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MINERALS

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 MAJOR ELEMENTS IN LIVING MATTER
1. Carbon
2. Hydrogen
3. Oxygen
4. Nitrogen
5. Phosphorus
6. Sulphur
7. Sodium
8. Potassium
9. Chloride
10. Calcium
11. Magnesium

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 TRACE ELEMENTS
1. Iron
2. Zinc
3. Copper
4. Cobalt
5. Iodine
6. Fluoride
7. Chromium
8. Manganese
9. Molybdenum
10. Selenium
11. Vanadium
12. Silicon etc.

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IRON

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 LEARNING OBJECTIVES
Fe⁺⁺
• Functions
• Dietary sources
• Recommended daily intake
• Distribution in the body
• Absorption
• Transport, storage and elimination
• Iron deficiency
• Investigations of Iron deficiency
• Iron overload

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 SOURCES
A. ANIMAL PRODUCTS ( Fe ++ )
1. Liver
2. Meat
3. Fish
4. Eggs
B. PLANT PRODUCTS ( FE +++)
1. Cereal ( Wheat, Corn, Rice )
2. Pulses
3. Soya bean
4. Green leafy vegetables
5. Dried fruit and Fresh fruits
6. Potato

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TOTAL IRON IN BODY
4 grams

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 DISTRIBUTION OF IRON IN THE BODY
TOTAL 4 grams
1. HEMOGLOBIN - 2.5 grams
2. STORES - 1.0 gram
a) Ferritin - 0.7 gram
b) Hemosiderin - 0.3 gram
3. TISSUES - 0.5 gram
a) Myoglobin - 0.32 gram
b) Haem enzymes - 0.08 gram
c) Non Haem enzymes - 0.10 gram

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DAILY IRON METABOLISM

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 DAILY IRON METABOLISM
• DIETARY INTAKE (12mg) → SMALL INTESTINE (1mg) ABSORBED → FECES (11 mg)
↓
PLASMA IRON ( TURNOVER 35 mg ) ↔ TISSUE STORE (1 g)
↑
BONE MARROW ↑ ALL CELLS ↑
↓ (20mg) ↓ (14mg) UTILIZATION
HEMOGLOBIN →↑ DEAD CELLS →↑
(F) ↓ ↓ OUTPUT
MENSTRUAL LOSS DESQUAMATION
(20-30 mg / month) ( SKIN, GIT, URINARY TRACT)
( 1mg )

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DAILY IRON METABOLISM

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 ABSORPTION OF IRON
(DUODENUM AND JEJUNUM 10 %)

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ABSORPTION OF IRON

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IRON METABOLIOSM

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 ABSORPTION OF IRON
(FEEDBACK CONTROL )
1. AMOUNT OF STORED IRON
( ↑ in Pregnancy, Iron deficiency )
2. ACTIVITY OF BONE MARROW
(↑ in Hemolysis, Non Iron deficiency anemia,
Giving Vitamin B12 in pernicious anemia)
3. OXYGEN TENSION IN INTESTINAL CELLS
(↑ in Hypoxia)

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 FACTORS AFFECTING
IRON ABSORPTION
1. FORM OF IRON ( Fe ++ or Fe +++ )
2. INSOLUBLE COMPLEXES OF IRON
( Phytates, Phosphates, Oxalates,
Carbonates, Protein)
3. PROMOTERS OF IRON ABSORPTION
( Vitamin C, Sugar, Citric acid, Amines,
Animal food)
4. ALCOHOL- bleeding ulcers, ↓absorption
5. TEA ( Polyphenols in Tannin)
6. GASTRIC HCl - ↑ Fe absorption
7. MALABSORPTION
8. ACUTE FEVER / CHRONIC INFECTION

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IRON ABSORPTION INCREASES WITH
INCREASED REQUIREMENT

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FACTORS AFFECTING
IRON ABSORPTION

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 TRANSPORT OF IRON
• TRANSFERRIN - 3 – 4 g / l ( 22 – 45 mol/l)

• TIBC - 3.1 – 5.1 mg / l (68-90mol/l)

• PLASMA IRON - 0.8 – 1.6 mg / l

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 IRON STORES
• FERRITIN and HEMOSIDERIN
• LIVER, SPLEEN, BONE MARROW

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IRON STORES

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 DAILY ELIMINATION
• FECES - 90% Dietary Iron -11mg/day
• URINE - Desquamated epithelialcells,
WBC, RBC - 0.1mg/day
• SWEAT - Desquamated skin cells
-0.1mg/day
• MENSTRUAL BLOOD- 20-30mg/month
• PREGNANCY - 400 mg/ pregnancy

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 RECOMMENDED DAILY INTAKE
• 10 mg - CHILDREN UPTO PUBERTY
MEN
POSTMENOPAUSAL WOMEN
• 10-20mg - ADOLESCENTS
• 20mg - WOMEN DURING
REPRODUCTIVE LIFE
• 30mg - PREGNANCY

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 RECOMMENDED DAILY INTAKE
( PAKISTAN )
• < 70% OF RECOMMENDED ALLOWANCE
• SPECIALLY in:-
PREGNANT and LACTATING women
NON PREGNANT ADULT WOMEN
CHILDREN < 5 years old

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 FUNCTIONS OF IRON
A. OXYGEN CARRIAGE :-

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BINDING OF OXYGEN TO A HEME
PROSTHETIC GROUP

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FUNCTIONS OF IRON
B. REDOX REACTIONS

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 FUNCTIONS OF IRON
B. REDOX REACTIONS
• OXIDATIONS:- • REDUCTIONS:-
Intermediary Synthesis of larger
metabolism molecules

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 FUNCTIONS OF IRON
B. REDOX REACTIONS
Cytochromes - b, c1, cc, aa3

• ELECTRON TRANSPORT
CHAIN
• Cytochromes are proteins
containing heme as a
cofactor.
Iron is found in the heme
core
• Cytochrome function:-
reversible redox change
Ferrous (Fe⁺⁺) ↔
Ferric (Fe ⁺⁺⁺)

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 FUNCTIONS OF IRON
B. REDOX REACTIONS
Cytochrome – p450
• Cytochromes P450 are hemeproteins containing heme as a cofactor
• They are the terminal oxidase enzymes in electron transfer chains
• They use a variety of molecules as substrates in enzymatic reactions.

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 FUNCTIONS OF IRON
B. REDOX REACTIONS
Cytochrome – b5
• Cytochromes b5 are ubiquitous electron transport
hemoproteins found in animals, plants, fungi and
bacteria

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 HEME ENZYMES
• TRYPTOPHAN PYRROLASE:-
Converts Tryptophan to Formyl Kynurenine

• PEROXIDASE:-
H2O2 + AH2 → 2H2O + A

• CATALASE:-
2 H2O2 → 2H2O+O2

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 NON HEME IRON CONTAINING
ENZYMES
• NADH Dehydrogenase
• Succinate Dehydrogenase
• Aconitase
• Xanthine Oxidase
• Monoamine Oxidase

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 INVESTIGATIONS
 Plasma iron 0.8-1.6 mg/l
 T.I.B.C 3.1-5.1 mg/l
 Transferrin 3-4 g/l
 Ferritin ≥ 10 ng/ml
 Free Erythrocyte protoporphyrin ≤ 10 μg/dl
 Hemoglobin ≥ 13 g/dl - Men
≥ 12 g/dl - Women
≥ 11 g/dl - Pregnant women and
Children< 6
 Erythrocyte Indices
 Biopsy of Bone marrow, Liver, Spleen
and staining with Potassium Ferricyanide

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INVESTIGATIONS

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 CAUSES OF IRON DEFICIENCY

INCREASED INSUFFICIENT DECREASED

NEED INTAKE ABSORPTION
Adolescence Limited diet Vitamin C deficiency

Menstruation Malnutrition Removal of upper small

intestine
Pregnancy Vegan diet High body stores of iron

Lactation Excess of iron complexes

Cancer Achlorhydria

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 CAUSES OF IRON DEFICIENCY
( Pakistan)
• Heavy Menses
• Repeated pregnancies
• Hookworm infestation
• Late weaning of babies
• Inadequate intake
• Excess of Phytates, Carbonates, Oxalates, Phosphates or
Polyphenols in diet
• Malabsorption
• ↑ Requirement
• Achlorhydria/Partial gastrectomy
• Chronic infections
• Hemorrhage
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Stages of iron deficiency
 Low stores  decreased
ferritin
 Low serum iron  increased
T.I.B.C
 Microcytic hypo chromic
anemia 
decreased Hb
decreased MCV
decreased MCH
decreased MCHC
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 Signs & symptoms of iron
deficiency
 Reversible alterations of cognitive
behavior.
 Decrease attention span & alertness.
 Impaired motor development.
 Decrease physical activity.
 Fatigue, irritability, anorexia.
 Abnormalities in thermo-regulation.
 Low scholastic achievements.
 Low immunological & defensive
response.
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 Signs & symptoms of iron
deficiency anemia
 Easy fatigue.
 Headache.
 Tachycardia.
 Ankle edema
 Exertional dyspnea.
 Inelastic, dry, wrinkled skin.
 Sore, atrophic tongue.
 Angular stomatitis.
 Pallor
 Pica
 Koilonychia
 Dysphagia
 Menstrual abnormalities
 Dry, scanty hair
 Pearly , white sclera
 Functional systolic murmur
 Gastric mucosal atrophy
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 Iron overload
 Iron poisoning.
 Hemochromatosis.
 Nutritional iron overload/Siderosis
 Iron overload
(Non Iron deficiency anemia)

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IRON OVERLOAD

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IRON OVERLOAD

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BRONZE DIABETES

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BRONZE DIABETES

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BRONZE SKIN

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INVESTIGATIONS FOR
HEMOCHROMATOSIS

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