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56. IRON DEFICIENCY ANEMIA
Authors & Affiliation
1.Bugubaeva Makhabat Mitalipovna
2.Mohammad Arshad
(1. Associate Professor, HOD Clinical Disciplines, Osh State Medical University, International Medical Faculty.)
(2. Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
ABSTRACT
The WHO has recognized iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world , with 30% of the population being affected with this condition. Although the most common causes of IDA are gastrointestinal bleeding and menstruation in women ,decreased iron and decreased iron absorption are also culpable causes. Patients with IDS should be treated with the aim of replenishing iron stores and returning the haemoglobin to normal levels. This has shown to improve quality of life ,morbidity, prognosis in chronic diseses and outcomes in pregnancy. Iron deficancy occurs in many chronic inflammatory condition, including congenial cardiac failure, chronic kidney disease and inflammatory bowel disease. This article will provide an updated overview on diagnosis and management od IDA in patients with chronic conditions, preoperative and in pregnancy. We will discuss the benefits and limitations of oral versus intravenous iron replacement in each cohort, with an overview on cost analysis between the different iron formulations currently on the market.
INTRODUCTION
Iron deficiency Anemia (IDA) is the most micronutrient deficancy in the world, bringing serious economic consequence and obstacles to national development. In India, National Family Health Survey-3 presents the statistis which show that the prevalence of anemia in children is high as 79 percent, while 56 percent of adolescent girls are anemic (1) Iron deficancy accounts for anemia in 5% of American women and 2% of American men (2) Iron is essential to virtually all living organisms and is integral to multiple metabolic functions. The most important function is to transport oxygen in hemoglobin (3) Hemoglobin is an iron -rich protein present in red cells, contains iron that carries the oxygen from the lungs to the rest of the body. Erythropoietin is a glycoprotein hormone synthesized in the kidneys that regulation red blood cell formation. The term Anemia ( from the ancient Greek , anaimia , meaning lack of blood ) is used for a group of conditions that result from an inability if erytripoirtin tissues to maintain a normal hemoglobin concentration on an account of inadequate supply of one or more nutrients leading to a rection in th total circulation hemoglobin. For the formation of and normal growth of red blood cells, iron and vitamins, like folic acid, vitamin c, vitamin e, and b12 are essential. Anemia can be further classified by RBC size (micro, normo and macrocytic anemia); RBC shape (Sickle cell anemia) and by etiology (nutritional anemia).
THE PROBLEM
According to World health Organization (4), globally, anemia affects 1.62 billion peoples, which corresponds to 24.8% of the population. The highest prevalence is in preschool-age children (47.4%) and the lowest prevalence is in men (12%). However, the population group with the greatest number of individuals affected is non-pregnant women and about 40% of preschool children are estimated to be anemic
Population
HB diagnostic of anaemia (g/dl)
Children age 6 month to 6 years
<11.0
Children age 6-14 years
<12.0
Adult man
<13.0
Adult non pregnant women
<12.0
Adult pregnant women
<11.0
WHO definition of anemia “vaiue obtained feom venous blood sample obtained at sea level
Pathophysiology
Iron is an essential element and is controlled primally by dietary intake, intestinal absorption and iron recycling. Dietary iron can be found in two forms: haem and non-haem iron. Haem iron is easily absorbable. Compounds such as phytate , oxalate, polyphenols and tannin, which are found in plants, diminish the uptake of non-haem iron, as do somr deugs,such as prton pump inhibitors. Ascorbic acid, citrate and gastric acid, conversely, facilitate iron absorption. In a healthy diet, approximately 5-15 mg of elemental iron and 1-5 mg of haem iron are daily although only 1-2 mg is ultimately absorbed the intestine, predominantly in the duodenum and proximal jejunum. Please see figure 1 for details on the iron pathways.
Assessment and diagnosis
The WHO defines anemia as blood Hb level below 130g/l 120g/l in women. In isolated iron deficiency, serum ferritin 9the storage molecular for iron) should be less than 30ug/l. however, ferritin is an acute phase protein and can be increased in the presence of inflammation. Thus if there s evidence of concomitant inflammation, such as elevated C reactive protein ferritin, ferritin less than 100UG/l is indicative of IDA transferrin, the iron transpoters, is generally elevated; however, it is indicative acute phase protein and, therefor, can be normal or reduced in chronic inflammatory states. Serum iron and transferrin saturations (TSAT) will be reduced with TSAT less 20% required for the diagnosis of IDA
CONVENTIONAL ORAL IRON FORMULATIONS
The british society of gastroenterology recommends ferrous preparations, specifically ferrous sulphate, as first-line therapy for iron replenishment as they are cheap, have good bioavailability, available in multiple preparations and have been shown to replenishment as they are chaep, have good bioavailability, available in multiple preparatins and have been shown to replenish iron atores and correct anaemia effectively. However, there are also many limitations to their use, with the most common being the frequency and severity of side effecs. A systematic review demonstrated that gi side effects were the most problematic with constipation being the most frequent complaint, followed by nausea and diarrhoea. This willhave a resultant effect on patient adhetence, likely leading to cessation and, thus, undequate treatment
References
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