HEMORRHAGE
2 . PARASITIC INFECTION
(HOOKWORM TRICHURIS trichiura)

FACTORS THAT MODIFY

IRON ABSORPTION

PHYSICAL STATE
(BIOAVAILABILITY) HEME > Fe 2+
> Fe 3 +
INHIBITORS
PHYTATES , TANNINS , SOIL ,
LAUNDRY STARCH , IRON OVERLOAD
COMPETITORS
COBALT, LEAD , STRONTIUM
FACILITATORS
ASCORBATE, CITRATE , AMINO ACIDS

ROLE OF IRON

DNA SYNTHESIS

HOST OF METABOLIC
PROCESSESS

OF
IRON DEFICIENCY
ANEMIA
1.ANEMIA
2.GROWTH AND DEVELOPMENTAL
RETARDATION
3.EPITHELIAL CHANGES
4.MISCELLANEOUS

STAGES OF IRON DEFICIENCY

1.PRELATENT IRON
DEFICIENCY

2.LATENT

IRON DEFICIENCY

3.FRANK

IRON

DEFICIENCY

STAGES OF IRON
DEFICIENCY
PRELATENT

IRON

DEFICIENCY

DEPLETED STORES WITHOUT

A CHANGE IN HCT OR SERUM IRON
LEVELS

RARELY DETECTED

STAGES OF IRON
DEFICIENCY

LATENT IRON DEFICIENCY

DECREASED SERUM IRON LEVEL
TOTAL IRON - BINDING CAPACITY
INCREASES WITHOUT A CHANGE IN
THE HCT
DECREASED TRANSFERRIN SATURATION

STAGES OF IRON
DEFICIENCY
IRON DEFICIENCY ANEMIA
ASSOCIATED WITH
ERYTHROCYTE,
MICROCYTOSIS AND
HYPOCHROMIA

EFFECTS OF IRON
DEFICIENCY

ANEMIA

GROWTH AND DEVELOPMENTAL

RETARDATION

EPITHELIAL CHANGES

MISCELLANEOUS

EFFECTS OF IRON
DEFICIENCY
ANEMIA
IMPAIRS TISSUE OXYGEN
WEAKNESS, FATIGUE,
PALPITATIONS AND
LIGHTHEADEDNESS
REACTIVE THROMBOCYTOSIS

EFFECTS OF IRON
DEFICIENCY

GROWTH AND DEVELOPMENT

GROWTH AND DEVELOPMENTAL
ABNORMALITIES
IMPAIRS NEUROLOGIC FUNCTIONS
(BEHAVIORAL ABNORMALITIES,
MOTOR INCOORDINATION AND
SEIZURE)

EFFECTS OF IRON
DEFICIENCY

EPITHELIAL CHANGES
ANGULAR STOMATITIS
GLOSSITIS
FLATTENED AND ATROPHIC LINGUAL
PAPILLAE
PLUMMER- VINSON
(FORMATION OF POSTCRICOID ESOPHAGEAL
WEB)
KOILONYCHIA OR SPOONING OF THE
FINGERNAILS

EFFECTS OF
IRON
DEFICIENCY
MISCELLANEOUS
PICA (CONSUME LAUNDRY STARCH, ICE AND
SOIL CLAY)
MASSIVE HEPATOSPLENOMEGALY
POOR WOUND HEALING AND BLEEDING
DIATHESIS
ZINC DEFICIENCY
LEAD INTOXICATION
PSEUDOTUMOR CEREBRI

DIAGNOSI
S
IN INFANTS: HIGH INDEX OF
SUSPICION

1.PREMATURITY
2.BLOOD LOSS
3.FED EXCLUSIVELY ON MILK
4.CHRONIC DIARRHEA

PREVENTION
1.ADMINISTRATION

OF IRON TO
EXPECTANT MOTHERS
2.EARLY INTRODUCTION OF SOLID
FOOD
3.SUPPLEMENTAL IRON : 1O 15 MG
OF ELEMENTAL IRON / DAY ( 6 -8
WKS OF AGE )

TREATMENT OF IRON
DEFICIENCY ANEMIA

DETERMINE THE CAUSE

CORRECT THE
ABNORMALITY

SPECIFIC TREATMENT
OF IRON DEFICIENCY
ANEMIA

1.ORAL SUPPLEMENTATION
2.PARENTHERAL IRON
REPLACE MENT

TREATMENT
( ORAL IRON )

ORAL FERROUS SULFATE: 6

MG/KG/DAY (68 WKS AFTER

NORMAL HGB VALUE IS
ATTAINED)
OLDER CHILDREN: 1OO
2OOMG/DAY
OF ELEMENTAL
IRON

POOR RESPONSE
TO ORAL IRON

NONCOMPLIANCE
ONGOING BLOOD LOSS
INSUFFICIENT DURATION OF
THERAPY
HIGH GASTRIC pH
INHIBITORS OF IRON
ABSORPTION/UTILIZATION
INCORRECT DIAGNOSIS

INHIBITORS OF IRON
ABSORPTION

LEAD INTOXICATION

ALUMINUM INTOXICATION
(HEMODIALYSIS)

CHRONIC

INFLAMMATION

NEOPLASIA

PARENTHERAL IRON
REPLACEMENT
INDICATIONS

1.POORLY

TOLERATED ORAL IRON

2.RAPID REPLACEMENT

IRON

STORES

3.GI

IRON ABSORPTION IS
COMPROMISED

IRON DEXTRAN

ADMINISTERED BY

IM

OR IV

ROUTE
Z- TRACK INJECTION TO
MINIMIZE SC LEAK
10 -15 % - TRANSIENT
ARTHRALGIA
RETICULOCYTOSIS IN IO DAYS
COMPLETE CORRECTION IN 3 -4
WKS

TREATMENT
( BLOOD TRANFUSION )
INDICATION :

SEVERE ANEMIA

DEBILITATED FROM INFECTION

SIGNS OF CARDIAC
DECOMPENSATION

EFFECT ON THE FETUS

OF MATERNAL IRON
DEFICIENCY
MATERNAL IRON
STATUS DETERMINES
THE IRON STORES OF
THE NEONATE .

" AN OUNZE OF
PREVENTION IS BETTER
THAN A POUND OF CURE .
"

SYSTEMIC DEFECTS
IN IRON DEFICIENCY
ANEMIA OF CHRONIC
INFLAMMATION:

1.INEFFECTIVE IRON UTILIZATION

2.LOW PLASMA
LEVELS

ERYTHROPOIETIN

CONSEQUENCES OF IRON
OVERLOAD

1.HEART
2.LIVER
3.ENDOCRINE