Anaemia iron deficiency

Clinical Knowledge Summaries (2008) Anaemia - Iron deficiency Available at http // www.cks.library.nhs.uk/anaemia iron deficiency/view whole guidance [Accessed 4 July 2008],... 

Aapro M, Osterborg A, Gasc6n P, Ludwig H, Beguin Y. Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron. Ann Oncol 2012 23(8) 1954-62. 

The use of farrowing crates is prohibited for organic producers, and so are routine teeth cutting and the automatic use of iron injections. However, a protective rail, farrowing box or nest is recommended, and teeth cutting for individual piglets or a litter when necessary to prevent injury to the sow is permitted, and so are iron injections for anaemia in the case of iron-deficient soils or chronic anaemia in free range systems. 

Fluxes of iron from the plasma towards BM and other tissues can be quantified by ferrokinetic studies, using 59Fe and sophisticated computer models (Ricketts et ah, 1975 Ricketts and Cavill, 1978 Barosi et ah, 1978 Stefanelli et ah, 1980). Plasma iron turnover (PIT), erythroid iron turnover (EIT), non-erythroid iron turnover (NEIT), marrow iron turnover (MIT), and tissue iron turnover (TIT) could be calculated in many disorders of iron metabolism and in all kinds of anaemias. Iron is rapidly cleared from the plasma in iron deficiency and in haemolytic anaemias. If more iron is needed for erythropoiesis, more transferrin receptors (TfR) are expressed on erythroblasts, resulting in an increased flux of iron from intestinal mucosal cells towards the plasma. In haemolytic anaemias MPS, and subsequently hepatocytes, are overloaded. In hereditary haemochromatosis too much iron is absorbed by an intrinsic defect of gut mucosal cells. As this iron is not needed for erythropoiesis,... 

SFT (Gutierrez et al., 1998) Stimulator of iron transport in endosomes (Fe(II) and Fe(III)) 7 Mild iron-deficiency anaemia ... 

Sla (Anderson Transport of iron sla mice (Manis, 1971 Iron-deficiency anaemia ... 

IREG1 (McKie et al., 2000) Transport of iron across intestinal basolateral membrane 7 Iron-deficiency anaemia... 

Iron-deficiency anaemia results from a discrepancy between iron availability and the amount required for production of red blood cells. The causes of acquired iron deficiency in so-called underdeveloped and developed countries must be differentiated. In underdeveloped countries, the main causes of iron deficiency are (a) the poor availability of iron in the diet due to low haem and high fibre and phytate content (D Souza et ah, 1987), and (b) chronic blood loss due to hookworm, schistosomiasis and malaria (Stoltzfus et ah, 1997 Olsen et ah, 1998 Dreyfuss et ah, 2000). Inflammation and vitamin A deficiency often interfere with the above causes of iron deficiency, causing a mixed type of anaemia. In underdeveloped countries diet improvement, iron fortification of natural foods and eradication of parasites will have a much higher impact than will refinement of diagnostic procedures and therapy of iron-deficiency anaemia. 

Various malignancies can also induce an anaemic state. This is often associated with decreased serum EPO levels, although iron deficiency, blood loss or tumour infiltration of the bone marrow can be complicating factors. In addition, chemotherapeutic agents administered to this patient group often adversely affect stem cell populations, thus rendering the anaemia even more severe. 

Clearly this patient has both clinical and haematological symptoms of severe anaemia. The cause is too few red cells low RBC count and PCV but the erythrocytes which are present contain a higher than usual concentration of haemoglobin (MCHC result). Iron deficiency and vitamin B12 deficiency can be ruled out by the high serum ferritin and normal MCV results respectively. The negative HbS screen rules out sickle cell anaemia which is fairly common in Africans. 

Hypochromic and microcytic cells Iron deficiency Sideroblastic anaemia Thalassaemia and haemoglobinopathy... 

Singh K, Fong YF, Kuperan P. A comparison between intravenous iron polymaltose complex (Ferrum Haus-mann) and oral ferrous fumarate in the treatment of iron deficiency anaemia in pregnancy. Eur J Haematol 1998 60 119-24. 

Anaemia is the decrease in number of red blood cells or hemoglobin content caused by blood loss, deficient erythropoiesis, excessive hemolysis, or combination of these changes. Iron deficiency anaemia is probably the most common nutritional deficiency in the world. It is estimated that at least 500 million people are affected. Iron deficiency anaemia is much more common in developing countries, as people are consuming too little food or a limited variety of food. 

After confirmation of iron deficiency iron therapy can be given by oral or parenteral route. Generally oral iron therapy is given unless the patient is suffering from severe anaemia, malabsorption syndrome, gastrectomy or patient is showing adverse effects to oral iron therapy. 

Nutritional iron deficiency anaemia other causes in which iron deficiency can occur are pregnancy, lactation, infants, children. In patients with malabsorption syndrome, patients who are taking NSAIDs for long period, patients with chronic inflammatory disease and in patients of gastrectomy. 

Cook JD Diagnosis and management of iron-deficiency anaemia. Best Pract Res Clin Haematol 2005 18 309. 

Following their earlier work69 on iron(III) acetohydroxamate as a suitable iron source in iron-deficient anaemia, Brown et al.10 have carried out a detailed comparative structural and spectroscopic study of the complexes of Fem, Co11, Ni11 and Cu11 with aceto-, propiono-, benzo-, AT-methyl-... 

The insertion of ferrous iron into the porphyrin ring in the biosynthesis of heme is catalyzed by the enzyme ferrochelatase. A deficiency in ferrochelatase activity results in an accumulation or the excretion of unchelated protoporphyrin in patients with erythrohepatic protoporphyria. Ferrochelatase catalyzes the synthesis of a range of metalloporphyrins,628 and, for example, produces zinc protoporphyrin in erythrocytes of patients with iron-deficiency anaemia. 

Most of the iron in the body is in the form of haemoglobin in red blood cells and myoglobin in muscle. The remainder is in the liver, spleen and other tissues. Haemoglobin is essential for the proper functioning of every organ and tissue of the body. Iron has a rapid turnover rate in the chicken therefore, it must be provided in a highly available form in the diet on a daily basis. Iron deficiency can result in microcytic, hypochromic anaemia in poultry. Any internal infection such as coccidiosis can also interfere with iron absorption and lead to a deficiency. 

The GP performs a blood count and the results show that she has iron-deficiency anaemia. 

Case study level 1 - Iron-deficiency anaemia - see page 218... 

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