1. The document discusses a case of childhood iron deficiency anemia in an 18-month old child who presents with pale skin and fatigue. 2. Laboratory tests confirm the diagnosis of iron deficiency anemia through low hemoglobin and iron levels. 3. Iron deficiency anemia is a major global health problem, affecting over 2 billion people worldwide, especially preschool children in developing countries. Treating the underlying cause and replacing iron stores orally or parenterally is important for management.

1. Khorfakkan Scientific anemia Day 1 st May 2010 Childhood Iron Deficiency Anemia Prof. Dr.Saad S Al-Ani Senior Pediatric Consultant Head of Pediatric Khorfakkan Hospital

3. Physical exam * Pale, chubby, wt at 95%, ht at 60% *HR 140, RR 20, BP 90/50, SPO2 97% *Conjunctiva and mucous membranes slightly pale *Chest clear *No organomegaly, no adenopathy

4. Lab values * CBC Hgb 5.4, Plt 735, WBC 8.5 with normal diff *MCV, MCHC decreased *Retic count low *Smear Microcytic, hypochromic cells *Ferritin 

5. Microcytic, hypochromic cells

6. Why is it important to know how to diagnose and treat IDA?

7. 30% of the world’s population has anemia, 1 billion have IDA Global prevalence is 53.6% in preschool children ANEMIA – A PUBLIC HEALTH PROBLEM McLean E, Egli I, Cogswell M, de Benoist B,Wojdyla D. Worldwide prevalence of anemia in preschool aged children, pregnant women and non-pregnant women of reproductive age .Ch1:1-12.In: Kraemer K, ed. Nutritional Anemia. Sight and Life press. Basel, Switzerland. 2007 .

8. Anemia is a severe public health problem in Africa, Asia, Latin America and the Caribbean ANEMIA – A PUBLIC HEALTH PROBLEM World Health Organization (WHO). Nutrition. Geneva: WHO, www. who.int /nutrition/en : WHO 2007

9. Iron deficiency identified as one of ten most serious risk in countries with high infant and adult mortalities ANEMIA – A PUBLIC HEALTH PROBLEM World Health Organization. The world health report 2002: reducing risks, promoting healthy life. Geneva, Switzerland: World Health Organization, 2002.

10. Anemia as a public health problem by country; preschool children

11. Anemia prevalence and number of Individuals affected in preschool- age children in each WHO region

21. Iron Concentration In Brain 25% 50% 75% 100% Birth 2 Years 10 Years Adult Human Maximum Myelination

23. Normal values Harriet Lane Handbook, The John Hopkins Hospital,15th edition 81 (70+ age per yr) 36 (33) 12.5 (11.0) > 6 Months 76 (68) 36 (31) 12.6 (11.0) 6 Months 95 (84) 35 (28) 11.2 (9.4) 2 Months 101 (91) 44 (33) 13.9 (10.7) 1 Month 108 (96) 51 (42) 16.5 (13.5) Newborn MCV Mean/ (-2SD) HCT% Mean/ (-2SD) Hgb Mean/ (-2SD) AGE

24. http://www.cdc.gov/hemochromatosis/training/ pathophysiology/iron_cycle_popup.htm Iron cycle

25. Mechanism of development of Anemia Normal Iron deficiency anemia

26. Factors Contribute To the Development Of Anemia http://www.caribou.bc.ca/schs/medtech/rice/IronDeficiency.html

31. Iron deficiency Anemia (cont.) Clinical Manifestation (Cont.) Decreased cognitive performance often accompanies iron deficiency and iron deficiency anemia Murray-Kolb LE, Beard JL. Iron treatment normalizes cognitive functioning in young women. Am J Clin Nutr. 2007; 85:778-787.

32. Iron deficiency Anemia (cont.) Clinical Manifestation (Cont.) Koilonychia: "spoon nails” Iron deficiency anemia

33. Iron deficiency Anemia (cont.) Clinical Manifestation (Cont.) Smooth, bald, burning tongue; Iron deficiency anemia

34. Iron deficiency Anemia (cont.) Clinical Manifestation (Cont.) Angular Cheilosis or Stomatitis

35. Iron deficiency Anemia (cont.) Bone marrow ABSENT IRON STORES IN BONE MARROW IN IRON DEFICIENCY Normal control Iron deficiency

43. IRON DEFICIENCY versus ACD Other hypochromic microcytic anemias Serum Iron Transferrin Ferritin Iron Deficiency ACD

44. PRINCIPLES OF TREATMENT 1.Use oral iron 2.Replace iron deficit in total 3.Establish and treat the cause

45. PRINCIPLES OF TREATMENT 4.The therapeutic dose should be calculated in terms of elemental iron 5. A daily total of 4 -6 mg/kg of elemental iron in three divided doses provides an optimal amount of iron 6.A parenteral iron preparation (iron dextran) is an effective form of iron ( Cont.)

46. PRINCIPLES OF TREATMENT ( Cont.) The regular response of iron-deficiency anemia to adequate amounts of iron is an important diagnostic and therapeutic features.

47. PRINCIPLES OF TREATMENT ( Cont.) Oral administration of simple ferrous salts ( sulfate, gluconate, fumartate) provides inexpensive and satisfactory therapy

48. Elemental iron (EI) in various forms of iron tablets 1.Ferrous sulfate (20%EI) (300 mg tablets) 60 mg 2.Ferrous gluconate (12 %EI) (300 mg tablets) 34 mg 3.Ferrous fumarate (33 %EI)(200 mg tablets) 66 mg

50. Parenteral therapy Iron dextran : (IM-IV) 50 mg iron/mL Low and high molecular weight Ferric gluconate complex (IV) less incidence of allergic reactions Iron sucrose : (IV) safe even with sensitivity to iron dextran

51. Parenteral therapy Ferumoxytol : safe and effective as a rapid intravenous infusion up to 510 mg in patients with chronic kidney disease and on dialysis. Ferric carboxymaltose : (IV) given at single doses of up to 1000 mg iron per week over of 15 minutes ( Cont.)

53. Responses to iron therapy in iron- deficiency anemia Repletion of stores 1 -3 mo Increase in hemoglobin level 4 -30 days Reticulocytosis, peak at 5 -7 days 48 -72 hr Initial bone marrow response 36 -48 hr Subjective improvement; decreased irritability, increased appetite 12 -24 hr Response Time after Iron Administration

58. Iron obtained from animal products is much more easily absorbed by the body than iron from plant sources ,

60. Good to have you with us, Farquhar. We could do with some fresh blood in this place.'