Iron Deficiency Anemia

Iron Deficiency Anemia

Most common cause ofanemia amongstwomen of child-bearing age and in particular pregnant (51%)

Definition; Iron deficiency anemia is a low serum ferritin concentration of <30 μg/l and Hb <11.0, 10.5 and 11.0 g/dl in 1st, 2nd, and 3rdtrimesters respectively. RBCs aremicrocytic and hypochromic.

Causes of IDA: an increase in iron

requirements, inadequate iron absorption, or both.

Causes of increasing requirements of iron requirements:

• Growth

• Menstruation

• Blood loss/donation

• Pregnancy

• Hemolytic disorders

• Drugs that cause hemolysis (e.g. antiretrovirals)

• Genitourinary tract infections

• Hookworm infestation

Causes of inadequate iron absorption:

• Diet low in hem iron

• Malabsorption

• Gastric surgery

• Malaria infection resulting in poor use

of dietary iron.

Phatho-physiology; iron carries oxygen from the lungs (hemoglobin)to the tissues in thefacilitating O2 use in musclessuch as myoglobin, and also transportation of cytochromeswithin cells for enzyme reactions in tissues.

Total body iron (female)2.3 g; 80% is found in RBC mass as hemoglobin

(Hb). Iron intake,loss, andstorage determine the total body iron.

Unused iron is stored asferritin,

soluble protein complex, present primarily in theliver, bone marrow, spleen and skeletal muscle.

Normalabsorption of iron is required to maintain the balance between functionaliron (Hb) and stored iron (myoglobin) levels.

GI absorbs 1–2 mg iron daily from the diet. The amount of iron stored in the body and thetype of iron in one’s diet are the main factors controlling ironabsorption.

Anemia can results in decreased blood capacity of oxygen-carrying.

Clinical S&Sx; mild tiredness------palpitations, breathlessness, cardiac failure.

Measurement of iron; Hb haematocrit

and ferritin concentration.Mean cell volume (MCV) isalso important as it falls in iron deficiency, but needs further

testing to distinguish from other causes of microcytosis.

Serum Ferritin Concentration, an early and most specific indicator of the statusof iron stores and its depletion.If the level ≤30 μg/l, it confirms iron deficiency among women who has low Hb and Hct. Serum ferritin can be raised in infection.

Normallevels in pregnancy (30–50) may

still indicate iron deficiency.

Complications:

• Palpitations

• Tiredness

• Irritability

• Depression

• Breathlessness

• Poor memory

• Muscle aches

• Poor appetite

• Cardiac failure

• Increased vulnerability if small amounts of blood are lost

Non-Pregnancy Treatment And Care

Iron-rich diet and iron supplementation

60–120 mg/day for four weeks

CBC and serum ferritin concentration. Conditions; thalassaemia cause mild

anemia unresponsive to iron therapy. The normal Hb level may be 10 g/dl, however the lowestnormal Hb in healthy non-pregnant women is defined as

12.0 g/dl2.

Iron absorption can be increased in a vegetariandiet by careful planning of meals to include other sources of

iron and enhancers of iron absorption.

Pre-Conception Issues And Care

A non-pregnant woman of reproductive age has an averageiron requirement of 1.3 mg/day.

This increases whenpregnant by an extra requirement of 3.0 mg/day mainly forincreases in maternal red cell mass, placental and fetalgrowth, blood loss at delivery, physiological intestinal bloodloss and menstruating loss over the child-bearing years.

A further iron requirement of 6–8 mg/day occurs after 32weeks’ gestation.

Avoid food that interfere with iron deficiency; tea, bread and chapatti.

1