04-09-2022

Anemia

MICROCYTIC HYPOCHROMIC ANEMIA

‫ طه المجيدي‬:‫اشراف الدكتور‬

Microcytic hypochromic anemia is characterized by decreased the following

.Haemoglobin, PCV, MCV, MCH, MCHC and normal to increased RDW

The peripheral blood smear shows red cells which are smaller in

.size (Microcytic) containing less haemoglobin (hypochromic)

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Causes of microcytic hypochromic anemia

Iron deficiency anemia
Anemia of chronic disorders
Disorders of globin synthesis
)eg. Thalassemia major(
Sideroblastic anemias
Lead Poisoning

Iron Metabolism
A basic understanding of iron metabolism is essential to understand the
.pathogenesis of iron deficiency anemia
Distribution of Iron in the Body
Hemoglobin – the major component of iron (60%) in the body is in RBC, 1 ml of
.RBC contains approximately 1 mg of iron
.Myoglobin – Iron is also present in muscle tissue
Enzymes – trace amounts of iron are present in certain enzymes in cells like
.cytochromes, catalases, peroxidases
Storage iron. Iron is recycled when RBC break down and is utilized for new
hemoglobin synthesis. Iron is stored as
Ferritin. The iron in macrophages is bound to a protein called apoferritin and is
.stored as ferritin
.Haemosiderin – is another form of storage iron in macrophages

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Iron Intake
.Iron is present in food as heme iron and as non heme iron
An average diet contains 10 – 15mg/day. Only (~3.5mg/day) is absorbed
.from the food
.Foods containing iron are meat, fish, eggs, liver, dried fruits and spinach
Iron Requirements
Males 1mg/day
Females 1.5mg/day
Pregnancy and lactation 2mg/day

Iron Absorption
Iron absorption is an active process and requires ion transporters and enzymes which
.control the amount of iron absorbed

It is absorbed in the proximal small intestine at the brush border of the lining
.epithelium, close to the gastric outlet

.In the stomach the pepsin and HCl is broken the iron into Fe++ and Fe+++ ions

.The pathways for absorption are different for heme and non heme iron (Fe2+, Fe3+)

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Iron Absorption
The ferric (Fe3+) non heme iron must first be converted into ferrous (Fe2+) form by
Duodenal cytochrome B (DcytB) so that it can be transported across the membrane via a
.transporter (Divalent metal ion transporter; DMT1)

.Heme iron is directly moved across the membranes

Depending upon the body requirements, the absorbed iron is either retained in
.themucosal cell or is transferred into plasma

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Iron Deficiency Anemia

Incidence
This is the most common type of anemia found worldwide. It is seen in all
age
.groups but is more common in pregnant women and in children

Cause
The anemia is caused by the deficiency of iron which is essential for the formation of
.normal hemoglobin

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Causes of iron deficiency

Iron deficiency occurs due to
Decreased iron intake
Decreased absorption
Chronic blood loss
Increased requirement

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Common causes of iron deficiency by age

Infants and children
Inadequate intake
Growth spurts with increased iron requirements
Premenopausal women Menstrual blood
loss Pregnancy
Adult men and postmenopausal women
Blood loss due to tumor, peptic ulcer, GI bleeding Malabsorption
Inadequate intake

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Evaluation of the Patient

History
Bleeding
Evidence for increased RBC destruction
Patient nutritionally deficient, Pica
Medication review

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Clinical symptoms

Patients may be asymptomatic or present with fatigue, poor performance status, have

.difficulty in swallowing and in severe cases may have breathlessness

.Some patients especially children may eat mud (Pica)

Patients have pallor, thin hair, ulcers in the angle of the mouth (Angular

.Stomatitis), bald tongue, flat and sometimes spoon shaped nails (koilonychia)

.There may be cardiac enlargement in severe anemia

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Pathogenesis of Iron Deficiency Anemia

.It is due to decreased synthesis of heme and can be divided into 3 stages
Stage 1 (Iron depletion): iron adequate to maintain normal hemoglobin level and•
.only serum ferritin decreased
Stage 2 (Iron deficient erythropoiesis): lowering of serum iron and transferrin•
saturation levels without anemia (Hb, MCV and MCH within normal range).
.Bone marrow shows iron deficient erythropoiesis
Stage 3 (Iron deficiency anemia): low serum iron, serum ferritin and transferrin•
.saturation
Impaired hemoglobin production. Morphologically, first reduction in the size
(microcytic) and later increase in the central pallor (hypochromia) of
.RBCs
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Laboratory diagnosis
:Diagnosis of IDA is based on
Complete blood counts 
Hemoglobin )a(
.Anemia is commonly around 6 -7g/dl
MCV, MCH and MCHC are all decreased. The RDW is increased ~17 – )b(
23%
.WBC count is normal )c(
.Platelet count may be normal or may show thrombocytosis )d(
Peripheral blood findings 
.Bone marrow morphology and iron stores 
.Iron status  23

Peripheral blood smear (PBS)

The peripheral blood smear shows variable morphology depending on the degree of iron
.deficiency

RBCs display variable degrees of anisocytosis (variation in size of RBC), microcytosis

(RBC size < 6.0µm diameter), hypochromia (increase in central pallor) and
.poikilocytosis (variation in shape)

.WBC morphology is normal Eosinophilia may be present in hook worm infestation

.Thrombocytosis is frequently encountered in iron deficiency anemia

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IRON DEFICIENCY ANEMIA

Iron Loss
Iron is lost from the body through shedding of skin and
mucosal epithelial cells. Women lose iron during menstruation, in
pregnancy and lactation

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.Student:-Naseem alrimy. Dr:-Taha almajidi