Iron

Hertanto W Subagio
 Sources
• Heme iron
- animal ( ± 30%)
• Non Heme iron
- vegetable, legumes etc.
Internal cycle of iron
 Absorption
Increase Decrease
- Acid in stomach - Phytic acid (dietary
- Heme iron fibre)
- High body demand - Oxalic acid
- Low body stores of iron - Polyphenols (tea,
- Meat protein factors coffee)
(MPF) - Full body stores of iron
- Vit C (converts ferri to - Excess of other
ferro) minerals (Zn, Mn,Ca)
- Reduction in stomach
acid
- Antacid

iron status regulated through absorption

 Transport

- Transferrin is a protein that transports iron in the blood

- When iron stores are adequate all iron binding sites are saturated
-Transferrin can be used as an indicator of overload or deficiency
- Almost all cells in the body have transferrin receptor (TfR)
- Serum soluble Tfr (sTfR) is a good indicator of deficiency.
Sintesis Hemoglobin
 Storage
 Ferritin is the primary store of iron
 Iron not taken up by transferrin is stored as ferritin in
the intestinal wall (short term store)
also stored in the liver and spleen as ferritin
 Hemosiderin is a stable iron-protein compound in the
liver that stores iron when iron exceeds the storage
capacity of ferritin.
 Iron Losses

 average iron loss of 1 mg / day in men and post menopausal

women
 sweat and urine = negligible
 exfoliation of the skin and GIT
 menstruation
 Deficiency and excess

Deficiency Excess

 IDA – high prevalence  Haemochromatosis –

 Reduced cognitive genetic disorders
functioning
 Fe deposits cause cell
 Reduce capacity for
damage in pancreas, liver
physical work
and heart
 Increased maternal
mortality  Leads to diabetes, liver and
 Stages : heart failure
normal- depletion of
storage- IDE – IDA.
Tahap deplesi besi dan indikatornya
 Public health programs

 supplementation
 fortification
 dietary modification
 food processing :
reduce inhibitory factors
 education
Elements of successful iron supplementation
programs
Fig.1. Elements of successful iron supplementation programs

Policy making

Tablet Supply Delivery System Consumer demand

Adequate budget Accessible to Good Quality

Data Base Target group Supplements
Ordering number Motivated, Well- Communications
In target group + Trained To educate Public
25% surplus Approachable and Promote
Timely ordering staff Program
Distribution
System

Coverage Compliance

Do intended Do recipients take

Recipients get the supplements
Supplements?

Impact

Reduction of Iron
Deficiency anemia

Monitoring and Evaluation

 Broek dan Lestky 2000

Among anemic pregnant women only 53%

showed biochemical evidence of iron
deficiency.
That is the maximum proportion of people
among whom anemia could be expected to
respond to the administration of iron
Perubahan Hb selama kehamilan