Iron deficiency anemia

Iron deficiency anemia

1. Epidemiology

   • children < 5 years 43%
   • pregnant women 38%
   • general population 32.9%
   • man between 15 - 60 years 12.7%
   • children in scholar age 25.4%
   • women between 15 - 49 years 29%

2. iron deficiency could be:

   • functional
     • body reserves are normal or elevated but the medular supply is deficient
     • present in some acute or chronic affectation
   • absolute
     • all body reserves are diminished

3. clinical presentation

   • very frecuent
     • paleness (45-50%)
     • fatigue (44%)
     • dyspnoea
     • headache (63%)
   • frecuent
     • alopecia (30%)
     • anthropic glossitis (27%)
     • restless legs syndrome (24%)
     • cardiac murmur (10%)
     • tachycardia (9%)
     • neurocognitive dysfunction
     • angina pectoris
   • rare
     • hemodynamic instability (2%)
     • syncope (0.3%)
     • plummer-vinson syndrome (<0.1%)

4. risk factors

   • physiological
     • infancy
     • adolescence in girls
     • pregnancy
     • regular blood donation
   • pathological
     • blood loss
     • malabsorption
     • anemia of chronic disease
     • genetic disorders

5. diagnostic investigation

   • HCM, VCM
   • Zinc protoporphyrin
   • bone marrow aspiration
   • serum ferritin, iron serum, ferritin saturation
   • haemoglobin value man <130; women < 120
   • serum ferritin boy: 12 to 300 ng/ml; girl 12 to 150 ng/ml

6. pathophysiology

   • iron function
     • essential component of haemoglobin red blood cells and of myoglobine in muscles
     • enzymatic processes, DNA syntesis, mitochondrial energy generator
     • hepcidine
       • control of iron availability to tissues
   • haem iron
     • animal food sources
   • non haem iron
     • vegetarian food sources
   • body contains 3-5 g of iron; 20 to 25 mg is needed daily for production of red blood cells and celular metabolism
     • dietary intake is limited 1 to 2 mg per day

7. iron supplementation

   • daily iron supplementation
     • 0-5 years =2 mg/kg/daily
     • 5 to 12 years = 30mg/kg/daily
   • 4 common iron supplementation
     • ferrous sulphate
     • ferrous sulphate exssicated
     • ferrous gluconate
     • ferrous fumarate
   • monthly measurement for 3 months and then 3 measurements a year
   • absorption enhancers