Iron Deficiency Anemia with Pregnancy Flashcards
WHO hemoglobin range to diagnose anemia
- below 120 g/l in nonpregnant women. (12 g/dl)
- below 110 g/l in pregnancy. (11 g/dl)
Percent of pregnant women experience Anemia
30% of nonpregnant women
40% of pregnant women experience anaemia.
The most common cause of anaemia worldwide is
iron deficiency, accounting for at least 50% of cases.
Why iron is important for human body
- DNA synthesis
- cell proliferation
- energy production, because it has a unique ability to mediate electron transfer (either reduction or oxidation) in enzymatic reactions.
Where is iron located in the body
- About 2/3 of the body’s iron is found in haemoglobin
- the remainder stored as ferritin and hemosiderin in the liver and reticuloendothelial system.
How is iron levels regulated
- is controlled by hepcidin, a peptide hormone mainly synthesised in the liver.
- Hepcidin is crucial for regulating gut iron absorption and erythrocyte recycling.
What affect levels hepcidin
- It increases in response to high circulating and tissue levels of iron.
- it decreases in tissue hypoxia, iron deficiency and increased erythropoietic activity as a result of inhibited transcription.
Iron distribution
3–4 g total body iron
* 1–2 mg iron is lost daily.
* 1 mg is lost during menstruation each month.
* Absorption in the gut is limited to 1–2 mg/day to replace iron loss, but can increase at times of need.
* Recycling of haem from aged erythrocytes generates approximately 40–60 mg iron/day, which is key to maintaining iron requirements.
What happens if iron has been taken up by enterocytes but is not required?
hepcidin prevents entry of iron into the circulation by reducing the expression of ferroportin, Iron therefore remains in the enterocyte and is lost when these cells are sloughed off.
What is ferroportin?
transmembrane protein that transports iron from the inside to the outside of a cell.
Hepicidin action in acute blood loss
If there is acute blood loss, hepcidin production decreases, which increases importation of iron by ferroportin
What is Hepicidin
5-amino acid peptide hormone that regulates iron uptake and release from stores in response to circulating and tissue levels of iron.
main storage protein for iron
Ferritin
Found in all cells and bodily fluids, the highest concentration being found in hepatocytes.
Blood loss effect on iron
For every millilitre of blood
lost, 0.5 mg iron is lost.
In postmenopausal women, the most common cause of anaemia is
blood loss from the gastrointestinal tract.
In premenopausal women from high-income countries, the most common cause of iron deficiency and iron-deficiency anaemia is
menstrual blood loss
HMB accounts forwhat percent of cases of iron-deficiency anaemia
20–30%
FIGO PALM-COEIN classification for abnormal uterine bleeding
Structural causes:
● P – Polyp
● A – Adenomyosis
● L – Leiomyoma
● M–Malignancy and hyperplasia
Unrelated to structural abnormality:
● C – Coagulopathy
● O – Ovulatory dysfunction E – Endometrial
● I – Iatrogenic
● N – Not otherwise classified
obese women may be at risk of iron deficiency and iron-deficiency anaemia through
locally produced proinflammatory cytokines from obese adipose tissue.
The recommended daily intake of iron for women in their reproductive years is
18 mg/day
although the median is 12 mg to combat loss due to menstruation.
Pregnancy iron requirement
1200 mg
What is maternal erythrocyte mass
increase in pregnancy
from 350 ml to 450 ml.
Classic symptoms of iron deficiency and iron-deficiency anaemia include
- fatigue
- weakness
- irritability
- hair loss
- poor concentration
● Furthermore, shortness of breath on exertion, palpitations, tongue discomfort, disturbance of taste, pruritus, headaches and tinnitus can occur.
Symptoms of severe iron deficiency including
- shortness of breath at rest
- angina
- ankle oedema
Severe deficiency typically appears at what Hb level
when haemoglobin is less than 70 g/l, unless there is coexisting cardiorespiratory disease.
Signs of iron-deficiency anaemia include
- pallor
- koilonychia (spoon-shaped nails with longitudinal ridges)
- angular cheilitis (ulceration at the corners of the mouth)
- atrophic glossitis (loss of tongue papillae, tongue typically appears dark red).
Sever iron deficiency anemia cardiac signs
- tachycardia
- cardiac murmur
- cardiac enlargement
- ankle oedema
- heart failure
All can be detected
What is iron deficiency
A relative or absolute depletion of body iron. Stores are particularly affected and inadequate to maintain the demands for erythropoiesis
What is iron deficiency anemia
Reduced amount of haemoglobin or number of erythrocytes because of insufficient iron for erythropoiesis
What is Iron-restricted erythropoiesis
Reduced supply of iron for erythropoiesis, irrespective of iron stores
Iron-restricted erythropoiesis
Reduced supply of iron for erythropoiesis, irrespective of iron stores
Functional iron deficiency
Erythroid iron not readily accessible despite increased requests and apparently adequate body iron stores. Associated with chronic disease, inflammatory conditions and malignancy
Ferric iron (Fe2+) and ferrous iron (Fe3+)
non-haem iron from cereal and vegetable sources contains ferrous and ferric forms of iron.
The ferrous form is better absorbed from the gut therefore the ferric iron is reduced to ferrous iron by stomach acid, ascorbic acid and enzymes.
What is transferrin
Iron-binding protein mostly produced by the liver which acts as an intercellular transporter for iron. Approximately 3 mg total body iron is bound to transferrin at any one time.
anaemia for those living at sea level
HB < than 130 g/I in men
< 120 g/I in women aged 15 y and over
<110 g/I in pregnant women.
Blood profile of Iron deficiency
microcytic, hypochromic red cells
reduced mean corpuscular volume reduced mean corpuscular haemoglobin.
Most reliable indicator for iron deficiency
Serum ferritin
in the absence of inflammation or chronic disease.
Serum ferritin level that indicates iron deficiency
Serum ferritin levels <15 ng/ml (33.70 pmol/I)
Antenatal care screening fir iron deficinecy
At booking and 28 weeks
Serum ferritin levels during pregnancy
Ferritin rises initially and then gradually declines as pregnancy continues so that by 32 weeks levels are 50% less than prepregnancy levels.
Treatment should be instigated when levels fall below 30 mcg/I.
Mild iron deficiency anemia
Non pregnant: 110-119
Pregnant: 100-109
Moderate iron deficiency anemia
Non pregnant: 80-109
Pregnant: 70-99
Severe iron deficiency anemia
Non pregnant: <80
Pregnant:<70
