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Iron metabolism by Dr Anurag Yadav
- 1. Iron Metabolism MNR MEDICALCOLLEGE & HOSPITAL Dr Anurag Yadav MBBS, MD Assistant Professor Department of Biochemistry Instagram page –biochem365
- 2. Distribution ● Total bodyiron content is 3 to 5 g; 75% of which is in blood, the rest is in liver, bone marrow and muscles. ● Iron is present in almost all cells. ● Blood contains 14.5 g of Hb per 100 mL. ● About 75% of total iron is in hemoglobin, and 5% is in myoglobin and 15% in ferritin.
- 3. Iron containing proteins Hemoglobin Myoglobin Cytochromeoxidase Cytochrome b, b5 Cytochrome c, c1 Cytochrome p450 Xanthine oxidase Nitric oxide synthase Aconitase Ferritin Transferrin
- 4. Requirement of Iron ●Daily 20mg of iron in Indian adult. Westerns require 15mg/day as their diet donot contain much phytates. ● Of which only 1-2mg is absorbed. ● Children between 13–15 years need 20–30 mg/day. ● Pregnant women need 40 mg/day. ● First 3 month of life, iron intake is negligible because the milk is poor reserve.
- 5. Source of iron ●Leafy vegetables (20mg/100g) ● Pulses (10mg/100g) ● Cereals (5mg/100g) ● Liver (5mg/100g) ● Meat (2mg/100g) ● Jaggery ● Iron utensil ● Milk- very poor source (0.1mg/100ml).
- 6. Factors influencing theabsorption ● Reduced iron form- Only Fe++ (ferrous) form (reduced form) is absorbed. . ● Fe+++ (ferric) form is not absorbed. ● Ascorbic acid: Ferric ions are reduced with the help of gastric HCl, ascorbic acid, cysteine and -SH groups of proteins. Therefore, these will favor iron absorption. ● Interfering substances: phytic acids, oxalic acids. ● Other minerals: calcium, lead, phosphates, copper.
- 7. MUCOSAL BLOCK THEORY ●Site of absorption: Duodenum and jejunum. ● Iron metabolism is unique = homeostasis is regulated at level of absorption. NOT by excretion. ● No other nutrient is regulated in this manner. ● The iron is termed as one-way element. ● When iron stores is depleted, absorption is enhanced and when adequate quantity of iron is stored than absorption is decreased. ● This is termed as mucosal block regulation.
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- 12. Regulation of absorptionby four mechanism ● Mucosal regulation ● Hepcidin ● Stores regulation ● Erythropoietic regulation ● Synthesis of ferritin and transferrin receptors
- 13. Iron transport inblood and Uptake by cells Transport form is TRANSFERRIN. Uptake is dependent on the transferrin receptors of body cells.
- 14. Storage of iron. Storageform is FERRITIN
- 15. Excretion of iron: Mostof the iron is conserved by using the haptoglobins. Iron is one-way element. No iron is excreted by the urine. Any type of bleeding will cause iron loss.
- 16. Iron deficiency anemia Thismost common nutritional deficiency disorder leaves about 30% of world population anemic. About 70% of Indians have iron deficiency and 85% of pregnant women suffer from iron deficiency anemia.
- 17. Causes of irondeficiency Nutritional deficiency of iron Hookworm infestation Repeated pregnancy Chronic blood loss Nephrosis Lack of absorption Lead poisoning
- 18. Clinical manifestation: Apathy Weakness Plummer-wilson syndrome-dysphagia Irritability Lowered memory Impaired attention koilonychia (Spoon nail)
- 20. Laboratory findings Low serumiron levels = 50-150microg/dl Elevated TIBC = 400microg/dL Increased levels of Transferrin receptors levels
- 21. Treatment of irondeficiency Oral iron supplementations. 100mg of Fe and Folic acid = preg women Vitamin C given along. (Fe3+ = Fe2+)
- 22. Toxicity : >50mg/day =nausea, diarrhea, abdominal pain >100mg of iron taken orally cause acute toxicity with presence of nausea, diarrhea and abdominal pain. ●Hemosiderosis - iron excess. (Hemosiderin) Hemosiderin is pigment- golden brown granules in spleen and liver. Seen in person requiring the repeated blood transfusion leading to iron overload. Eg. Hemophilic child or thalassemia etc.,
- 23. Toxicity : ●Bantu siderosis-seen in africans, due to corn as staple diet. ●Cooking in iron vessels. ●Hemochromatosis : total body level higher than 25-30gm; hemosiderin deposits in liver, leads to cell damage and liver cirrhosis. Deposits under the skin to cause yellow-brown discoloration ●Bronze diabetes - triad: cirrhosis + hemochromatosis + Diabetes.
- 24. Treatment of hemosiderosis ●Repeated phlebotomy till serum iron and ferritin reach normal level ● Desferroxamine – chelating agent forms iron chelate which is excreted in urine.
- 25. Dr Anurag Yadav MBBS,MD Assistant Professor Department of Biochemistry Instagram page –biochem365 Email: [email protected]