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Iron deficiency Anemia

  1. Is the most common cause of nutritional anemia in world
  2. Absorption of iron- absorbed from the duodenum and upper jejunum Ferrous salts are better absorbed than ferric salt.
    1. Extra luminal factor- iron absorption is controlled by the body stores of iron, rate of erythropoiesis and the iron needs of the body, iron absorption is augmented in anemia of infancy and childhood after hemorrhage.
    2. Intra luminal factor
      1. Phosphates, phytates, calcium salts, tannic acid in tea milk and egg in the diet- inhibit iron absorption
      2. Lactose, ascorbic acid, fruit juices and certain amino acids such as cystine, lysine and histidine enhance the iron absorption. 

Sequence of Changes in iron deficiency

  1. Iron store in the body hemosiderin in liver and bone marrow
  2.   Serum ferritin <10mg/ ml
  3.   Transferrin saturation
  4. ↑  Erythrocyte protoporphyrin
  5.   Hemoglobin
  6.   MCH
  7.   MCV
  8. Microcytic hypochromic picture 

Clinical picture

  1. Pallor is the most important symptom
  2. Pagophagia the desire to ingest unusual substances
  3. When Hb < 5gm% - irritability and anorexia are prominent; tachycardia and cardiac dilatation occur and systolic murmurs often present. 



Attention span, school performance and general activity of children may get adversely affected.


Laboratory investigation

  1. Hb                              
  2. PBF microcytic hypochromic anemia
  3. MCV, MCH, MCHC              
  4. Retic count
  5. Serum iron <30μgm%          
  6. TIBC> 350μgm/ dL
  7. Saturation of transferrin is less than 15% 

Response to iron therapy in iron deficiency Q


Time after iron                  Response



  1. 12-24 hours              Replacement of intracellular iron enzyme subjective improvement, decreased irritability increased appetite
  2. 36 – 46 hours           Initial bone marrow response, erythroid hyperplasia
  3. 48 – 72 hours         Reticulocytosis peaking at 5-7 days
  4. 4 – 30 days              Increase in hemoglobin level
  5. 1- 3 moths               Repletion of stores

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