IRON DEFICIENCY ANEMIA

• Hypochromic anemia can be due to iron deficiency.
• Commonest nutritional deficiency disorder throughout the world is iron deficiency.
• Storage form of iron is serum ferritin (Fe⁺³) in liver, spleen, bone marrow.

Iron Metabolism-

• Heme iron is better absorbed than non heme iron.
• Heme iron enters mucosal cells and non heme iron is first reduced to ferrous iron and then absorbed in duodenum.
• Then, it is transported inside enterocytes via apical transport called DMT1 (divalent metal transporter 1).
• Absorbed iron transported to basememnt membrane which requires ferroprotein & Hephaestin for conversion of ferrous to ferric form.
• Iron hemostasis is regulated by Hepacidin which degrades to ferroprotein & iron absorption.
• This iron taken up by transferring will be delivered to bone marrow & hepatocytes.
• Finally ferric iron will be utilized for maturation of erythroid precursors.
• DMT1 also facilitates uptake of cadium & lead.

Iron excretion-

• Amount of iron lost per day- 0.5 – 1 mg.

Pathogenesis-

• Increase blood loss
• Increase requirements
• Inadequate dietry intake
• Decreased intestinal absorption

Factors affecting iron absorption- 

Clinical Features-

• Anaemia
• Weakness, fatigue, pallor of skin
• Menorrhagia
• Koilonychia
• Atrophic glossitis
• Angular stomatitis
• Plummer Vinson syndrome

Lab findings-

• Anaemia- iron level indicated by reticulocytosis
• Haemoglobin decreased
• RBC- hypochromic & microcytic
• Anisocytosis & poikilocytosis
• Reticulocytes count is normal.
• MCV, MCH, MCHC-  reduced.
• WBC count is normal.
• Platelets count normal.

Bone marrow findings-

1. Marrow cellularity increased
2. Erythropoiesis- micronormoblasts
3. Iron staining on bone marrow aspirate shows decrease iron stores (Prussian blue reaction)

Biochemical findings-

1. Serum level decrease
2. TIBC increase
3. Serum ferrritin decrease
4. Red cell protoporphyrin decrease
5. Serum transferring receptors protein increased. (STFR to log of ferritin) 

Treatment-

• Correction of iron deficiency.

Oral therapy-

1. Oral iron salts (0-3 months)- 100- 150 mg
2. Parentral therapy- Iron dextran may be given IM or IV.

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