IRON DEFICIENCY ANEMIA

Definition Iron deficiency anemia is the common anemia found in the developing country. Iron deficiency anemia is caused by abnormality in eritropoesis in maturation step. Iron is important in hemoglobin making. Iron absorbed in duodenum in Ferro (fe+2) form and excreted though hair, nail, urine and des uamation intestinal epithelial. In the body iron is save in feritin form and haemosiderin form in reticular endothelial system, such as! liver, spleen and bone marro". In the plasma iron binding "ith protein "hich call transferin. #en need $%2 mg iron every day and "oman and child need &,'%$ mg more than man. (here are ) grade before iron deficiency anemia, they are! $. Iron depletion 2. Iron deficiency ). Iron deficiency anemia Etiology Iron deficiency anemia cause by ! $. *ecreased iron intake. 2. +bnormality in absorption. it is happen at post intestinal surgery and patient "ith malabsorbtion syndrome.

). ,hronic bleeding. chronic bleeding common cause by peptic ulcers, gastritis, hiatus hernia, hemorrhoid, neoplasm and parasite intestinal, as specially ankilostoma. -. Increased iron utili.ation iron utili.ation increase in post natal gro"th spurt and adolescent gro"th spurt Clinical Manifestation ,linical manifestation of iron deficiency anemia cause by basic disease manifestation and anemia manifestation it self. (he symptoms of anemia are!

(ired Fatigue /eakness 0ead ache *yspnea 1ale 2lossitis 3tomatitis 4oilonychias

Laboratory Finding $. 5ed blood cell morphology

#ikrositer hipokrom

2. Iron serum concentrate decrease and iron binding capacity increase ). 0aemosiderin bone marro" decrease -. Feritin serum concentrate decrease Therapy (herapy of iron deficiency anemia consist of therapy of anemia it self and therapy of basic diseases. (herapy of anemia is !

5est 0igh calorie and high protein diet 3ulfa ferosus (ransfusion

CA E RE!ORT + male patient age $) years old "as admitted to internal medicine department of general hospital *5. +hmad #uchtar 6ukittingi on #arch $&th , 2&&) "ith! Chief Co"plain#

7ausea and vomit since 2 days ago

!resent Illness $istory#

7ausea and vomit since 2 days ago. if patient eat, he "ill vomit all thing
"as he eat.

 2 days ago patient abdomen kicked by his brother and made patient
unconscious. +fter conscious patient feel nausea, head ache, pain at left side of abdominal, and vomited if he eat.

1ale since 2 "eeks ago Fatigue, "eakness since 2 "eeks ago 3ince 8 months ago, he live "ith his aunty and there he eat irregularly (here are no bleeding story (here is no abnormality in defecation and urinate
!re%io&s Illness tory#

1atient didn9t have this illness before

The Fa"ily Illness tory#

7one of family members had disease like this

!hysical E'a"ination (!E) # *ital ign # 2eneral appearance ! moderate illness ,onsciousness 6lood pressure 1ulse rate 5espiratory rate (emperature 6ody height ! compos mentis cooperative ! $$&:;& mmhg ! ;2x:minutes ! 2&x:minutes ! )8,<o, ! $); cm

6ody "eight 6#I +in # 1ale ,yanosis ! (+) ! (%)

! )8 kg ! $=,<& ( normal )

Ly"ph node ! 7o enlargement $ead# +yes ! +nemic con>unctiva and sclera not icteric ?ars, mouth and nose ! (here is no abnormality Nec+ # @A1 '%2 cm02B (hyroid gland ! 7o enlargement Chest # Cung and heart are no abnormality Abdo"en # I 1a 1er + E'tre"ities # 5F 51 ! +:+ ! %:% ! 7o s"ollen ! Civer "as not palpable, spleen palpable (3%$) ! (ympani ! 1eristaltic sound (+) normal

?dema ! %:%

Laboratory Finding ,lood # 0b Ceukocyte C?* *iff. ,ount ?rythrocyte 0aematocrit 5etikulocyt 56, morphology (rombosit (otal protein +lbumin 2lobulin (otal bilirubin 6ilirubin I Ereum 4reatinin -rine # 6ilirubin Erobilin 1rotein 5eduksi ! (%) ! (+) ! (%) ! (%) ! 8,2 mg:dl ! 88&&:mm) ! $$,' mm : hour ! &:2:):--:-=:) ! 2.&&&.&&& :mm) ! $' vol D ! 2,' D ! +. mikrositik hipokrom ! $<2.&&&:mm) ! =,)& gr:dl ! ),;= gr:dl ! -,'2 gr:dl ! $.8; mg:dl ! &,); mg:dl ! $=,< mg:dl ! &,2 mg:dl

3ediment ! ?rythrocyte Ceukocyte ?pitel ,rystal Bval fat bodies ! &%$ ! $%2 ! (+) ! (%) ! (%)

Fesses # ?rythrocyte Ceukocyte +nkilostoma egg ! (%) ! (%) ! (%)

.or+ing Diagnosis ! $. Iron deficiency anemia ec. Co" intake 2. 1ost abdominal trauma Differential Diagnosis Therapy # % % % % % % % % 6ed rest 0igh calories and protein diet 3ulfa ferosus )F$ tab: day +s. Folat )F$ tab: day 6. complex )F$ tab:day +ntacid F$ tab: day Ailapon F$ tab:day 6lood transfusion ! $. (halasemia

!lanning E'a"ination # % % % % % % Follo/ -p # March 01th 2 3445 A ! Fatigue (+), /eakness (+) 7ausea (%), Aomit (%) 1ain at left side abdomen (%) 0ead ache (%) 1ale (+) !E ! 2+ , C, moderate ,#, , 6p , $$&:;& 15 ;&x:i , 55 2&x:i , ( )8,<o, 6lood, urine and fesses routine examination 5ed blood cell morphology Iron serum concentration Iron binding capacity 6one marro" biopsy Feritin serum concentrate

3kin ! pale (+) ,on>unctiva anemic +bdomen %I % 1al % 1er %+ .D ! ! 7o 3"ollen ! Civer not palpable, spleen palpable at 3%$ ! (ympani ! 1eristaltic 3ound (+) 7ormal

! $. Iron *eficiency +nemia ec. 3usp. Co" Intake

T$

! 3top antacid and vilapon, other ! continue

March 06th 2 3445 A ! Fatigue (+), /eakness (+) 1ale (+) !E ! 2+ , C, moderate ,#, , 6p , $$&:;& 15 ;2x:i , 55 $=x:i , ( )8,=o,

3kin ! pale (+) ,on>unctiva anemic +bdomen %I % 1al % 1er %+ .D T$ ! ! 7o 3"ollen ! Civer not palpable, spleen palpable at 3%$ ! (ympani ! 1eristaltic 3ound (+) 7ormal

! $. Iron *eficiency +nemia ec. 3usp. Co" Intake ! ,ontinue

March 34th 2 3445 A ! Fatigue (+), /eakness (+) 1ale (+) !E ! 2+ , C, moderate ,#, , 6p , $$&:;& 15 ;8x:i , 55 $=x:i , ( );o,

3kin ! pale (+) ,on>unctiva anemic +bdomen !

%I % 1al % 1er %+ .D T$

! 7o 3"ollen ! Civer not palpable, spleen palpable at 3%$ ! (ympani ! 1eristaltic 3ound (+) 7ormal

! $. Iron *eficiency +nemia ec. Co" Intake ! ,ontinue

March 30th 2 3445 A ! Fatigue (+), /eakness (+) 1ale (+) !E ! 2+ , C, moderate ,#, , 6p , $$&:;& 15 ;2x:i , 55 2&x:i , ( )8,=o,

3kin ! pale (+) ,on>unctiva anemic +bdomen %I % 1al % 1er %+ LF .D T$ ! ! 7o 3"ollen ! Civer not palpable, spleen palpable at 3%$ ! (ympani ! 1eristaltic 3ound (+) 7ormal

! 0b ! ;,= mg:dl ! $. Iron *eficiency +nemia ec. 3usp. Co" Intake ! ,ontinue

March 33th 2 3445 A ! Fatigue (+), /eakness (+)

1ale (+) !E ! 2+ , C, moderate ,#, , 6p , $$&:;& 15 =-x:i , 55 2&x:i , ( );o,

3kin ! pale (+) ,on>unctiva anemic

+bdomen %I % 1al % 1er %+ LF ! Fesses

! ! 7o 3"ollen ! Civer not palpable, spleen palpable at 3%$ ! (ympani ! 1eristaltic 3ound (+) 7ormal !% +nkilostoma egg (%) % ?rythrocyte (%), Ceococyte (%)

.D T$

! $. Iron *eficiency +nemia ec. Co" Intake ! ,ontinue

March 37th 2 3445 A ! Fatigue (+), /eakness (+) 1ale (+) !E ! 2+ , C, moderate ,#, , 6p , $$&:;& 15 ;2x:i , 55 2&x:i , ( )8,=o,

3kin ! pale (+) ,on>unctiva anemic +bdomen !

%I % 1al % 1er %+ .D T$

! 7o 3"ollen ! Civer not palpable, spleen palpable at 3%$ ! (ympani ! 1eristaltic 3ound (+) 7ormal

! $. Iron *eficiency +nemia ec. Co" Intake ! ,ontinue

March 38th 2 3445 A ! fatigue (+) 1ale (+) !E ! 2+ , C, moderate ,#, , 6p , $$&:;& 15 ;2x:i , 55 $=x:i , ( )8,8o,

skin pale (+) con>unctiva anemic abdomen %I % 1al % 1er %+ LF .D T$ ! ! 7o 3"ollen ! Civer not palpable, spleen palpable at 3%$ ! (ympani ! 1eristaltic 3ound (+) 7ormal

! 0b ! $&,' mg:dl ! $. Iron *eficiency +nemia ec. Co" Intake ! ,ontinue

DI C-

ION

/e diagnosed this patient as iron deficiency ec. Co" intake ! +namnesis ! 1ale since 2 "eeks ago Fatigue and "eakness since 2 "eeks ago 3ince 8 ounths ago, patient live "ith his aunty and there he eat irregularly

1hysical examination ! Caboratory fining ! 6lood ! 0b ?rythrocyte 0aematocryte 5etikulocyte ! 8,2 mg:dl ! 2.&&&.&&&:mm) ! $' volD ! 2,' D 3kin +yes ! 1ale (+) ! ,on>ungtiva anemic

56, morphology ! +. #ikrositik 0ipokrom