Anemia Presentation PDF

ANEMIA Ref: Nutritional anemia by klaus kraemer and michael zimmermann & Extra articles on moodle Dr. Nihal Natour MS. Marah Shakhshir Outline Anemia definition and assessment criteria Indicators of Ir...

ANEMIA Ref: Nutritional anemia by klaus kraemer and michael zimmermann & Extra articles on moodle Dr. Nihal Natour MS. Marah Shakhshir Outline Anemia definition and assessment criteria Indicators of Iron status Iron deficiency Types of Anemia & consequences Categoeris at risk of iron deficiency Micronutrients and Anemia Dietary Aspects  Anemia Anemia, defined a condition in which the number of red blood cells (RBCs) or the haemoglobin concentration within RBCs is lower than normal. Anemia is a widespread public health problem associated with an increased risk of morbidity and mortality, especially in pregnant women and young children  But First What is Haemoglobin (Hb) ? Marah Shakhshir  Haemoglobin (Hb) Haemoglobin is a protein that can bind oxygen in lungs to transport it to body tissues. It can also bind CO2 from tissues and send back to lungs where it can exhaled. Each haemoglobin molecule contains four polypeptide chains (globin, a protein) and 4 heme groups that has an Iron centre (Ferrous, Fe+2 ) Each Heme group can bind an oxygen atom Marah Shakhshir  Heme group with an iron atom that can bind Ferrous iron) Each blue animated circle represnsts heme group that can bind iron atom that can bind oxygen (Ferrous) Marah Shakhshir  Haemoglobin It is used as an index of the blood’s oxygen- carrying capacity Despite its use as a screening test for iron deficiency anemia, isolated measurements of hemoglobin concentration or hematocrit level are not suitable as the sole indicator of iron status Marah Shakhshir  Iron storage Iron is an essential element for the living body The human body stores iron in the form of ferritin and hemosiderin mainly in liver, spleen, bone marrow, and others including: duodenum, skeletal muscle and other anatomic areas The primary storage form of iron is Ferritin Hemosiderin and ferritin are iron-containing proteins  Assessment of anemia Measuring hemoglobin is essential (Hb) Category Cut off Children 6 month – 5 y < 110 g/L Children 5- 11 y < 115 g/L Children 12-18y < 120 g/L Men < 130 g/L Women < 120 g/L Pregnant women < 110 g/L  Indicators of iron status Haemoglobin: which is not directly affected in the first stages of developing anemia. Ferritin: a sensitive indicator of iron status is the measurement of ferritin. The serum levels correlate well with the iron stores, and in the first stage of iron deficiency the concentration of ferritin already decreases, which makes it the most sensitive parameter It is affected by infection and inflammation (serum levels can be increased) A ferritin value below 10 mg/dL certainly shows iron deficiency.  Other indicators of iron status Soluble transferrin receptor (sTfR): Transferrin is a protein that carries iron and increases in case of its deficiency. It is used in condition where infection is a factor. Hematocrit: it’s the percentage of RBCs making up the entire volume of whole blood - correlates with Hb and depends on RBC volume Others  Iron Deficiency Iron depletion can be presented in three stages The first stage where iron stores are deplted without any physiologic effects, but can be presented in decreased serum ferritin levels (iron stores). The second stage, iron deficiency without anemia, which is an early or mild iron deficiency and adverse physiologic consequences can begin. The third stage, iron-deficiency anemia, characterized by decreased serum ferritin (along with other blood indicators). Marah Shakhshir  Types of Anemia Anemia can be classified into macrocytic and microcytic, depending on the volume of red blood cells, which can help differentiate the causes Microcytic: RBCs are smaller than normal Macro : RBCs are larger than normal Marah Shakhshir  Iron Deficiency Anemia Iron deficiency is the most widespread micronutrient and overall nutritional deficiency. Over 30% of the world’s population – are anemic with about 1 billion suffering from iron deficiency anemia. In many developing countries one out of two pregnant women and more than one out of every three preschool children are estimated to be anemic WHO estimates that some 800,000 deaths worldwide are attributable to iron deficiency anemia  Consequences of iron deficiency anemia Mild iron deficiency anemia may have few consequences because human bodies have compensation mechanisms to extract oxygen. Moderate (Hb 70–90 g/L) and severe (Hb