MINERALS �IRON
Dr. Ashish Agravatt ,
MBBS, MD.
IRON
Sources
RDA
Metabolism
Functions
Disorders
IRON - SOURCES
Green leafy vegetables
Liver and meat
Egg
Jaggery
Pulses
Cereals
IRON - RDA
10-20 mg/day
Adult
40mg/day
Pregnancy
IRON - METABOLISM
Absorption
Transport
Storage
Excretion
IRON - ABSORPTION
Site
Small intestine
Forms
Heme
Non-haem
Efficiency
About 10% of total food iron is absorbed
FACTORS AFFECTING IRON ABSORPTION
Factors decreasing iron absorption
Phytates and phosphate
Antacid, achlorhydria
Gastrointestinal diseases
Factors increasing iron absorption
Ferrous form
Ascorbic acid
Cysteine
HCl
MECHANISM OF IRON ABSORPTION
Ferric Iron
Fe+++
Ferrous Iron
Fe++
Heme iron
Vit C
Ferric reductase
Fe++
Fe+++
Ferritin
Apoferritin
Heme iron
Fe++
Fe++
Fe+++
Transferrin
Fe+++
Lumen
Mucosal cell
Blood
Ceruloplasmin
Apotransferrin
Ferroxidase
Ferroreductase
( divalent metal transporter 1)
REGULATION OF IRON ABSORPTION
Mucosal block theory
STORAGE OF IRON
Storage Form
Ferritin
Hemosiderin
Storage Site
Liver
Intestine
Spleen
Bone marrow
EXCRETION OF IRON
Normal excretion
Very little
About 1mg/day
Stool
0.7mg/day
Physiological loss
Menstruation
20-30mg/cycle
Delivery
750mg
FUNCTIONS OF IRON
Heme compounds
Non-haem compounds
Iron is a component of several functionally important compounds
FUNCTIONS OF IRON
Haem compounds
Haemoglobin
Myoglobin
Cytochrome
Catalase
Non-haem compounds
Succinate dehydrogenase
Xanthine oxidase
Iron sulfur proteins
DISORDERS OF IRON METABOLISM
Iron deficiency
Iron excess
IRON DEFICIENCY ANEMIA
Causes
Features
Lab findings
Treatment
IRON DEFICIENCY - CAUSES
Decreased intake of iron
Malnutrition
Decreased absorption of iron
Achlorhydria and chronic diarrhea
Increased loss of Iron
Bleeding, hookworm infestation
Increased iron requirement
Pregnancy, infancy
IRON DEFICIENCY – FEATURES
Pallor
Fatigue
Dizziness
Dyspnea
Palpitation
Angular stomatitis
Pica
Clinical Presentation
IRON DEFICIENCY – LAB FINDINGS
Hematological findings
Decreased hemoglobin
Microcytic hypochromic anemia
Biochemical findings
Decreased serum iron
Increased serum total iron binding capacity
Decreased plasma ferritin
IRON DEFICIENCY – TREATMENT
Treatment of underlying causes
Treating
Hookworm
Controlling bleeding
Administration of iron preparations
Orally
I.V
TREATMENT
IRON SUPPLEMENT
IRON OVERLOAD
Haemosiderosis
Increase in iron stores as haemosiderin
Without associated with tissue injury
Haemochromatosis
Excessive deposition of iron in the tissue
Associated with tissue injury