Biochemical Basis of

Anaemia
Iron , B12 and folate deficiency
anaemia
 What is iron deficiency anaemia ?

Iron deficiency anemia is a condition characterized

by insufficient iron levels in the body,
leading to a decreased production of red blood cells
and a subsequent impairment of oxygen transport .
 Features of red cell indices:

Red cell indices Measurements Normal range Iron deficiency

anaemia
Hemoglobin (Hb) g/dl Male: 14-18 <13.8 (may vary)
Female: 12-14 <12.1 (may vary)
Mean corpuscular volume fl (Femtoliters) 80-100 <80
(MCV)
Mean corpuscular pg (picograms) 27-31 <27
Hemoglobin
(MCH)
Mean corpuscular g/dl 32-36 <32
hemoglobin
concentration (MCHC)
 Importance of Iron in human body
Oxygen Transport: Iron is a crucial component of hemoglobin, the protein
in red blood cells responsible for binding and transporting oxygen from the
lungs to the rest of the body.
Cellular Energy Production: ron is involved in the electron transport
chain, a key process in the production of adenosine triphosphate (ATP), the
primary source of energy for cells.
Immune Function: Iron plays a role in supporting a healthy immune
system, helping the body defend against infections and illnesses .
Brain Function: Adequate iron levels are essential for proper cognitive
function and development, as the brain relies on oxygen supplied by iron-
containing hemoglobin .
Prevention of Anemia: Iron deficiency can lead to anemia.
Figure of Iron absorption
 Causes of the iron deficiency anaemia
Inadequate Dietary Intake: Insufficient consumption of iron-rich foods,
such as red meat, poultry, fish, and iron-fortified foods.
Poor Iron Absorption: Certain conditions, like celiac disease, inflammatory
bowel disease, and gastric bypass surgery, can hinder iron absorption.
Blood Loss: Chronic or acute blood loss due to gastrointestinal bleeding
(ulcers, tumors, or gastrointestinal disorders) or heavy menstrual periods in
women.
Pregnancy and Breastfeeding: Increased iron demands during pregnancy
and breastfeeding can lead to depletion if dietary intake is insufficient.
Parasitic Infections: Some parasitic infections, like hookworm infestations,
can contribute to iron deficiency by causing blood loss .
Growth Periods : Infants, toddlers, and adolescents may experience
increased iron needs during rapid growth phases.
 Symptoms
Fatigue: Due to reduced oxygen-carrying capacity of the blood.
Weakness: Muscles may not function optimally.
Pale Skin: Reduced hemoglobin affects skin color.
Shortness of Breath: Difficulty in breathing due to inadequate
oxygen supply.
Headache and Dizziness: Insufficient oxygen to the brain
 Diagnosis:
Blood Tests:
I. Hemoglobin and hematocrit levels are lower than normal.
II. Serum ferritin levels indicate the amount of stored iron.
Medical History and Physical Examination:
Symptoms, diet, menstrual history, and potential sources of blood loss are
considered .
 Treatment
I. Oral iron supplements to replenish iron levels.
II. Increasing intake of iron-rich food.
III. Treating conditions causing chronic bleeding or poor absorption.
 Folate deficiency anaemia
 Folate-deficiency anemia is a decrease in red blood cells (anemia) caused by folate
deficiency.
 The hematologic manifestations of folate deficiency are similar to those of Cbl deficiency
but neurologie abnormalities do not occur .
Symptoms:
 Tiredness
 Headache
 Sore mouth and tongue
 Pallor
 Causes of folic acid deficiency
 The main causes is decrease dietary intake
 Old age
 Alcoholism
 Chronic diseases.

 Mal absorption:
 Tropical sprue.
 Gluten-sensitive enteropathy.
 Increase requirements:
 Pregnancy.
 Infancy.
 Malignancy.
 Drugs:
 Methotrexate, oral contraceptives.
 Mechanism

Deficiency of folic acid

Lack of tetrahydrofolate
Complications of purine and pyrimidine synthesis
Impaired DNA synthesis
Improper cell division
Formation of immature nucleus that appears large and dense named as
megaloblast with fragile membrane .
Short life of megaloblast
Megaloblastic anaemia (Folate deficiency anaemia )
 Vitamin B-12 deficiency anaemia
Pathology:
Intrinsic factor (IF) is needed for vit B-12 absorption in distal ileum .
Lack of IF can cause impaired absorption resulting in B12 deficiency .
Risk factor that can cause deficiency :
 GI surgery : gastrectomy , gastric bypass
 Gastric disorder : gastric mucosal atrophy
 Dietary intake : high risk for strict vegetarians .
Common symptoms :
 Weakness
 Paresthesia
 Confusion
 Dementia
 Tachycardia
 Tachypnea
 Diagnostic tests
CBC: RBC Hb
MCV
Others : Gastrin level
Intrinsic factor level
Homocystine level
Complications :
 Decrease in CNS function
 Neuropathy
Treatment :
 Supplementary B12
 Dietary B12
 Gastric disorder treatment
 Mechanism
Deficiency of Vit B12
Impaired conversion of homocysteine to methionine
Impaired conversion of 5-methyl tetrahydrofolate to tetrahydrofolate
Trapping of nonfunctional 5-methyl tetra hydro folate
 Impaired purine and pyrimidine synthesis
Impaired DNA synthesis
Formation of megaloblast with fragile membrane due to impaired cell
division
Short life span of megaloblast
Vit B12 deficiency anaemia
Thank You