Iron

Hertanto W Subagio

Iron (Fe)
Functions
a key attribute of iron is its ability to take up and release oxygen atoms and electrons. This allows it to participate in carrying oxygen in the blood and transferring electrons in the electron transport chain of the cell mitochondria

Carrier of oxygen in the blood (Hb). Storage of oxygen in muscle (myoglobin) Involved in electron transport chain and production of ATP (cytochromes)

Sources
Heme iron - animal ( 30%) Non Heme iron - vegetable, legumes etc.

Internal cycle of iron

Absorption
iron status regulated through absorption

Increase
Acid in stomach Heme iron High body demand Low body stores of iron Meat protein factors (MPF) Vit C (converts ferri to ferro) -

Decrease
Phytic acid (dietary fibre) Oxalic acid Polyphenols (tea, coffee) Full body stores of iron Excess of other minerals (Zn, Mn,Ca) Reduction in stomach acid Antacid

Iron Absorption

Model of iron absorption

Iron in the intestinal lumen

Enterocytes in the crypts

Enterocyte along the villus

Intestinal iron absorption

Iron in the human body

Transport
- Transferrin is a protein that transports iron in the blood

- When iron stores are adequate all iron binding sites are saturated
-Transferrin can be used as an indicator of overload or deficiency - Almost all cells in the body have transferrin receptor (TfR)

- Serum soluble Tfr (sTfR) is a good indicator of deficiency.

Sintesis Hemoglobin

Internalisasi besi

Serum transferrin receptor (sTfR)

Storage
Ferritin is the primary store of iron Iron not taken up by transferrin is stored as ferritin in the intestinal wall (short term store) also stored in the liver and spleen as ferritin Hemosiderin is a stable iron-protein compound in the liver that stores iron when iron exceeds the storage capacity of ferritin.

Iron Losses
average iron loss of 1 mg / day in men and post menopausal women sweat and urine = negligible exfoliation of the skin and GIT

menstruation

Deficiency and excess

Deficiency
IDA high prevalence Reduced cognitive functioning Reduce capacity for physical work Increased maternal mortality Stages : normal- depletion of storage- IDE IDA.

Excess
Haemochromatosis genetic disorders Fe deposits cause cell damage in pancreas, liver and heart Leads to diabetes, liver and heart failure

Tahap deplesi besi dan indikatornya

Perubahan parameter pada defisiensi besi

Table 1. Changes in Laboratory Test in Relation to progression Of Iron Deficiency SID D N N N N N N N N N IDE D I D I D I N N N N IDA D I D I D I D I D D

Serum Ferritin Serum TfR Serum Iron Total Iron Binding Capasity Transferrin Saturation Erythrocyte Protoporphyrin Mean Cell Volume Red Cell Distribution Width Hemoglobin Hematocrit
SID IDA IDE : Storage Iron Depletion : Iron Deficient Erythropoiesis : Iron Deficiency Anemia

Adapted from Cook and Finch and Skikne et al, 1990.

Diagnosis defisiensi besi berdasar feritin dan sTfR

Public health programs

supplementation

fortification
dietary modification food processing : reduce inhibitory factors education

Elements of successful iron supplementation programs

Fig.1. Elements of successful iron supplementation programs Policy making

Tablet Supply Adequate budget Data Base Ordering number In target group + 25% surplus Timely ordering Distribution System

Delivery System Accessible to Target group Motivated, WellTrained Approachable staff

Consumer demand Good Quality Supplements Communications To educate Public and Promote Program

Coverage Do intended Recipients get Supplements?

Compliance Do recipients take the supplements

Impact Reduction of Iron Deficiency anemia

Monitoring and Evaluation

Allen et al. 2000

Suplementasi besi gagal karena tingginya prevalensi kurang gizi kronik dan defisiensi berbagai zat gizimikro lain

Broek dan Lestky 2000

Among anemic pregnant women only 53% showed biochemical evidence of iron deficiency.
That is the maximum proportion of people among whom anemia could be expected to respond to the administration of iron

Prevalensi defisiensi zat gizimikro pada kasus anemia

80 70 60 50 40 30 20 10 0 vit A Besi Seng B12

Defisiensi besi belum tentu merupakan penyebab dominan anemia

Berapa % anemia yg bisa disembuhkan dengan suplementasi besi ?

Prevalensi defisiensi zat gizimikro pada ibu hamil anemia di Karangawen, Malawi dan Nepal

Keterangan : Seng dan Cu tak diperiksa di Malawi dan Nepal

Pola defisiensi zat gizimikro pada kasus anemia

5 5 .6 0 %

3 7 .0 0 %

3 .7 0 %

3 .7 0 %

besi

besi+gm lain

gm lain

tdk defisiensi gm

Defisiensi gizimikro tunggal jarang terjadi

Apakah semua yg defisien besi bisa sembuh dg suplementasi besi ?

Perbandingan defisiensi zat gizimikro pada ibu hamil yg anemia di Karangawen dan Malawi

Causes of microcytic anemia

Langsung pakai obat tambah darah untuk mengatasi anemia ?

Perubahan kadar Hb ibu hamil yang mendapat suplementasi besi