heme

globin

A Iron deficiency period (ID): iron stores in the body are depleted

B Iron-deficient erythropoietic phase (IDE): iron deficiency in red blood cells

C Iron deficiency anemia (IDA): It is the final stage of iron deficiency (including ID, IDE, IDA) and manifests as microcytic hypochromic anemia.

1) Functional state iron

2) Store iron

1) Red blood cells destroyed by aging (main source)

2) Normal people consume 1 to 1.5 mg of iron from food every day, and pregnant and lactating women consume 2 to 4 mg of iron.

Mainly located in the duodenum and upper jejunum

1) Animal foods have high iron absorption rates, while plant foods have low iron absorption rates.

2) Vitamin C and other reducing agents reduce high iron to ferrous iron; protein decomposition products can promote iron into a dissolved state, both of which can promote iron absorption.

3) Gastrointestinal function (pH, etc.), body iron storage capacity, bone marrow hematopoietic status and certain drugs (such as vitamin C) will affect iron absorption

1) In plasma: ferrous iron is oxidized to ferric iron by ceruloplasmin, combined with transferrin, and transported to various tissues

2) In red blood cells: Iron is separated from transferrin, reduced to ferrous iron, and combined with protoporphyrin and globin on the mitochondria to form hemoglobin.

1) Reuse: The heme iron after the destruction of red blood cells is used to produce heme for new red blood cells.

2) Excretion: It can be excreted with the feces through the exfoliated cells of the intestinal mucosa, and a small amount can be excreted through urine, sweat, and milk.

It is stored in the monocyte-macrophage system in the liver, spleen, bone marrow and other organs in the form of ferritin and hemosiderin.

I Increased iron requirements and insufficient iron intake

II Iron malabsorption

III Excessive iron loss

I Effect of iron deficiency on iron metabolism

II Effects of Iron Deficiency on Hematopoietic System

III Effects of iron deficiency on tissue and cell metabolism

1) Dark stools, bloody stools or abdominal discomfort caused by peptic ulcers, tumors or hemorrhoids

2) Abdominal pain or changes in stool properties caused by intestinal parasitic infection

3) Weight loss in neoplastic diseases

4) Hemoglobinuria with intravascular hemolysis

1) Common symptoms include fatigue, easy tiredness, dizziness, dizziness, tinnitus, etc.

2) Paleness and increased heart rate

1) Abnormal mental behavior, such as irritability, irritability, pica, etc.

2) Decreased physical strength and endurance

3) Susceptible to infection

4) Children’s growth retardation and mental retardation

5) Stomatitis, glossitis, dysphagia, etc.

6) Dry and falling hair

7) Dry and wrinkled skin

8) Finger (toe) nails become flat, even concave and spoon-shaped (spoon-shaped nails)

1) Microcytic hypochromic anemia: MCV<80fl, MCH<27pg, MCHC<32%

2) The red blood cells are small in size and the central light-stained area is expanded in the blood film.

1) Active or obviously active proliferation

2) Mainly hyperplasia of the erythroid system, with no obvious abnormalities in the granulocyte and megakaryocytic systems

3) Young red blood cells show the phenomenon of “old nuclei and young plasma”

4) After iron staining, extracellular iron and sideroblasts decrease or disappear.

1) Serum iron (SI) <8.95 μmol/L, total iron binding capacity (TIBC) increases, transferrin saturation (TS) decreases, and serum soluble transferrin receptor (sTfR) increases

2) Serum ferritin (SF) <12μg/L

3) Decreased iron levels inside and outside cells

1) sTfR measurement is the best indicator of iron deficiency erythropoiesis

2) sTfR>26.5nmol/L (2.25μg/ml) can diagnose iron deficiency

I ID

II IDE

IDA

IV etiology diagnosis

Differentiate from microcytic anemia

I sideroblastic anemia

II globinogenic anemia/thalassemia

III anemia of chronic disease

IV transferrin deficiency

1) Encourage to eat more iron-rich foods or iron-fortified foods with higher absorption rates such as meat

2) Infants and young children should add complementary foods in time

3) Women during menstruation, especially during pregnancy, may consider preventive iron supplementation

4) Identify the cause and treat the primary disease

I Oral Iron

II Iron injection (intramuscular injection)

1) The effective performance of oral iron medication is firstly an increase in reticulocytes (Ret) in peripheral blood, with the peak occurring 5 to 10 days after starting to take the medication.

2) Ret concentration increases after 2 weeks and usually returns to normal in about 2 months

3) Iron therapy should be continued for at least 4 to 6 months after hemoglobin returns to normal, and should be discontinued when ferritin returns to normal.