Enaam Hussein, PhD

Anemia classification based on the

morphology
1. Microcytic hypochromic:
Group of anaemias that characterized by
reducing red cell indices, due to defect in
haemoglobin synthesis.

2.................
3..................
 Microcytic anaemias classified in to:
Haemoglobin

Haem Globin
1. Thalassemias

Iron Protoporphrin ring

2. Iron deficiency anemia 4. Sideroblastic anemia
3. Anemia of chronic disease
 The Cause of Hypochromic Anemia
Iron Protoporphyrin

• Iron deficiency
• Chronic inflammation • Sideroblastic anemia
or malignant

Heme + Globin

• Thalassemia

Hemoglobin
Microcytic hypochromic anaemias mainly
include:-
 1...........................
 2...............................
 3.................................
 4.....................................
Iron intake (dietary)
 2+ 3+
• To accept & donate electron (Fe Fe )

• Component of cytochromes

•Oxygen-binding molecules

• Cell growth,proliferation, differentiation

• Damage tissues
Fe2+ Fe3+

H2 O2 OH
• Iron metabolism
• Iron distribution & transport
• Dietary iron
• Iron absorption
• Iron requirements

• Disorders of iron metabolism

• Hypochromic anemia
• Iron distribution & transport
• transferrin, transferrin receptor
3+
• ferritin , hemosiderin (Fe )
• myoglobin, iron-containing enzymes

• Dietary iron
• Iron absorption
• Iron requirements
Body iron distribution and transport
The transport and storage of iron is largely
mediated by three proteins:-
 Transferrin
 Transferrin receptor
 Ferritin
Dietary iron
Dietary iron

 Present in food as:-

 ferric hydroxide
 ferric protein complexes
 Haem protein complexes
 DIETARY SOURCES OF IRON

Inorganic Iron eg Organic iron eg beef

lentils

Daily iron requirement:

-10-15mg/day (5-10% absorbed)
-Can increase to 20%-30% in iron deficiency or pregnancy
IRON ABSORPTION
 organic dietary iron is partly absorbed as
haem and partly broken down in the gut to
inorganic iron
 Absorption occurs in duodenum mainly and
is favoured by factors to keep iron in ferrous
 Iron combines with apoferritin to form
ferritin and then absorbed through villi
ABSORPTION OF IRON

Enterocyte Gut
Fe+++
Ferritin
Tf- Fe++
Fe++
Fe+++ Fe++
Haem
Tf
GI Absorption of Iron
Factors favouring iron absorption
1- Ferrous form
2- Inorganic iron
3- Acid;Hcl and Vit.C
4- Solublizing agents; sugars and amino acids
5- Iron defiency
6- Increased erythropoiesis
7- Pregnancy.
8- Primary haemochromatosis.
Factors reducing absorption

1- Ferric form.
2- Organic form.
3- Alkalis; antacids, and pancreatic secretions.
4- Precipitating agents; phytates and phosphate
5- Iron excess
6- Decreased erythropoiesis
7- Infections (D.t. decrease utilization)
8- Tea
9- Desferroxamine.
Iron Transport
 The majority of non-heme Fe in plasma is bound to a
beta-globulin protein called transferrin.
Transferrin:
Delivers iron to tissues which have transferrin receptors
(B.M erythroblast)
 Carries Fe from mucosal cell to RBC precursors in
marrow
 Carries Fe from storage pool in hepatocytes and
macrophages to RBC precursors in marrow
Iron transport
 At the end of RBCs life, RBCs are broken
down in macrophages (MQs) of RES.
 The iron released from Hb , enters plasma
and provides most of iron on transferrin.
 Only small amount of plasma transferrin
iron comes from dietary iron after
absorbstion
 IRON STORAGE
Some iron is stored(ferric form) in RES as:-

1. Ferritin

2. Haemosiderin
 Ferritin
 Water- soluble protein –iron complex
 Made up of an outer protein shell , apoferritin
and ferric iron (iron-phosphate- hydroxide
core)
 20% of its weight is iron
 Not visible by light microscopy
Cont. Ferritin
 It is found in blood, tissue fluids, and
cells.
 Hepatocytes are main site of ferritin
storage
 Minute quantities are present in plasma in
equilibrium with the intracellular ferritin.
 Hemosiderin
 An insoluble protein iron-complex
 Contains about 37% of iron by weight
 Derived from partial lysosomal digestion of
aggregates of ferritin molecules
 Visible in macrophage by light microscopy.

bone marrow film stained for haemosiderin

Cont. Haemosiderin
 Found in macrophages and assessed by staining
bone marrow with Prussian Blue stain.
Tissue iron
 Muscles (myoglobin)
 Most cells of iron containing enzymes(e.g
cytochromes)
This tissue iron are less likely to become
depleted than haemosiderrin, Ferritin and
Hb in iron deficiency
Con.
 The level of ferritin and transferrin receptor
(TfR) are linked to iron status so:-
 Iron overload causes a rise in tissue ferritin
and a fall in TfR ,whereas in iron deficiency
ferritin is low and TfR increased .
 When plasma iron and transferritin
saturated, the amount of iron transferred to
parenchymal cells (Liver,..)is
APPROXIMATE DISTRIBUTION OF
BODY IRON IN A MAN

Hemoglobin 2000mg
Storage Iron 1000mg
Myoglobin iron 130mg
Labile Pool 80mg
Other tissue Iron 8mg
Transport Iron 3mg
Body Iron Distribution and Storage
Duodenum Dietary iron
(average, 1 - 2 mg
Utilization Utilization
per day)

Plasma
transferrin (TIBC)
(3 mg)
Bone
Muscle marrow
(myoglobin) Circulating (300 mg)
(300 mg) erythrocytes
Storage
iron (hemoglobin)
(Ferritin) (1,800 mg)

mucosal cells
Desquamation/Menstruation
Liver Other blood loss
(1,000 mg) (average, 1 - 2 mg per day) Reticuloendothelial
macrophages
Iron loss (600 mg)
 BODY IRON DISTRIBUTION
A. Metabolically Active Iron:
 Haemoglobin.
 Serum” iron bound to a protein transferrin in
blood.
 Tissue Iron: in cytochromes and enzymes.
 Myoglobin: oxygen reserve in muscles.
B. Storage Iron:
Ferritin
Haemosiderin:
C. Transport Iron:
Transferrin.
Estimated daily iron requirements, Units are mg/day

Adult men 0.5-1

Postmenopausal female 0.5-1

Menstruating female 1-2

Pregnant female 1.5-3

Children 1.1

Female (age 12-15) 1.6-2.6