Definition

Iron deficiency anemia is an anemia caused by the reduced provision of iron for
eritropoesis, because empty iron reserves (depleted iron stores) that ultimately resulted in the
formation of haemoglobin is reduced.
Epidemiologi
Prevalens iron deficiency Anemia in infants is high, the same thing is also found in
school age children and adolescents. Figures for the incidence of iron deficiency anemia in
children of school age (5-8 years) in the city of around 5.5%, 2.6% of adolescent children and
teenage girls who are pregnant is 26%. Based on the research ever done in Indonesia
prevalens iron deficiency anemia in toddlers around 25-35%
IRON METABOLISM
The process of absorption of iron is divided into 3 phases
1. Luminal phase: the iron in foods processed in the stomach then ready absorbed in the
duodenum. The absorption of iron in the intestines there are two forms, namely in the form of
absorption of non-heme and absorption in the form of heme
2. Mucosal phase: the process of absorption in the intestinal mucosa is an active process
Iron absorption occurs primarily through the mucosa of the duodenum and proximal jejunum.
Absorption occurs actively through the process very complex and controlled. Heme iron is
maintained in a State is dissolved by the influence of gastric acid
3. Korporeal phase: covers the process of transport of iron in circulation
After the iron is absorbed through the intestinal epithelium, basal enters the intestinal
capillaries. Then in the blood is bound to apotransferin be transferin. One molecule of
transferin can bind to a maximum of two molecules of iron

The formation of hemoglobin

Haemoglobin synthesis starts in proeritroblas and then proceed a little bit in the
reticulocyte stage, because when the reticulocyte leave bones and get into the blood stream,
thus forming a little fixed the reticulocyte haemoglobin during the next few days.
First, suksinil KoA formed in the krebs cycle bound to glycine to form pyrrol molecules.
Then, four pyrrol merged to form protoporfirin which later merged with iron to form heme.
Finally every molecule of heme joined the globin are synthesized by Ribosomes to form a
haemoglobin.
Etiology
Iron deficiency can be caused by:
1. the increasing needs of physiologically
- the growth
- Menstruation
2. reduced iron is absorbed
- Input iron from food that is not adekuat
- Malabsorption of iron
3. Bleeding
4. Transfusion-feto-maternal
5.Hemoglobinuria
6. over Exercise
Patofisiologi
Iron deficiency anemia is the end result of the negative balance iron lasts long. When
the iron balance is settled will cause iron reserves continued to decline. There are 3 stages of
iron deficiency like this

 Iron depletion
Characterized by iron reserves decreased or absent but the levels of hemoglobin and serum
iron is still normal. In these circumstances an increase in absorption of non heme iron
Iron deficient erythropoietin/iron limited erythropoiesis
In this state of iron supply is obtained is not sufficient to support the eritropoiesis. On
examination the laboratory obtained serum iron levels and saturation of transferin decreased
while the TIBC and FEP is increased
-Iron deficiency anemia
This is an advanced stage of iron deficiency. This State is characterized by declining iron
reserves or no, low serum iron levels, saturation of transferin is low, and the levels of Hb or
low Hematokrit
Clinical Symptoms
A common symptom is :
-pale.
- Looks pale especially on the mucosa of the lips and pharynx,
-. Papil's tongue seemed to atrophy.
- When Hb levels down 5 g/dl < symptoms of anorexia
-. When the anemia continues flutter can occur, dilation of the heart and systolic murmur.
-But sometimes on the levels of Hb, 3-4 g/dl patients do not complain because the body
already held compensation, so that the severity of the symptoms of the ADB often does not
correspond to the levels of Hb 3.
Children also Seem limp, often tired quickly, palpitations, headaches, etc. They don't look
sick because of the nature of his illness chronical journey.

Diagnosis
Diagnosis of iron deficiency Anemia are enforced based on findings from the anamnesis,
physical examination and laboratory that can support with respect to the clinical symptoms
that often are not typical.
The criteria of diagnosis according to WHO:
a. Hb less than normal Levels according to age age
b. the concentration of Hb erythrocytes average < 31% (N: 32-35%)
c. levels of serum iron < 50 Ug/dL (N: 80-180 Ug/dL)
d. the saturation of transferin < 15% (N: 20-50%)

Laboratory Examination
1. Hemoglobin (Hb)
2. determination of the index of Erythrocytes
-Determination of the index of erythrocytes indirectly by flowcytometri or by using the
formula:
a. Mean Corpusculer Volume (MCV)
MCV is the average volume of erythrocytes, MCV will plummet if iron deficiency is getting
worse, and at the time began to develop anemia. MCV is an indicator of iron deficiency are
spesiflk after chronic disease anemia and Thalassemia are removed. Calculated by dividing
the hematokrit with numbers of red blood cells. Normal value of 82-92, mikrositik fl < 82 fl
and makrositik > 92 fl
b. the Mean Corpusculer Haemoglobin (MCH)
MCH is the weight of the average hemoglobin in one red blood cell. Calculated by dividing
the hemoglobin by the number of red blood cells. The normal value is 27-32 pg, mikrositik
hipokrom < makrositik and pg 27 > pg 32

c.Mean Corpuscular Haemoglobin Concentration (MCHC)

The hemoglobin concentration MCHC is erythrocytes average. Calculated by dividing the
hemoglobin by hematokrit. The normal rate of 30-35% and 30% < hipokrom.
3. Examination of Blood Banks
4. Serum Ferritin
Diferential diagnosis
-thalasemia
- anemia due to chronic disease.
Management
Iron Deficiency Anemia treatment principle is to know the cause and address them as well as
provide replacement therapy with iron preparations.the iron preparations can be peroral and
parenteral.
1. Iron peroral preparations
Preparations are available in the form of ferrous gluconate, fumarate and succinate
2. iron parenteral preparations
Preparations are often used is the dekstran iron. This solution contains 50 mg of iron/ml.
A dose of iron (mg) = weight (Kg) x desired Hb Levels (g/dl) x 2.5
3. Blood transfusion
given only on the State of anemia of very heavy or accompanied by an infection that may
affect response to therapy. In General, for sufferers of severe anaemia Hb levels with 4 g/dl <
given only PRC with a dose of 2-3ml/by granting time KgBB accompanied grant of diuretic
such as furosenamid.

Prevention
Important actions that can be done to prevent iron deficiency early in life:
a. Increase the use of exclusive BREAST MILK
b. Provide baby food containing iron as well as food that is rich in Ascorbic acid (fruit juice)
at the time of introducing solid foods.
c. Provide supplementation to preterm infant Fe
d. Suspend the use cow's milk until age 1 year with respect to the risk of the occurrence of
bleeding channel of cerna which are disguised in some babies.
The prognosis
The prognosis is good if the cause of the iron deficiency just because anemianya only and is
known to cause and then do the handling of adekuat. Symptoms of anemia and other clinical
manifestations will be improved by administering iron preparations.
In case of failure in the treatment, to consider some of the following possibilities:
a wrong Diagnosis.
b. Drug Dose not adekuat
c. improper iron Preparations and expiration
d. Impaired absorption of digestive tract

CONCLUSION
Iron deficiency anemia is anemia caused by depletion of the iron required for
hemoglobin synthesis. Iron Deficiency Anemia Prevalens (ADB) high in infants, the same is
also found in school age children and adolescents. The absorption of iron in the intestines
there are two forms, namely in the form of absorption of non-heme and absorption in the
form of heme. The cause of the iron deficiency may be caused:-increased physiologically
Needs such as growth, menstruation.--lack of iron that is absorbed is composed of: input of

iron from food that is not adekuat, malabsorption of iron-bleeding and hemoglobinuria. There
are 3 phases in iron deficiency that is composed of Iron depletion, erythropoietin deficient
Iron/iron limited Iron deficiency erythropoiesis, anemia. Clinical symptoms of iron
deficiency anemia of the child looked pale, limp, often tired quickly, palpitations, headaches,
etc. The diagnosis is based on the results of findings upheld the ADB from the anamnesis,
physical examination and laboratory. ADB management principle is knowing the cause
factors and address them as well as provide replacement therapy with iron preparations.
Granting of iron preparations can be peroral and parenteral