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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*