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IRON DEFICIENCY ANEMIA

Endang Windiastuti

Hematology Oncology Subdivision

Dea!tment o" C#ild Healt#

$nive!sity o" Indonesia

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% &!otein

% 'itamin Folic Acid( ) *+ Hematooiesis

% Mine!al , Cooe!( I!on

commonest 

  De"iciency Anemia

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-ISS$E DIS-RI)$-ION AND F$NC-ION OFIRON

&!otein -issue.cells -otal body Function o" i!on/01 comound

Hemoglobin  Red blood cells 22 O+ t!anso!t by blood

Myoglobin Muscle *3 O+ t!anso!t in muscle/non4en5 muscle !oteins1 

Heme en5ymes All cells * O+ t!anso!t( utili5ati4

/cytoc#!om(   on 6 consumtion in all

 o7ido !eductase1    cells

Non #eme i!on All cells 8 O+ t!anso!t( i!oncomounds   !ese!ves in all cells

Fe!!itin 6 9ive!(sleen *3 I!on sto!age

Hemoside!in  Ma!!o:

-!ans"e!!in &lasma 6 e7t!a vasc ;

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DISTRIBUTION of IRON

Ferrt & Hemosd

Myoglb

Cytochr, transfr,Catals

Hemoglobin

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IRON ABSORPTION (%)

0 5 10 15 20 25

Meat

Fish

Peanuts

corn

Spinach

Rice

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Absotion o" Food I!on

  HEME NON HEME

'it C

Suga!s  Amino A

Meat

HCl ytates

Ca( &O=

Fibe! 

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Three Stages of Iron Deficiency

  Deletion I!on De" I!on De"

  I!on Sto!es Anemia /41 Anemia/>1

  Se!um Fe!!itin

  -!ans"e!!in  Satu!ation

  E!yt#!ocyte

  &!otoo!#y!in

  Hemoglobin

  MC'

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&RE'A9ENCE o" IRON DEFICIENCY

  Age

 Neonates Pre-school School  Stage

  1 year 1-5 years -1! years

  No

  " - - 1 1

  "" - #1 1! !$

  """ % 15 1& !#

  'otal % ! #$ %

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E-IO9O?Y o" IRON DEFICIENCY ANEMIA

*< NEONA-ES /unde! * y!

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Etiology o" I!on De"< Anemia /at#ogenesis1

*< Deletion o" I!on sto!age% &!ete!m baby

% ?ameli

% &!egnant mot#e! :it# i!onde"< Anemia

% Hemo!!#age in "etus

+< 9o: i!on inta@e

% )aby doesnt consumesu""icient dieta!y i!on

% Food :it# less Fe #eme3< Inc!ease demand

% Raid g!o:t#

% Acute.c#!onic in"ection

=< Malabso!tion% Dia!!#ea% Malnut!ition

8< E7cessive bloodloss% C#!onic

gast!ointestinal

bleeding% Meno!!#agia2< Combination

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Clinical Mani"estation o" I!on De"iciency

% Anemia% Fatigue 6 ca!diovascula! symtoms /tac#yca!dia( alitation(

di55iness( dysnoe 1  Decomensatio co!dis

% Eit#elial mani"estations , nails  Boilonyc#ia

% -ongue 6 mout# , Absence o! "latte!ing o" aillae o" t#etongue

% S@eletal c#anges , Reta!ded s@eletal g!o:t# 6 develoment

-#e most imo!tant ,

&syc#omoto! delay in in"ants 6 young c#ild!en

Imai!ed :o!@ e7e!cise tole!ance and e!"o!mance in olde!individuals

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  Mono7idase  no!eine#!ine   i!itable

 ti!o@sin  sc#ool e!"o!mance

  Alde#ido7idase  muscle concent!ation

IRON   se!otonin 

  Cytoc#!ome o7idase   i@a 

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9eu@ocyte and 9ym#ocyte "unction

IRON 

  bacte!icide o" neut!o#il

in"ection

  lym#ocyte -

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MANA?EMEN- o" IRON DEFICIENCY

*< Dete!mine t#e unde!lying cause<

+< -otal body i!on /i!on sto!es1 must be !elenis#ed<

Oral IRON Therapy :

- Effective dose for children :

1-2 mg elementary iron/kg !

Response of therapy :First hematologic response : reticulocyte ↑

 (7-10 day after therapy)

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PREVENTION of IRON DEFIIEN!

% &RIMARY &RE'EN-ION<

 &a!ents can !event t#ei! in"ants by !oviding adeuatesou!ces o" i!on

 I!on sulement Healt# education 6 sanitation<

% SECONDARY &RE'EN-ION

 Selective sc!eening "o! i!on de"iciency anemia

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CONC9$SION

Iron "eficiency ane#ia is associate" $ith ong

asting effects on infant "e&eo'#ent $hich #aynot e easiy reser&e" e&en $ith iron thera'y*